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PT: Nutrition Exam 2 > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Most K+ is located where in the body? Does this affect replacement frequency?

A

In the cells; Yes, you may need multiple bolus administrations to bring serum K+ up to normal when in a deficit due to unknown deficit in the tissues

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2
Q

As pH increases, how is K+ affected? pH decrease?

A

Increase in pH = more K+ into cell (Hypokalemia risk)

Decrease in pH = more K+ into serum (Hyperkalemia risk)

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3
Q

How does low K+ affect insulin? high K+?

A

Low K+ = inhibition of insulin release

High K+ = increased release of insulin

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4
Q

Hypokalemia severity classification

A

[K+] <3.5

a. Mild to Moderate = 3.5 to 2.5
b. Severe = <2.5

Digoxin therapy: Less than 3.5 = concern

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5
Q

Signs/Symptoms of hypokalemia

A
  1. muscle weakness
  2. myalgia
  3. decreased tendon reflex
  4. cardiac symptoms
    - HTN / EKG abnormalities / Arrhythmias
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6
Q

When do you initiate drug therapy of K+?

A

If patient is symptomatic

If patient has [K+] < 3.0 mEq/L (<3.5 for digoxin pts)

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7
Q

Whats the usual adult dosage for K+ supplementation?

A

20 to 80 mEq PO QD

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8
Q

Who should we be careful with K+ supplementation? Why?

A

Diabetics = insulin release issues
ACE-Inhibitor pts = may induce HYPERkalemia
Renal dysfunction = decreased excretion

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9
Q

K+ Infusion rate rules:

A

<10 mEq/hr does not need telemetry
10 to 20 mEq/hr requires telemetry
Max IV rate of K+ = 20 mEq/hr

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10
Q

Primary Intracellular electrolytes

A

Potassium
Magnesium
Calcium

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11
Q

Primary Extracellular electrolytes

A

Sodium
Bicarbonate
Chloride

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12
Q

What electrolyte problem must you correct to reduce K+ wasting?

A

hypomagnesemia; K+ needs Mg2+ for absorption

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13
Q

Hyperkalemia severity classification

A

Moderate: [K+] > 5.5 + T wave peak/PR prolongation
Severe: [K] > 7 + Prolonged QRS/VFib
Complete block @ [K+] conc. > 8mEq/L

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14
Q

How do you treat a symptomatic HYPERkalemic patient?

A
  1. IV Calcium STAT: 1 g push
  2. Insulin and GLU: promote increase K+ to cells and prevention of hypoglycemia via increased insulin release
  3. Loop diuretics to increase excretion
  4. Kayexelate to increase excretion
  5. Hemodialysis to excrete excess
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15
Q

Hypomagnesemia Signs/Symptoms

A

CNS: lethargy, weakness, confusion
CV: V-tach, V-fib, ventricular premature contraction

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16
Q

Treatment for Hypomagnesemia

a. Symptomatic and [Mg] <1
b. [Mg] <1 mg/dL w/o symptoms
c. [Mg] >1 mg/dL w/o symptoms

A

a. IV Mag Sulfate: 2 gram bolus + 0.5 to 1 mEq/kg/day to replenish stores over 2-5 days
b. . IV Mag Sulfate: No bolus! - continuous infusion
c. Oral Mag Supplement: Mag Oxide 400 to 800 mg QID

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17
Q

Hypermagnesemia Signs/Symptoms

A 
[Mg] > 8.0 mg/dL
Absent deep tendon reflexes
Muscle weakness
Sedative-like effect
Vasodilation
Diarrhea
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18
Q

Treatment for Hypermagnesemia

A

Discontinue magnesium treatment
Use Calcium to reverse effects
Give diuretic to promote excretion

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19
Q

Hypocalcemia severity classification

A

Mild to Moderate = <8.5 to 6.0mg/dL

Severe = Total serum [Ca] <6.0 mg/dL

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20
Q

Hypercalcemia severity classification

A

Mild to Moderate = >10.5 to 13 mg/dL

Severe = Total serum [Ca] >13 mg/dL

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21
Q

Calcium is 50% bound to what in the plasma? What does this influence?

