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Clin Med 3- Exam 2 > Electrolytes and Imbalances > Flashcards

Electrolytes and Imbalances Flashcards

1
Q

What 7 electrolytes are included in the “fish bone”?

A

(1) Na+
(2) Cl-
(3) BUN
(4) blood glucose
(5) K+
(6) HCO3-
(7) SCr

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2
Q

What is osmolality?

A

Concentration of solutes/electrolytes per liter of solution/water

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3
Q

What does increased serum osmolality suggest?

A

Volume depletion → inc [ ] of electrolytes

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4
Q

What does decreased serum osmolality suggest?

A

Volume overload → dilution of electrolytes

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5
Q

What is water regulation primarily controlled by?

A

Secretion of ADH

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6
Q

What is the mechanism of water regulation in the body?

A

Blood volume decreases→ pituitary releases ADH→ ADH tells the kidney to hold onto water

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7
Q

What is third spacing?

A

When there is a large volume of fluid from the intravascular compartment that shifts into an interstitial space

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8
Q

What are colloids?

A

Solutions that don’t cross the cell membrane b/c they’re too big→ remain in the intravascular compartment and expand the intravascular volume and draw fluid from extravascular spaces via higher oncotic pressure

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9
Q

What are crystalloids?

A

Solutions that contain small molecules that easily pass through the cell membrane and inc fluid volume in both interstitial and intravascular spaces

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10
Q

What is an isotonic solution?

A

Same concentration of solutes in blood so cell content stays the same (when you give, it doesn’t change the water content of the cell)

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11
Q

What is a hypotonic solution?

A

Same concentration of solutes in blood so cell content stays the same (when you give, it doesn’t change the water content of the cell)

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12
Q

What is a hypertonic solution?

A

Higher [ ] of solutes so solutions pull fluid from the cells-shrink

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13
Q

What are 3 examples of isotonic IV fluids?

A

(1) normal saline 0.9% NaCl
(2) lactated ringer
(3) ringers solution

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14
Q

When do you give normal saline?

A

When the extracellular volume is low (ex: dehydration, vomiting/diarrhea, shock, hemorrhage, etc.)

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15
Q

What isotonic solution most closely mimics the blood and plasma concentration?

A

Lactated ringers

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16
Q

What 5 electrolytes do lactated ringers contain?

A

(1) sodium (2) potassium (3) chloride (4) calcium (5) bicarb-lactate

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17
Q

What pts will benefit greatly from lactated ringers?

A

Pts requiring electrolyte replacement

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18
Q

What 4 types of pts should you avoid giving lactated ringers to?

A

(1) lactic acidosis
(2) liver disease
(3) renal impairment
(4) pH >7.5

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19
Q

What 4 electrolytes are in ringers solution?

A

(1) sodium
(2) chloride
(3) potassium
(4) calcium

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20
Q

In what 2 situations should you give ringers solution?

A

(1) when giving lactate is c/i

(2) in lactic acidosis

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21
Q

What is special about dextrose 5%?

A

It is isotonic, but when metabolized it becomes hypotonic and causes fluid to shift into cells (it also provides minimal cals while pt is NPO)

22
Q

When are hypotonic IV fluids used?

A

Used to tx pts w/conditions causing intracellular dehydration (hypernatremia, DKA, hyperosmolar hyperglycemia)

23
Q

What 3 things is sodium important for?

A

(1) regulates transmission of impulses in nerve and muscle fibers
(2) main factor in determining volume of extracellular space
(3) helps maintain acid-base balance

24
Q

What are 5 conditions associated with hyponatremia?

A

(1) acute illness
(2) HF
(3) cirrhosis
(4) renal failure
(5) aggressive IV fluid administration

25
Q

Excess of what can cause hyponatremia and what is the mechanism leading to hyponatremia?

A

Hyperglycemia→ high serum sugar→ cells release water → sodium gets diluted while body gets overloaded with water (body is trying to dilute the sugar by inc water, but that dilutes salt too causing hyponatremia)

26
Q

What 3 things lead to hyponatremia?

A

(1) syndrome of inappropriate ADH
(2) chronic alcoholics
(3) water intoxication-marathon runners, drugs

27
Q

How do you tx hyponatremia?

A

Tx depending on cause: if fluid overload→ fluid restriction, if severe and symptomatic→ fluid restriction + sodium replacement

28
Q

Why do you want to correct hyponatremia slowly?

A

B/c of risk of Central Pontine Myelinolysis (CPM)- an osmotic demyelinating injury

29
Q

What are 5 signs of hypernatremia?

A

(1) fever
(2) sweating
(3) vomiting
(4) diarrhea
(5) primary hypodipsia

30
Q

What are the 2 mechanisms of diabetes insipidus causing hypovolemic hypernatremia?

A

(1) dec secretion of ADH (2) inc renal resistance to ADH (cannot [ ] urine); you’re peeing out the water, but Na+ is staying

31
Q

What happens in hyperaldosteronism leading to hypernatremia?

A

Problem w/adrenals (usually a benign tumor) → excess production of aldosterone → sodium and water inc and potassium dec

32
Q

What 2 things do you tx hypovolemic hypernatremia pts with?

A

(1) IV isotonic solution (0.9% saline)

(2) limit salt intake

33
Q

What do you tx euvolemic hypernatremia pts with?

A

IV hypotonic fluids (D5W)

34
Q

What 2 things do you tx hypervolemic hypernatremia pts with?

A

(1) D5W

(2) diuretics

35
Q

What are the 3 most common causes of dyskalemia?

A

(1) medications: ACE inhib- Lisinopril, K+ sparing diuretics (Spironolactone), OCP- Yaz
(2) renal dysfunction
(3) dietary intake

36
Q

What 3 categories of medications cause hypokalemia?

A

(1) diuretics
(2) insulin
(3) beta adrenergic agents

37
Q

What are 3 findings on an EKG of hypokalemia?

A

(1) flat T wave
(2) ST segment depression
(3) formation of U waves

38
Q

How do you tx mild hypokalemia?

A

Oral KCl

39
Q

How do you tx severe hypokalemia?

A

IV KCl

40
Q

How do you tx hypokalemia + low Mg+?

A

Mg+ first THEN K+ (b/c must be cardioprotective first before fixing K+)

41
Q

What 3 medications cause hyperkalemia and what is a common complication that leads to hyperkalemia?

A

(1) ACE inhib- Lisinopril
(2) ARBs- Losartan
(3) Aldosterone antag- Spironolactone

kidney failure/insufficiency

42
Q

What are 2 clinical manifestations of hyperkalemia?

A

(1) muscle weakness

(2) paresthesias

43
Q

What are 3 findings on an EKG of hyperkalemia?

A

(1) tall or peaked T waves (2) widened/bizarre QRS (3) flat P waves

44
Q

What is the first agent to have on board in tx of hyperkalemia?

A

IV calcium (gluconate or chloride)- cardioprotective!!

45
Q

What tx helps move excess K+ into the cells?

A

IV hypertonic glucose + regular insulin

46
Q

What 4 processes require Ca+?

A

(1) blood coagulation
(2) nerve excitability
(3) development of action potentials for muscle contraction
(4) osteoclast activity

47
Q

What are 5 common causes of hypocalcemia?

A

(1) parathyroid disease (2) thyroid disease
(3) thyroid or parathyroid-ectomy
(4) chronic renal failure (5) Vit D deficiency

48
Q

A deficiency of what can cause pseudohypocalcemia?

A

Albumin

49
Q

What are 2 classic physical findings of hypocalcemia?

A

(1) Chvostek sign: facial spasm following the percussion of the facial nerve
(2) Trousseau’s sign: spasm of the hand elicited by inflation of a BP cuff

50
Q

What is a finding on an EKG of hypocalcemia?

A

Prolonged QT interval

51
Q

What is the tx of asymptomatic hypocalcemia? Symptomatic?

A

Asymptomatic: oral Ca+ Symptomatic: IV Ca+

52
Q

What are the 3 most common causes of hypercalcemia?

A

(1) hyperparathyroidism
(2) bone malignancy (multiple myeloma)
(3) prolonged immobilization

Clin Med 3- Exam 2 (15 decks)

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