Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal > Electrolytes lecture > Flashcards

Electrolytes lecture Flashcards

1
Q

increase in total body fluid/Na

*increased weight; edema, ascites
ie HF

A

volume overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

wt loss, excessive thirst, postural hypotension and dry mucous membranes;
BOTH** water and salt are loss

ie..vomiting, diarrhea

A

volume depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

refers to volume depletion with DISPROPORTIONATE WATER DEFICIT; may lead to increased Na, osmolality

A

dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

diarrhea; other heat related illnesses, fevers, vomiting

A

most common causes of dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

breakdown product of muscle energy metabolism; lower in women than men, reflects lean muscle mass. Good indicator of glomerular filtration.

A

Creatinine

0.6-1.2 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

end product of protein metabolism; excreted by kidney

A

blood urea nitrogen (BUN)

8-20 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

weakness, delerium, seizures

A

HYPOnatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

arrhythmias, muscle weakness, cramps

A

HYPOkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

weakness, diarrhea

A

HYPERkalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cramps, arrhythmias, seizures

A

HYPOcalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

polyuria, constipation, lethargy/confusion

A

HYPERcalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is essential in patients with neuromuscular symptoms?

A

measurement of electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

glucose, BUN, Cr, electrolytes (Na, K, Cl, HCO3), Ca, Mg, O2 sat

A

assessment of metabolic and renal status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Na under 130 meq/L

A

HYPOnatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

most cases of HYPOnatremia result from ____ imbalance

A

water imbalance

NOT Na imbalance**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

increased ADH secretion can lead to…

A

water reabsorption, and ultimately HYPO Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

very small increases in plasma osmolality (1-2%) result in…

A

ADH secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

large changes in volume (5-10%), with concomitant decrease in BP, results in…

A

ADH release

  • mediated through baroreceptors in the circulation
  • free H20 is retained, leading to HypoNa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

decreased Na with decreased extracellular volume can be caused by either….

*total body Na/H2O decreased

A

RENAL (diuretics) or EXTRARENAL (vomiting, diarrhea, volume loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ADH secretion is increased to maintain….

A

intravascular volume

*this drive OVERRIDES the need to sustain normal osmolality. pt often initially unable to take in adequate Na/H2O orally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q 
Pt has.....
decreased volume
total Na/H2O decreased
serum osmolal decreased
ADH secretion increased
renal status preserved
HYPOnatremia
HYPOkalemia

Rx?

A

isotonic fluids IV (normal saline/0.9% saline or ringers lactate) with KCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If there is a mild volume decrease and oral intake intact…suggest what?

A

electrolyte drink (Gatorade) plus KCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hyponatremia with increased ECF seen in what kind of disorders?

A

Edema related*

ie…HF**, cirrhosis, nephrotic syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

total body Na/H20 increased but CIRCULATING BLOOD VOLUME IS SENSED AS INADEQUATE BY BARORECEPTORS because of decreased CO and BP

A

Hypervolemic hypotonic HypoNa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

decreased cardiac output leads to decreased renal perfusion, which causes….

A

INCREASED ADH + activation of RAA system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tx of hypervolemic HypoNa (i.e. HF, cirrhosis, nephortic syndrome)

A

Water restriction*
diuretics
tx underlying condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q 
euvolemic
normal or mildly decreased Na
serum osmolality decreased
increased ADH secretion
normal renal status
hyponatremia
increased urine osmolality
A

Euvolemic hypoNa

*SIADH is the most common cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Syndrome of inappropriate antidiuretic diuretic hormone secretion (SIADH) is the most common cause of…

A

euvolemic HypoNa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

disorders of CNS (stroke), tumors (lung ca, others), pulmonary lesions (TB, lung abscess), drugs with ADH-like effects (SSRIs), post op pain, etc

can all lead to…

A

Euvolemic HypoNa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hyponatremia, decreased serum osmolality with inappropriate high urine osmolality is seen with…

A

Euvolemic HypoNa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  • Absence of cardiac, liver, renal, adrenal or thyroid disease.
  • Urine Na greater than 20meq/L. Natriuresis (RAAS turned off) compensates for slight increase in volume from ADH.
  • Serum BUN and uric acid are low due to increased clearance (mild volume expansion).
A

SIADH

32
Q

symptomatic HypoNa (Na under 120) is a….

A

medical emergency!!!

33
Q

correction of hyponatremia must be done…

A

SLOWLY!! (less than 10-12 me/L/ day)

34
Q

Osmotic demyelination of brainstem can occur if…

A

HypoNa correction occurs too quickly

35
Q

Marked excess free H2O intake, greater than 10 L/d or more.
*Seen in patients with psychiatric disease who may be on psychiatric meds (SSRI’s, others) that can interfere with H2O excretion.

A

psychogenic polydipsia

36
Q

Euvolemia maintained via renal excretion of H2O and Na (urine Na more than 20 meq/L).

  • Serum ADH levels are low.
  • Urine osmolality is low.
A

Psychogenic polydipsia

37
Q

post-op pain does what to ADH?

A

increased ADH secretion!

38
Q

If post-op pt in pain receives hypotonic fluids, can cause….

A

severe HypoNa
seizures
HA

39
Q

Treatment: Appropriate pain control with administration of isotonic fluids until patient able to take adequate fluids orally.

A

Post-op HypoNa

40
Q

Seen with significant hyperglycemia in diabetics, especially if insulin dependent, with an acute rise in BS →↑osmolality. Water is drawn from cells into extracellular space

A

Hypertonic HypoNa

41
Q

Na falls 2-4 meq/l for every 100mg/dL rise in glucose above 200mg/dL; resolves with insulin infusion and volume expansion.

