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Exam 1 Electrolytes: Renal: Diuretics: CKD & ESRD > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

what is the IBW for men?

A

IBW = 50kg + (2.3 x inches over 60’’)

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2
Q

what is the IBW for women?

A

IBW = 45.5kg + (2.3 x inches over 60”)

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3
Q

what is the equation for NBW?

A

NBW = IBW + 0.25 (wt-IBW)

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4
Q

when do you use NBW and what does it apply to when doing calculations?

A

–> use NBW if ABW > 130%s of IBW
–> this applies to fluid, electrolytes, and nutrition (FEN) parameters

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5
Q

what is the fluid distribution like in the body?

A
  • intracellular –> 2/3 (40% of wt)
  • extracellular –> 1/3 (20% of wt)
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6
Q

what are the two types of extracellular fluid, what they are, and what percent of extracellular are they?

A
  1. interstitial – 3/4 – surrounding cell
  2. intravascular – 1/4 – plasma
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7
Q

when balancing fluids what are the 3 key organs and how do we balance fluids?

A
  1. skin
  2. lungs
  3. kidneys
    – fluid intake = fluid losses ( in=out)
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8
Q

what is the body water composition for women, men, and neonates?

A

W – 45-55%
M – 50-60%
N – 75-90%

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9
Q

what is the average fluid loss for sensible and what does that mean?

A

sensible – urination, poop, wounds
—– 1-1.5 L/day

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10
Q

what is the average fluid loss for insensible and what does that mean?

A

insensible – skin and lungs
——- 1 L/day

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11
Q

what is not counted toward the daily balance?

A

gastric, intestinal, pancreatic, and biliary secretions and almost completely reabsorbed

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12
Q

what are some additional fluid losses we don’t think about that may or may not be measurable?

A
  • NG output
  • vomit
    – diarrhea
    – large wounds
    – burns
    – drains
    – bleeding
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13
Q

what is isotonic solutions range and meaning?

A
  • same conc in as out
  • between 275-290 mOsm/L
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14
Q

what is hypotonic range and meaning?

A
  • less conc in than out
  • < 275 mOsm/L
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15
Q

what is hypertonic range and meaning?

A
  • more conc in than out
  • > 290 mOsm/L
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16
Q

why do we care about the osmolarity?

A

it can result in hemolysis of RBCs, renal failure, and even death

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17
Q

how do you calculate osmolarity of IVs?

A
  • total osmolarity = osmolarity of IV solution + osmolarity of added electrolytes
  • in mOsm/ L
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18
Q

How do you calculate MIVF and what are the amount needed?

A

– use 30-40 mL/kg x weight in kg = MIVF/ day
– for hourly rate use MIVF/ day and divide by 24 h to get mL/hr

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19
Q

what is the tonicity of crystalloids?

A

isotonic, hypertonic, and hypotonic

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19
Q

what is the tonicity of colloids?

A

hpertonic

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20
Q

what do crystalloids solutions do?

A
  • provide water and sodium
  • maintain fluid between intravascular and extravascular space
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21
Q

when is normal saline used (0.9%)?

A
  • for fluid replacement
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22
Q

when is 1/2 NS uses (0.45%)?

A
  • for maintenance
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23
Q

when do you use LRs?

A
  • for resuscitation (trauma, burns, when they need blood)
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24
Q

when do you use dextrose 5%?

A
  • for free water replacement
  • NOT BY ITSELF & NOT RESUSCITATIVE FLUID
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25
Q

what are some examples of balanced salt solutions (buffer- solutions)?

A
  • LRs
  • Normosol-R
  • Plasma-lyte
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26
Q

How much sodium is in 0.9% and 0.45%?

A

0.9% – 154
0.45% – 77

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27
Q

when are colloids used?

A
  • to inc. plasma oncotic pressure
  • move fluid into plasma
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28
Q

what are colloids place in therapy?

A

for volume expansion
- people who need blood

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29
Q

what is albumin used for and its adverse effects?

A
  1. AEs
    – azotemia
    – hypervolemia
  2. supportive/ symptomatic tx unless hypoproteinemia
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30
Q

when do you use 5% vs. 25% albumin

A

5%- when need volume
25%- when need protein

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31
Q

tell me about blood as a colloid?

A
  • 1 unit RBC = 230-350mL
  • low hemoglobin < equal to 7-8 g/dL
  • 1 unit of blood increases Hb by 1 g/dL
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32
Q

what is the most common MIVF?

A

D5W + 1/2 NS + 20 mEq KCl/L
- similar to urine

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33
Q

what do we monitor for in fluid status?

A
  1. volume status –> dehydration
  2. OUP in mL/kg/hr
  3. weight, vitals, ins/outs
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34
Q

what are possible signs of dehydrations?

A
  • tachycardia and hypotension
  • BUN/SCr > 20
  • decreased urine output < 0.5 mL.kg.hr
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35
Q

what is the normal sodium range?

A
  • 135-145 mEq/L
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36
Q

what is hyponatremia and what classifies it?

A
  • most common electrolyte disturbance
  • Na < 135
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37
Q

how do we calculate serum osmolarity?

A
  • Osm= (2 x Na) + (BUN/2.8) + (Glucose/18)
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38
Q

what is pseudohypontremia and when can we see this in patients?

A
  • normal Osmserum
  • can be seen with hypertriglyceridemia (TG > 1000) or hyperproteinemia
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39
Q

what is hypertonic hyponatremia and what population is it most seen with?

A
  • high Osm >290
  • in people with elevated BG
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40
Q

how do you calculate corrected serum sodium?

A

corrected Na = Naserum + (1.6 (BG-100)/100)

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41
Q

what is low osm for low sodium?

A

hypotonic hyponatremia

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42
Q

what makes a volume status of hypotonic hyponatremia HYPOVOLEMIC?

A

decrease in both TBW and Na+

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43
Q

what are the renal causes for HYPOvolemic “”?

A

urine >20
– diuretics
– salt losing nephropathy
- adrenal insufficiency

44
Q

what are non-renal causes of HYPOvolemic “”?

A
  • blood loss
  • skin loss
  • GI loss
45
Q

what classifies hypotonic hyponatremia to “ISOvolemic”?

A
  • increase in TBW and normal or slightly inc. Na+
46
Q

what is a cause of ISOvolemic “”?

A

SIADH

47
Q

what is SIADH and what is its main cause?

A
  • syndrome of inappropriate AntiDiuretic Hormone release
  • drugs are the main cause
48
Q

what drugs specifically are the main cause?

A
  • antipsychs
  • carbamazepine
  • SSRIs (prozac, zoloft)
49
Q

how do you treat SIADH?

A
  • remove underlying cause if possible
  • first line: free H20 restriction
50
Q

what makes it HYPERvolemic “”?

A

both TBW and Na+ increase

51
Q

what are some clinical presentations of hypotonic hyponatremia for both hypo and hypervolemic?

A
  • hypovolemic: dehydration
  • hypervolemic: fluid overload
52
Q

what are the goals in treatment of hypotonic hyponatremia?

A
  • not to rise serum sodium > 0.5 mEq/L/hr or no more than NMT 8-12 mEq/L/day
53
Q

what are the treatment options for hypovolemic hyponatremia (hypertonic and isotonic)?

A
  • hypertonic NaCl 3% if symptomatic
  • isotonic 0.9% if asymptomatic
54
Q

what is the treatment for isovolemic hyponatremia?

A
  • lasix and 3% NaCl if symptomatic
  • 0.9% NaCl if asymptomatic and water restirction
55
Q

how do you treat hypervolemic hyponatremia?

A
  • lasix and judicious 3% if symptomatic
  • lasix only if asymptomatic
56
Q

what is acute hyponatremia?

A
  • <48 hours
  • very severe
    –> canc ause AMS, seizures, cerebral edema
  • need prompt treatment
57
Q

how do you treat acute symptomatic hyponatremia?

A
  1. increase serum Na+ by 1-2mEq/L/hr
    - if too rapidly can cause central pontine myelinolysis
    - max increase is 8-12 mEq/L in first 24 hours
58
Q

what is the rule of 8s?

A
  • replace half sodium deficit in 8 hours, then remaining deficit within 8-16hrs
59
Q

how do you calculate TBW in M/F?

A
  • M = 0.6 x wt (in kg)
  • F = 0.5 x wt (in kg)
60
Q

how do you calculate a sodium deficit?

A

TBW x Na goal - current Naserum)

61
Q

what is hypernatremia and what must we access?

A
    • associated with hypertonicity
  • must assess volume status
62
Q

what classifies hypernatremia?

A

Na+ > 145 mEq/L

63
Q

What classifies hypovolemic hypernatremia and where at?

A
  • loss of water and sodium
  • renal, GI, lungs, skin
63
Q

what classifies hypervolemic hypernatremia?

A
  • gain H20 and Na+
  • sodium overload and mineralocorticoid excess
64
Q

what classifies isovolemic hypernatremia?

A
  • loss of H20 and na+ is normal or slightly high
  • diabetes insipidus
  • skin loss
65
Q

how do you calculate free H20 deficit for hypovolemic hypernatremia?

A

Free H20 deficit =TBW x [(Naserum/140)-1]

66
Q

how do you replace free water deficit?

A
  • provide free water
  • match I/O
  • don’t correct too quickly
  • goal is 0.5 mEq/L/hr decrease in Naserum
67
Q

what are the monitoring parameters for serum Na+ conc. and fluid status?

A
  • check every 3-6hrs over the first 24 hours
  • when sx resolve and Na+ < 145, then q 6-12hrs
  • I/O q8-12hr
  • overall fluid balance q24h
68
Q

what is the treatment for ISOvolemic hypernatremia?

A
  • desmopressin (DDAVP)
  • vasopressin
69
Q

tell me about hypervolemic hypernatremia and treatment?

A
  • generally this is uncommon
    – hypertonic saline resuscitation
  • tx: diuretic if needed
  • match I/O
70
Q

how do you calculate the estimated change in sodium?