A

ALBUMIN

  1. amount of active calcium
  2. pH of the blood is raised as more calcium is BOUND
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22
Q

What hormone increases calcium reabsorption to raise levels to normal?

A

PTH: Parathyroidhormone

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23
Q

What medication is a common cause of elevated calcium levels?

A

THIAZIDE DIURETICS

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24
Q

Hypercalcemia Signs/Symptoms

A 
[Ca] > 10.5
Constipation, Nausea and Vomiting
Others:
Confusion
lethargy
weakness
HYPOreflexia
Renal chg: polyuria &amp; stones
CVD: HTN, heart
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25
Q

Treatment of Hypercalcemia: [Ca] >12 or symptomatic

A

a. Hydration + mobilization: 0.9% NaCl bolus with LOOP diuretic that reduces calcium reabsorption
b. Calcitonin = inhibits osteoclasts + increased renal excretion
- Aredia/Zometa bisphosphonates
c. Hemodialysis
d. Sensipar = PTH gland receptor

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26
Q

Hypocalcemia Signs/Symptoms

A 
[Ca] = <8.5 mg/dL
High albumin levels
Acute: Neuromuscular and Cardiac symptoms
- Cramping
- Spasms (eye twitch)
Chronic: confusion, hair loss, psoriasis
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27
Q

Treatment for hypocalcemia

a. Acute, Symptomatic
b. Chronic

A

a. Ca-gluconate 3gm OR CaCl2 1gm IV push

b. Oral calcium/Vit D supplementation

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28
Q

A patient with end-stage renal disease has high albumin in the plasma. What is the concern with measured calcium levels?

A

Must correct calculated [Ca] using equation provided to re-assess whether there is a deficit or surplus of [Ca]

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29
Q

Hyperphosphotemia severity classification

A 
Mild = >4.6 to 6.5 mg/dL
Moderate = >6.5 to 7 mg/dL
Severe = >7.0 mg/dL
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30
Q

Hyperphosphotemia Signs/Symptoms

A 
[P] >4.6
Precipitation with Calcium = deposits in the arteries
*Similar to HYPOcalcemia**
Neuromuscular and Cardiac symptoms
- Cramping
- Spasms (eye twitch)
Confusion, hair loss, psoriasis
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31
Q

Treatment of Hyperphosphotemia

A

AVOID PROCESSED FOODS, Renagel

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32
Q

Hypophosphotemia severity classification

A 
Moderate = <2.5 to 1 mg/dL
Severe = <1.0 mg/dL
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33
Q

Treatment for hypophosphotemia

A

Moderate: Oral Supplement
- Neutra-phos K 1.25 g PO BID to TID
Severe: 0.2 mmol/kg over 3 to 12 hours

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34
Q

Where is the majority of sodium located in the body?

A

Extracellular Fluid

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35
Q

Hyponatremia severity classification

A

Large, rapid changes = More severe
Mild = < 134 mEq/L
Moderate = <120 mEq/L
Severe = <115 mEq/L

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36
Q

Hyponatremia Signs/Symptoms

A

Mild: Confusion, headache, agitation, nausea, vomiting

Mod to Sev: Seizures, coma, death

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37
Q

Treatment of Hyponatremia

A

Limit of 8 to 12 mEq/24 hours (0.33 to 0.5 mEq/hour)

Fluids: Restriction v 0.9% NS v 3% NaCl

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38
Q

What is Euvolemic hypotonic hyponatremia?

A

Having appropriate hydration but low osmolality and low sodium concentrations in the blood

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39
Q

SIADH

A

Syndrome of Inappropriate anti-diuretic hormone

  • Xs production of ADH
  • Xs water reabsorption

Causes: SSRIs/SNRIs + Ecstasy

Treatment: Only if [Na+] < 115 mEq/L

  • 3% NaCl to correct deficit
  • Chg in diuretic
  • Fluid restriction
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40
Q

How do you treat HYPOvolemic hypotonic hypernatremia?

A

Symptomatic:
Start with 0.9% NS 200 - 300 mL/hour then use D5W (free water) and/or lower NS conc.