A

Hypertonic HypoNa

42
Q

20% of ambulatory and 50% of hospitalized patients with _____ have HypoNa

A

AIDS (HIV)

43
Q

Pathophysiology: multiple mechanisms involved, often a combination of GI fluid and electrolyte loss along with inappropriate ADH secretion associated with CNS and/or pulmonary involvement from ____ infection.

A

HIV

44
Q

Unusual with intact thirst mechanism and access to H2O. “Stranded in the desert/lost at sea.”
*Appropriate H2O intake not possible (no H2O available or unconscious).

Signs/Sx: Orthostatic hypotension, dehydration; oliguria.

A

HyperNa with concentrated urine

45
Q

urine osmolality greater than 400 with intact renal function

*ADH levels increased

A

HyperNa with concentrated urine

46
Q

Correct cause of fluid loss and replace volume, water and electrolytes as indicated.
Replace water deficit slowly to avoid cerebral edema (brain cell adaptation to serum hyperosmolality). Fluid deficit should be replaced over 48-72 hours.

A

tx of HyperNa

47
Q

CHF, nephrotic syndrome, renal failure, hepatic cirrhosis…all cause?

A

Hyponatremia with HYPERvolemia

48
Q

SIADH, hypothyroidism, glucocorticoid excess..all cause?

A

Hyponatremia with EUvolemia

49
Q

Renal and nonrenal sodium loss..all cause?

A

Hyponatremia with HYPOvolemia

50
Q

lethargy, disorientation, muscle cramps, anorexia, hiccups, nausea, vomiting, seizures
*weakness, agitation, hyporeflexia, orthostatic hypotension, Cheyne-Stokes respirations, delirium, coma, stupor

A

HYPOnatremia

51
Q

*Diabetes Insipidus: ↑↑thirst, ↑↑H2O (polydipsia)

Urine osmolality

A

Hypernatremia with dilute urine

52
Q

Major intracellular ion

A

K

53
Q

K uptake by cells stimulated by _____ in the presence of glucose and facilitated by beta adrenergic stimulation.

A

insulin

54
Q

RAA system is a major excretion of….

A

K+

RAA system AKA Renal K modulation

55
Q

Symptoms/signs: weakness, muscle cramps, fatigue, constipation.
ECG: NSST-T* changes and “U” waves; PVC’s

A

HYPOkalemia

56
Q

Aldosterone facilitates urinary K excretion; most important regulator of body K content. Most diuretics lead to renal K losses.

A

Renal losses of K+ (leading to HYPOkalemia)

57
Q

Treatment for mild to moderate K losses

A

oral KCL

58
Q

Severe hypokalemia treatment

A

SLOW** IV fluids/KCL

cardiac monitoring

59
Q

Patients with renal insufficiency are at risk for which potassium disorder?

A

HYPERkalemia

60
Q

Mild hyperkalemia may accompany which acid-base disorder?

A

Metabolic acidosis

61
Q
  • Severe renal insufficiency
  • Renal insufficiency plus K supplements (KCL), K sparing diuretic or ACEI
  • Combination of KCL + K sparing diuretic as Rx of hypokalemia: avoid for most patients
A

Risk factors for HYPERkalemia

62
Q

Abnormalities in neuromuscular function: weakness, diarrhea, rarely paralysis.
**Characteristic ECG findings may occur: Peaked T waves, widening of QRS, increased intervals, loss of P waves, etc.

A

HYPERkalemia

63
Q

50% of this electrolyte is ionized and used for muscle and nerve function

A

Calcium

64
Q

Important to measure serum ____ to determine if Ca levels reflect true deficiency.

A

albumin

65
Q

Is ionized calcium effected by albumin levels?

A

NO!

66
Q

For every 1 gram ↓of albumin, total Ca ↓s by ___ meq/L

A

0.8

67
Q

Most common cause of HYPOcalcemia

A

renal failure

68
Q

Signs/Sx: Increased excitation of nerve and muscle cells; cramps, tetany, paresthesias and convulsions.
Chvostek’s sign, Trousseau’s sign
* ECG: Prolonged Q-T interval/arrhythmias

A

HYPOcalcemia

69
Q

If symptomatic: IV calcium gluconate via bolus and infusion.

If asymptomatic: Oral calcium and Vitamin D.

A

Tx for HYPOcalcemia

70
Q

Etiologies include hyperparathyroidism, malignancy (tumors produce PTH related proteins), milk-alkali syndrome (Ca antacids + Vit D excess).

A

HYPERcalcemia

71
Q 
Signs/Sx: Often without sx if mild ↑Ca
Renal/GI: polyuria (H2O* reabsorption is blocked by hypercalciuria), nephrolithiasis; nausea, constipation.  
Neuro changes (drowsiness, weakness, lethargy, stupor/coma) if severe
A

HYPERcalcemia

72
Q

ECG findings: Shortened Q-T, PVC’s.

Lab: increased Ca with nl. or low PO4.

A

HYPERcalcemia

73
Q

Treat underlying disease process.
Promote Na rich diuresis which will be accompanied by excretion of Ca.
Infusion of 0.9% Saline + IV furosemide will expand ECF volume and promote Na/Calcium rich diuresis.
**Avoid Thiazide diuretics: Can worsen

A

HYPERcalcemia

74
Q

Symptoms similar to hypocalcemia: weakness, muscle cramps, tremors, neurmuscular and CNS hyperirritability.
Often associated with hyopK and hypoCa
*can cause dangerous (ventricular) cardiac arrhythmias, esp if K is low.

A

HYPOmagnesemia

75
Q

Very common in hospitalized patients, especially those on diuretics who are receiving continuous IV fluid support.

A

HYPOmagnesemia

Renal (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions