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Renal YR3 > Electrolytes and Fluid Balance > Flashcards

Electrolytes and Fluid Balance Flashcards

1
Q

What is hypernatraemia often due to?

A

Water deficit

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2
Q

Consequences of hypernatraemia

A
  • Cellular dehydration
  • Vascular shear stress - bleeding and thrombosis
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3
Q

Symptoms of hypernatraemia

A
  • Thirst
  • Apathy
  • Irritable
  • Weakness
  • Confusion
  • Reduced conc
  • Seizures
  • Hyperreflexia
  • Spasticity
  • Coma
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4
Q

Causes of hypovolaemic hypernatraemia

A

Renal water loss:
* osmotic diuresis (via NG feeding),
* loop diuretics
* intrinsic renal disease
Non-renal water loss:
* excess sweating
* burns
* diarrhoea
* fistulas

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5
Q

Cause of euvolaemic hypernatraemia

A

Renal:
* Diabetes insipidus
* Hypodipsia (no thirst mechanism)

Extra renal:
* Insensible - skin, resp, stool
* Respiratory losses

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6
Q

Causes of hypervolaemic hypernatraemia

A
  • Primary hyperaldosteronism
  • Cushing syndrome
  • Hypertonic dialysis
  • Hypertonic sodium bicarbonate
  • Sodium chloride tablets
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7
Q

Diabetes insipidus differential

A

Psychogenic polydipsia

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8
Q

Urine in diabetes insipidus

A

Dilute - osmolality of <300

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9
Q

Diabetes insipidus symptoms

A
  • Polydipsia
  • Polyuria
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10
Q

Na+ in diabetes insipidus

A

Not always hypernatraemic
If are will be euvolaemic

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11
Q

What are two types of diabetes insipidus?

A

Cranial - impaired release of ADH
Renal - impaired response/resistance to ADH

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12
Q

Causes of cranial diabetes insipidus

A
  • Trauma/post op
  • Cerebral sarcoid/TB
  • Infection - meningitis/encephalitis
  • Cerebral vasculitis (SLE/Wegener’s)
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13
Q

Causes of renal diabetes insipidus

A
  • Congenitial
  • Drugs (lithium, amphotericin, demeclocyline)
  • Hypokalaemia
  • Hypercalcaemia
  • Tubulointerstitial disease
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14
Q

Treatment for hypernatreamia

A

Free water

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15
Q

Hyponatraemia symptoms

A
  • Decreased perception
  • Gait distubance
  • Yawning
  • Nausea
  • Reversible ataxia
  • Headache
  • Apathy
  • Confusion
  • Seizures
  • Coma
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16
Q

What causes psuedohyponatraemia?

A

Occurs with:
* high lipids
* myeloma
* hyperglycaemia
* uraemia

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17
Q

Investigations for hyponatraemia

A
  • Plasma osmolality - if normal or raised then pseudohyponatraemia
  • K+ and Mg levels - Hypokalaemia/hypomagnesia potentiates ADH release
  • Urine sodium - if less than 20 non renal loss, >40 = SIADH
  • TSH
  • 9am cortisol
  • Calcium
  • Albumin
  • Glucose
  • LFT
  • CT head/chest if suspect SIADH
18
Q

How to assess whether hypovolaemic hyponatraemia is renal or non renal loss?

A

Urine Na+
If more than 20mmol/L - renal loss
If Less than 20 - non renal loss

19
Q

Renal losses causing hypovolaemic hyponatraemia

A
  • Diuretics - thiazides
  • Osmotic diuresis (glucose, urea in recovering acute tubular necrosis)
  • Addisons disease
20
Q

Non-renla losses causing hypovolaemic hyponatraemia

A
  • Diarrhoea
  • Vomitting
  • Sweating
  • Third space losses - burns, bowel obstruction, pancreatitis
21
Q

Treatment for hypovolaemic hyponatraemia

A
  • IV fluids - 0.9% saline at 1-3ml/kg/hr
  • Give K+ if needed
22
Q

Causes of eurvolaemic hyponatraemia

A
  • Hypothyroidism
  • Primary polydipsia (if urine osmolality less than 100)
  • Glucocorticoid deficiency - adrenal insifficiency
  • SIADH
23
Q

SIADH findings

A
  • Low serum osmolality
  • Concentrated urine - inapporpirate greater than 100
  • Urine Na is more than 20
  • Euvolaemia
  • NOt on diuretics
  • Elimination diagnosis - normal renal, thyroid, adrenal function
24
Q

Management SIADH

A
  • Fluid restrict less than 800ml per day
  • PO sodium chloride
  • Furosemide?
  • Demeclocycline induces diabetes insipidus (reverse)
  • Tolvaptan alternatively
25
Q

Causes of hypervolaemic hyponatraemia

A
  • CHF
  • Nephrotic syndrome
  • Liver cirrhosis
26
Q

Treatment of hypervolaemic hyponatraemia

A
  • Fluid restrict
  • Consider furosemide
27
Q

Risk of correcting hyponatraemia too fast

A
  • Pontine/osmotic myelinosis
  • Aim to correct less than 12mmol/L/day
28
Q

general acute treatment of hyponatraemia

A
  • If within 48hrs and symptomatic
  • Give 3% hypertonic saline IV boluses +/- furosemide
29
Q

Usual causes of acute hyponatraemia

A
  • Iatrogenic
  • Polydipsia
  • Colonoscopy prep
  • Ecstasy
30
Q

Treatment for chronic hyponatraemia

A

If >48hrs and symptomatic
* hypertonic saline boluses if seizing
* Otherwise isotonic saline and furosemide - aim to correct 8mmol/L in 24hrs
* If chronic and asymptomatic - water restrict, stop offending drug, if dehydrated restore volume, if overloaded Na and water restriction and diuretics

31
Q

Causes of hyperkalaemia

A
  • CKD or K+ rich diet + CKD
  • Drugs - ACEi, ARBs, Spironolactone, amiloride, NSAIDs, LMWH, heparin
  • Hypoaldosteronism
  • Addisons disease
  • Acidosis
  • Massive tissue damage - tumour lysis, burns, haemolysis, rhabdomyolysis
  • Psuedohyperkalaemia - haemolysed blood sample
32
Q

Rarer cause of hyperkalaemia

A
  • Hyperkalaemic periodic paralysis
  • Gordons syndrome
33
Q

ECG changes in hyperkalaemia

A
  • Tall tented T waves
  • P wave flattened
  • Prolonged QRS
  • Slurred ST segment
  • Asystole?
34
Q

Treatment for hyperkalaemia steps

A
  1. Stabilise myocardium
  2. Shift K+ into cells
  3. Eliminate K+ from body
35
Q

Stabilise myocardium treatment

A

10 mls of 10% calcium gluconate over 5-10 minutes

36
Q

Shifting K+ back into cells treatment

A
  • 10 units of IV fast acting insulin
  • And IV glucose/dextrose 50% 50mls
  • 500mls of 1.4% Sodium bicarbonate (only effective it pt acidotic)
  • 5-10mg Salbutamol nebuliser
37
Q

Eliminating K+ from body treatment

A
  • Calcium resonium - 15-45g oral or rectal mixed with sorbitol or lactulose
  • Furosemide 20-80mg depending on hydration
  • Dialysis - if resistant to medical treatment
38
Q

Symptoms of hypokalaemia

A
  • Fatigue
  • Confusion
  • Proximal muscle weakness
  • Paralysis
  • Cardiac arrhtymias
  • Worsened glucose control in diabetics
  • Hypertension
39
Q

Causes of hypokalaemia

A
  • Pseudohypokalaemia - acute leukaemia
  • Vomitting + diarrhoea
  • Conns syndrome
  • Cushing syndrome
  • Diuretics
40
Q

ECG changes in hypokalaemia

A
  • Small T waves
  • U wave (after T wave)
  • Increased PR interval
41
Q

Treatment for hypokalaemia

A

Replace magnesium
Oral K+ replacement
IV K+ replacement (usually in 0.9% saline avoid in dexrose as induces further hypokalaemia)

Insulin secreted when dextose given = K+ into cells

42
Q
A

Renal YR3 (11 decks)

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