No symptoms:
Use D5W (free water) and/or lower NS conc. + remove diuretics
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41
Q

Diabetes insipidus may result in which sodium alteration? Which fluid replacement would you use?

A

ISOvolemic Hypernatremia

Use D5W due to ICF loss = ECF loss

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42
Q

Hypernatremia severity classification

A

Mild to Moderate = >145 to 160 mEq/L

Severe = >160 mEq/L

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43
Q

Hypernatremia Signs/Symptoms

A

Mild to Moderate: polyuria and polydypsia
Severe: Neurological distrubances
- Confusion, rigidity, tremor, coma

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44
Q

% body water trend with age

A

Decreases with age (75-85% in newborns)

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45
Q

% body water trend with increasing body fat

A

Decreases

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46
Q

For each 1 mEq decrease in serum [K+] below 3.5 mEq/L, the total body K+ deficit is ___ mEq

A

100-400 mEq

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47
Q

Acidosis effect on K+

A

Increases serum K+ as H+ is exchanged for K+ in the blood

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48
Q

Alkalosis effect on K+

A

Decreases serum [K+] as it drives it into cells (in exchange for H+ into the blood)

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49
Q

Insulin/K+ relationship

A
  1. Hyperkalemia induces insulin release, which facilitates K+ movement into cells (+ Na/K ATPase activity)
  2. Hypokalemia inhibits insulin release
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50
Q

Why might diuretics cause hyperglycemia in Type II diabetics?

A

Hypokalemia (diuretics cause loss of K+) inhibits the release of insulin, putting patient at risk for hyperglycemia

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51
Q

Beta-agonist/K+ relationship (albuterol, epinephrine)

A
  1. Increases Na/K ATPase activity, which drives K into cells

2. Increases glycogenolysis, which increases glucose and insulin, drives K+ into cells

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52
Q

Aldosterone/K+ relationship

A

Promotes K secretion @ distal convoluted tubule and collecting duct (increases Na/K ATPase activity, which keeps Na/water)

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53
Q 
CAUSES: inadequate intake
Cellular shifting
vomiting
NG suction
Diarrhea
Diabetic ketoacidosis
A

Hypokalemia

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54
Q

Drug-induced: amph B
Laxatives
Steroids
Loop diuretics**

A

Hypokalemia

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55
Q

Mild-moderate hypokalemia: mEq/L

A

2.5-3.5 mEq/L

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56
Q

Severe/critical hypokalemia: mEq/L

A

<2.5 mEq/L

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57
Q

Who are we especially worried about when we see hypokalemia?

A

Digoxin users

Those with pre-existing arrhythmias

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58
Q

S/S of hypokalemia are not usually seen until [K+] < ____ mEq/L

A

3 mEq/L

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59
Q

“Patient complaints” of hypokalemia: (<3 mEq/L)

A

Muscle weakness
Decreased tendon reflex
Myalgia

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60
Q

EKG abnormalities of hypokalemia=

A

ST depression
Inverted T waves
Elevated U waves

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61
Q 
Clinical observations:
Cardiac arrhythmias
EKG abnormalities
Digoxin toxicity
HTN
A

Hypokalemia

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62
Q

Non-symptomatic patient’s [K+]= 3-3.5 mEq/L…treatment?

A

Non-pharmacologic intervention is OK

Diet switch to higher potassium foods (bananas, meat, broccoli, nuts)

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63
Q

Patient’s [K+] < 3 mEq/L…treatment Y/N?

A

Yes

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64
Q

Patient is symptomatic of hypokalemia…do you proceed with treatment, Y/N? (Regardless of K lab value?)

A

Yes

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65
Q

Digoxin user with [K+]< ___ mEq/L warrants treatment.

A

< 3.5 mEq/L

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66
Q

5 general treatments for hypokalemia

A
  1. Oral replacement products
  2. IV replacement (NPO or moderate-severe deficiency)
  3. K+ sparing diuretic (for diuretic-induced hypokalemia)
  4. Correct hypomagnesemia
  5. Evaluate acid/base balance
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67
Q

Preferred treatment for hypokalemia:
Dose
ADEs
Caution IN

A

Oral replacement products (KCl, KPO4, K-acetate, K-citrate, K-gluconate)
20-80 mEq daily (for adults)
Tastes like shit, N/V, gas, diarrhea
Caution in diabetics, ACE-inhibitors, renal dysfunction

68
Q

Treatment for hypokalemia for patients with NPO or symptomatic/severe deficits:

A

(<2.5 mEq/L)

IV replacement

69
Q

IV replacement for hypokalemia infusion rate MAX

A

20 mEq/H (40 for life threatening situations only)

70
Q

IV replacement for hypokalemia infusion rate with telemetry monitor (ICU)

A

10-20 mEq/H

71
Q

IV replacement for hypokalemia infusion rate on non-telemetry wards

A

≤ 10 mEq/H

72
Q

For diuretic-induced hypokalemia, which drug treatment could be considered? Who should this NOT be used for (or used with caution)?

A

K+-sparing diuretics

Diabetics, ACE-inhibitors, renal dysfunction (increased risk for HYPERkalemia)

73
Q

What is the timeline of monitoring in a stable patient with oral therapy for hypokalemia? For a hospitalized patient with IV therapy?

A

Monthly…daily/PRN (read the room)

74
Q 
Some causes include...
Acute renal failure
Blood stored for long periods of time
Addison's disease
Massive tissue damage
Salt substitutes
A

Hyperkalemia

75
Q 
Drug-induced =
K+ sparing diuretics
NSAIDs
ARBs
ACE-inhibitors
K+ supplements
A

Hyperkalemia

76
Q

Main S/S of hyperkalemia:

A

CARDIOVASCULAR

77
Q

Normal K= 3.5-5 mEq/L
Moderate hyperkalemia: > ___ mEq/L
EKG abnormalities=

A

> 5.5 mEq/L
T waves peak
PR prolongation

78
Q

Severe hyperkalemia: ___ mEq/L

EKG abnormalities/arrhythmias=

A

7-8 mEq/L
QRS complex prolongation
V-fib

79
Q

With [K+] at 8-10 mEq/L, what S/S would you expect?

A

Complete heart block
Asystole
(BAD, FATAL)

80
Q

What is pseudohyperkalemia? Treatment?

A

False hyperkalemia finding due to bad blood sample with traumatized RBCs

81
Q

List the 8 treatments for hyperkalemia in a symptomatic patient (general!)

A
  1. IV calcium chloride
  2. Insulin +/- glucose
  3. Albuterol
  4. Sodium bicarbonate
  5. Elimination of K+ source
  6. Loop diuretics
  7. Polymeric exchange resins (Kayexelate, patiromer, Veltassa, ZS-9)
  8. Hemodialysis
82
Q

Why is calcium chloride given to symptomatic patients with hyperkalemia? What is the dose?

A

Counteracts K’s effect on neuromuscular membranes (protects the heart!)
1 g IV push, repeated 5-10 minutes if no effect
Repeated as needed as effect wears off

83
Q

Why is insulin given to symptomatic patients with hyperkalemia?
Dose?

A

Insulin promotes K+ entry into cells

10-20 Units of short-acting insulin

84
Q

If insulin is being administered to a hyperkalemic patient, should glucose be given also? If yes, why? Dose?

A

Yes, glucose is added if blood glucose is low or at normal levels to prevent hypoglycemia.
25 g of 50% dextrose solution given over 30 minutes (also stimulates endogenous insulin release!)

85
Q

What could be given to a hyperkalemic patient exhibiting symptoms and acidosis? Why?
Dose:

A

Sodium bicarbonate
Promotes K+ entry into cells (acidosis pushes K+ into blood, alkalosis pushes K+ into cells)
50-100 mEq IV push

86
Q

Should loop diuretics be given to patients with symptomatic hyperkalemia? Why, or why not?

A

Yes… and no.
They promote renal elimination of K+, but their full effect occurs in 1-2 hours.
Other interventions should be done along with this.
Not suitable for renally impaired patients.

87
Q

List 3 polymeric exchange resins used for hyperkalemia

A
  1. Sodium polystyrene sulfonate (Kayexelate)
  2. Patiromer (Veltassa)
  3. Sodium zirconium cyclosilicate (FDA approval pending)
88
Q 
Sodium polystyrene sulfonate (Kayexelate):
Indication
Dose
MOA
Onset
Contraindication
A 
Hyperkalemia in symptomatic patients
15-60 g SPS powder in water PO or PR
Exchanges ~ 1 mEq K for ~1 mEq Na
Onset in ~ 1 hour, may repeat Q4H
Avoid with GI immobility or dysfunction
89
Q 
Patiromer (Veltassa):
Indication
Dose
Onset
ADEs
DDIs
A

Chronic hyperkalemia (symptomatic patient)
8.4, 16.8, 25.2 g packets for suspension
Delayed onset!! (Not for acute hyperkalemia)
ADEs= constipation, hypermagnesemia (5-10%)
DDIs= administer 6 hours apart from other drugs

90
Q

What is the indication for hemodialysis in a patient with hyperkalemia?

A

Used for more emergent cases (probably rare though?) or chronic/long-term use (patients already on hemodialysis)

91
Q

Hyperkalemia treatment in asymptomatic patient:

A
  1. Eliminate the K+ source
  2. Loop diuretics (1-2 hours onset)
  3. Patiromer (delayed onset, chronic cases)
92
Q

Calcium normals= 8.5-10.5 mg/dL

What are the critical values (total Ca)?

A

< 6 mg/dL

> 13 mg/dL

93
Q

Calcium (free/ionized) critical values

Normals= 1.18-1.30 mmol/L

A

< 0.9

> 1.6

94
Q

How is Ca binding to albumin influenced by pH? How much is normally bound to albumin?

A

Alkalosis increases binding, 50% bound

95
Q

Corrected Ca=

A

(4-current albumin)*0.8 + (current Ca)

96
Q

Causes of hypercalcemia (5)

A 
Hyperparathyroidism
Lung/breast cancer
Vitamin D toxicity
Calcium carbonate toxicity (or just excess administration?)
Thiazide diuretics
97
Q

Patient complaints of hypercalcemia usually do not occur until [Ca2+] > ___ mg/dL

A

> 13 mg/dL

98
Q

Confusion, lethargy, weakness, hyporeflexia, polyuria, renal stones
Short QT, V-tach, atherosclerosis, HTN, constipation, N/V

A

S/S of hypercalcemia

99
Q

List the treatment options for hypercalcemia (Ca > 12 mg/dL or symptomatic) (7)

A
  1. Hydration with 0.9% NaCl given by infusion or bolus, then a loop diuretic
  2. Calcitonin
  3. Hemodialysis
  4. Bisphosphonates (delayed, but prolonged effect)
  5. Glucocorticoids (in cancer)
  6. Calcimimetic (Cinacalcet)
  7. Monoclonal Ab (denosumab)
100
Q

What is the indication for calcitonin?
Administration?
MOA?

A

HYPERcalcemia
Intranasal or parenteral (CAUTION: ALLERGY TEST BEFORE)
Inhibits osteoclasts and promotes renal excretion of calcium

101
Q

Hypercalcemia treatment with a delayed, but prolonged effect

Inhibits osteoclast activity

A

Bisphosphonates

102
Q

Hypercalcemia treatment more indicated for cancer/non-emergent cases:
MOA?

A

Glucocorticoids

Tumor lysis, decrease Ca absorption from GI, inhibit vitamin D synthesis

103
Q

Hypercalcemia treatment for renal disease or parathyroid cancer patient:
MOA?

A

Calcimimetic= Cinacalcet (Sensipar)

Binds Ca-sensing receptor on parathyroid gland and increases its sensitivity to Ca (decrease PTH, decreases serum Ca)

104
Q

Cinacalcet (Sensipar):
Indication
Monitoring
DDIs

A 
Hypercalcemia (renal disease, parathyroid cancer)
Monitor PTH/Ca/PO4 weekly until maintenance dose, then every 1-3 months
CYP3A4 substrate (erythromycin, -azoles)
CYP2D6 inhibitor (tri-cyclics, flecainide)
105
Q

Indicated for osteoporosis & bone tumors, with an off-label indication for hypercalcemia:
Dose?
MOA?
Cautions?

A

Monoclonal Ab- denosumab (Prolia, Xyera)
60 mg SQ every 6 months
Binds RANKL, inhibits osteoclasts, inhibits Ca release
Caution with CrCl < 30

106
Q

Asymptomatic hypercalcemia, Ca < 12 mg/dL treatment:

A

Observe/monitor

Correct reversible causes

107
Q

Can be caused by drugs, such as furosemide, bisphosphonates, phenobarbital/phenytoin
Hypomagnesemia
Renal failure
Hypoparathyroid hormone

A

Hypocalcemia

108
Q

Hypocalcemia labs:

Normals= 8.5-10.5, 1.18-1.3

A

Total Ca < 8.5 mg/dL

Ionized serum Ca < 1.1

109
Q

Acute hypocalcemia S/S:

A 
Neuromuscular &amp; cardiac:
Tetany**
Paresthesia
Cramping
Spasms
110
Q

Chronic hypocalcemia S/S:

A

CNS & skin:
Confusion
Hair loss
Psoriasis

111
Q

Treatment for acute hypocalcemia (or symptomatic):

A
  1. Treat underlying condition

2. 3 g calcium gluconate OR 1 g calcium chloride by slow vein push (over 10 minutes)

112
Q

Treatment for non-acute hypocalcemia:

A

Oral daily supplements of calcium (1-3 g elemental Ca) & vitamin D (0.5-3 mcg 1,25 dihydroxyvitamin D3)

113
Q 
Ca acetate= \_\_% calcium, \_\_ mEq Ca/g
Ca carbonate= \_\_\_ % calcium, \_\_ mEq Ca/g
Ca \_\_\_= 6.5% calcium, 3.3 mEq Ca/g
Ca gluconate = \_\_\_ % calcium, 4.5 mEq Ca/g
Ca \_\_\_= 21% calcium, 10.5 mEq Ca/g
A 
25%, 12.5
40%, 20
Glubionate
9%, 4.5
Citrate
114
Q 
Causes:
Acute/chronic renal failure
Excess administration
Hypoparathyroidism
Rhabdomyolysis
Diabetic ketoacidosis
A

Hyperphosphatemia

115
Q

Moderate hyperphosphatemia

Normal= 2.7-4.6 mg/dL

A

> 6.5 mg/dL

116
Q

Severe hyperphosphatemia

Normal= 2.6-4.6 mg/dL

A

> 7 mg/dL

117
Q

S/S of hyperphosphatemia:

A

X-ray CaPO4 deposits (Ca x PO4 > 55 at risk)

Hypocalcemia (due to Ca precipitation…tetany, paresthesia, cramping, spasms, confusion, hair loss, psoriasis)

118
Q

Treatment for severe hyperphosphatemia (> 7 mg/dL):

A

IV calcium (to form CaPO4 precipitates)

119
Q

Treatment for mild/moderate hyperphosphatemia

A 
Phosphorous binders
Dietary restriction (low protein)
120
Q

Examples of phosphorus binders.

Indication?

A

Sevelamer (Renagel)
Lanthanum carbonate (Fosrenal)
Sucroferric oxyhydroxide (Velphoro)
Hyperphosphatemia

121
Q 
Causes:
Malnourishment (re-feeding)
Acute respiratory alkalosis
Diabetic ketoacidosis
Antacids
A

Hypophosphatemia

122
Q

S/S: hemolysis, leukocyte dysfunction, muscle weakness, rhabdomyolysis, irritability, weakness, seizures, coma

A

Acute hypophosphatemia

123
Q

S/S of chronic hypophosphatemia:

A

Bone pain

Osteomalacia

124
Q

Treatment for moderate hypophosphatemia (1-2.5 mg/dL):

A

Oral therapy (Neutra-phos 1.25 g BID-TID or Fleets phospho soda)

125
Q

Treatment for severe hypophosphatemia (< 1 mg/dL)

A

IV therapy

0.2 mmol/kg over 3-12 hours

126
Q

Associated causes are renal disease, SIADH, CHF, cirrhosis

A

Hyponatremia

127
Q

Associated causes are renal disease, adrenal disease, diabetes insipidus

A

Hypernatremia

128
Q

Mild hyponatremia labs

Normal= 134-145 mEq/L

A

< 134 mEq/L

129
Q

Moderate hyponatremia labs

Normal= 134-145 mEq/L

A

< 120 mEq/L

130
Q

Critical hyponatremia labs

Normal= 134-145 mEq/L

A

< 115 mEq/L

131
Q

S/S: mild- headache, confusion, agitation, N/V, disorientation

A

Hyponatremia

132
Q

S/S: moderate-severe- seizures, coma, death

A

Hyponatremia

133
Q

Rule for serum Na correcting:

A

No more than 8-12 mEq/L per 24 H or else there is risk for central pontine myelinolysis

134
Q

Calculating the sodium deficit in HYPOnatremia:

A

(Na,desired-Na,current)*(body water)= mEq to replace

135
Q 
% H20:
Child
Male <70
Male ≥ 70
Female < 70
Female ≥ 70
A
  1. 6,
  2. 6,
  3. 5,
  4. 5,
  5. 45
136
Q

Once you calculated the Na deficit (mEq to replace), how do you find the infusion rate of 3% NaCl? When to use this fluid?

A

513 mEq= X Na deficit to replace (mEq)
1000 mL. Y mLs
Y mls/24 hour= infusion rate
Use 3% NaCl when patient is hyponatremic AND euvolemic (or doesn’t need excess fluid)

137
Q

Once you calculated the Na deficit (mEq to replace), how do you calculate the infusion rate of 0.9% NaCl? When would you use this fluid?

A

154 mEq = X Na deficit to replace (mEq)
1000 mL. Y mls
Y mls/24 hours= infusion rate
Use 0.9% NaCl when patient is hyponatremic and hypovolemic (or needs more fluids)

138
Q

Calculate the change in [Na] if 1 L of 3% NaCl was administered:
UNITS?

A 
*(IV,na-S'na)/(BW + IV,vol)= mEq/L*
IV,na= [Na] of infusion, 513 mEq/L
S'na= initial [Na] of patient
BW= body water
IV, vol= 1 L
139
Q

Calculate the change of [Na] if 1 L of 0.9% NaCl was administered:

A 
(IV,na-S'na)/(BW + IV,vol)= mEq/L
IV,na= [Na] content of infusion, 154 mEq/L f
S'na= initial [Na] of patient
BW= body water
IV, vol= 1 L
140
Q

How do you calculate the infusion rate after finding the change in [Na] after 1 L of fluid administered?

A

Solved X Na change mEq= desired change in [Na]
1000 mls. Y mL
Y ml/24= infusion rate

141
Q

Hypotonic hyponatremia (serum Osm < 280 mOsm): euvolemia causes

A 
Water intoxication (either too much intake or decreased excretion)
SIADH (too much ADH, too much water reabsorption)
142
Q

Condition caused by SSRIs and SNRIs, MDMA, and ecstasy

A

SIADH (syndrome of inappropriate anti-diuretic hormone) with too much production of ADH
Euvolemic hypotonic hyponatremia

143
Q

Condition caused by NSAIDS, hypoglycemic agents (1st gen.), carbamazepine, cyclophosphamide

A

SIADH (syndrome of inappropriate anti-diuretic hormone) with increased renal sensitivity
Euvolemic hypotonic hyponatremia

144
Q

Treatment of ACUTE euvolemic hyponatremia (hypotonic):

Na levels < ____ mEq/L and/or symptomatic

A

< 115 mEq/L
3% NaCl infusion
+/- diuretics
Fluid restriction (not ideal)

145
Q

Treatment of non-acute euvolemic hyponatremia (hypotonic):

Na levels > ___ mEq/L and/or asymptomatic

A 
> 115 mEq/L
Fluid restriction
Chronic therapy OF....
Diuretics
Salt or urea tabs
Demeclocycline (SIADH go-to)
ADH receptor antagonist (conivaptan IV, tolvaptin oral)
146
Q 
Hypervolemic hypotonic hyponatremia:
EABV
Conditions
Water relation to Na
Kidney response
A

Decreased EABV
CHF, cirrhosis, nephrosis
Water&raquo_space; Na
Kidney senses volume depletion (edema), so aldosterone levels are increased

147
Q

Treatment of hypervolemic hyponatremia (hypotonic, 4 steps):

A
  1. Treat underlying disease
  2. Diuretics (spironolactone would counter aldosterone increase)
  3. Increase oncotic pressure (help with edema)
  4. Fluid restriction
148
Q

Hypovolemic hyponatremia (hypotonic) has high urine osmolarities. If sodium content in urine is HIGH, this indicates:

A

Kidneys are the problem (renal losses)
Diuretics
Adrenal insufficiency

149
Q

Hypovolemic hyponatremia (hypotonic) has high urine osmolarities. If sodium content in urine is LOW, this indicates:

A

Kidneys are functioning properly

GI/skin/lung loss

150
Q

Hypovolemic hyponatremia (hypotonic) treatment

A

Volume replacement with 0.9% NaCl

151
Q 
Loss of water
Associated causes:
Diabetes insipidus
Skin losses
Osmotic diuresis
Polydipsia
A

Isovolemic HYPERnatremia

152
Q

Associated causes: sodium overload, mineralcorticoid excess

A

Hypervolemic HYPERnatremia

153
Q

Associated causes: renal loss, adrenal, GI/skin/lung loss
Water loss&raquo_space; Na loss
Exercise, infection

A

Hypovolemic HYPERnatremia (dehydation)

154
Q

Hypernatremia labs (+ critical)

A

> 145 mEq/L

> 160 mEq/L (CRITICAL)

155
Q

Mild-moderate hypernatremia S/S:

A

Polyuria, polydipsia, thirsty

156
Q

Severe hypernatremia S/S

A 
*Neurologic*
Confusion
Rigidity
Tremors
Coma
Stupor
157
Q

Calculate the water deficit in a hypernatremic patient:
Variables?
Generally, what fluid is used?

A

Water deficit= TBW,current * [(S’na/S2na)-1]

TBW, current= current weight * %h20
S’na= current serum Na
S2na= desired [Na]

D5W

158
Q

Hypernatremia case:
Water losses in ECF=ICF
Usually asymptomatic

A

Isovolemic (most common)

159
Q

Diabetes insipidis is associated with which type of hypernatremia?

A

Isovolemic

160
Q

Diabetes insipidis with 3-15 L urine/day

A

Central DI (decreased ADH production)

161
Q

DI with 3-4 L urine/day

A

Nephrogenic DI (decreased renal sensitivity)

162
Q 
These meds are associated with \_\_\_.
Aminoglycosides
Lithium
Glyburide
Colchicine
Amph B
Cisplatin
Demeclocycline
Methoxyflurane
A

Diabetes insipidis (isovolemic hypernatremia)

163
Q

Treatment of isovolemic hypernatremia:

A
  1. Replace water deficit with D5W
    - central DI maintenance= desmopressin
    - nephrogenic DI maintenance= NSAIDS, thiazides
164
Q

Water and sodium excess treatment

A

(Hypervolemic hypernatremia)

  1. Replace deficit with D5W (or lesser concentration of NaCl, or combination)
  2. Loop diuretic to remove excess Na and water
  3. Hemodialysis if renal failure
165
Q

Water loss&raquo_space; Na loss

Symptomatic treatment:

A

(Hypovolemic hypernatremia)
200-300 mL/H of 0.9% NaCl
THEN replace water deficit with D5W (or less conc. Of NaCl or combo)

166
Q

Water loss&raquo_space; Na loss

Asymptomatic treatment:

A

(Hypovolemic hypernatremia)

D5W to replace water deficit (or less conc. NaCl or combo)

PT: Nutrition Exam 2 (10 decks)

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