A
  • Change in Naserum= (Nafluid-Naserum)/(TBW + 1L)
  • estimates change per one liter
71
Q

what is the normal range for potassium?

A

3.5-5

72
Q

what factors affect potassium?

A
  • Na/K ATPase pump
  • kidneys
  • arterial pH/ acid-base status
73
Q

what are the causes of hypokalemia?

A
  • magnesium depletion
    –> co-factor for Na/K ATPase
74
Q

what is the treatment for potassium of levels 3.5-4?

A

none
- if in ICU goal is 4 so may need to treat

75
Q

what is the treatment for potassium at 3-3.4?

A
  • debatable
  • po potassium with cardiac outputs
76
Q

what is the treatment for potassium <3?

A
  • po route preferred if asymptomatic
  • iv for symptomatic or patients who can’t take PO
77
Q

what do you do with any treatment of potassium?

A

attempt to correct magnesium deficit

78
Q

what are some warnings/precautions with IV K+?

A
  • arrhythmia or cardiac arrest if given too quickly
79
Q

how do you administer IV K+?

A
  • infusion rate WITHOUT cardiac monitor
    —–> 10 mEq/hr
  • infusion WITH cardiac monitoring
    —–> 20 mEq/hr
80
Q

what are the different stages of hyperkalemia?

A
  • mild
    – 5.5-6
  • moderate
    – 6.1-6.9
  • severe
  • > or equal to 7
81
Q

what is a clinical presentation of hyperkalemia?

A

cardiac arrhythmias
– peaked T waves

82
Q

what are goals of therapy for hyperkalemia?

A
  • antagonize AEs
  • everse symptoms
  • return K+ to normal
  • correct underlying cause
83
Q

how do you treat severe hyperkalemia (>7)?

A
  1. antagonize membrane actions
  2. decrease extracellular K+ concentrations
  3. remove K+ from the body
84
Q

how do we antagonize the membrane actions?

A
  • calcium
85
Q

how do we decrease extracellular K+ conc.?

A
  1. albuterol
  2. bicarb
  3. insulin and glucose
86
Q

how do we remove K+ from the body?

A
  • lokelma
  • diuretics
  • renal unit for dialysis of patient
87
Q

what is the normal range for magnesium?

A

1.5-2.5

88
Q

what are some fun facts about magnesium?

A
  • it is a co-factor for many enzymes in the body such as ATP and Alkaline phosphatase
  • it is related to Ca2+ and K+ metabolism
89
Q

what is a major drug cause of hypomagnesemia?

A
  • diuretics (thiazide or loop)
90
Q

what is the treatment for hypomagnesemia for asymptomatic patients?

A
  • PO with Mg2+ > 1 mg/dL
    —- MOM
    —- Mag-Ox
91
Q

what is the treatment for hypomagnesemia for symptomatic patients?

A
  • goal in ICU is > equal to 2mg/dL
    IV
    – mg 1-2 mg/dL : 0.5 mEg/kg
    – mg < 1: 1mEq/kg

—- 8mEq/1g= infuse 1 gm per hour

92
Q

what is the normal range for calcium?

A

8.5-10.5

93
Q

what are the etiologies for hypocalcemia?

A
  • mag deficiency
  • large volumes of blood products
  • hypoalbuminemia (correct Ca2+)
94
Q

how do you correct Calcium?

A
  • measured Ca2+ +[(4-measured albumin) x 0.8]
95
Q

what is the acute treatment for hypocalcemia?

A
  • 100-300 ELEMENTAL Ca2+
    —-> 1 g Ca CHLORIDE = 3 g Ca GLUCONATE = 270 ELEMENTAL Ca
96
Q

what is the rate for acute treatment for hypocalcemia and what else must you correct?

A
  • admin at a rate of 1gm/hr
  • correct hypomagnesemia
97
Q

what is the chronic treatment for hypocalcemia?

A
  • PO calcium
  • 1-3g of ELEMENTAL/ day
  • Vit D supplements
    – calcitriol
98
Q

what is the normal range for phosphorus?

A

2.5-4.5

99
Q

what is mild to moderate hypophosphatemia?

A

conc of 1-2

100
Q

what is severe hypophosphatemia?

A

< 1
- icu goal is > or equal to 3

101
Q

what are the etiologies of hypophosphatemia?

A
  1. dec. intake
    - impaired absorption
    - intracellular shifts
102
Q

how do you treat mild to hypophosphatemia?

A

ORAL
- Phos-NaK
- Fleets Phospho-Soda

103
Q

how do you treat severe hypophosphatemia?

A

IV
- KPhos when K+ < 4
- NaPhos when K+ > or equal to 4

104
Q

what is the phos replacement numbers for NaPhos ratio?

A

1 mMol = 1.33 Na & 1.33 Phos

105
Q

what is the phos replacement numbers for KPhos ratio?

A

1 mMol = 1.47 K & 1.47 Phos

106
Q

how do you administer IV phos replacements?

A

no faster than 7 mMol/hr

Exam 1 Electrolytes: Renal: Diuretics: CKD & ESRD (5 decks)

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