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Therapeutics II > Exam 1 FINAL: fluids + renal > Flashcards

Exam 1 FINAL: fluids + renal Flashcards

1
Q

IBW

A

50 + 2.3*inches over 60”

45.5 for female

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2
Q

Nutrition body weight

A

IBW + 0.25(wt-IBW)

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3
Q

hypotonic

A

-fluid moves into cell
-ECF more concentrated than ICF
-<275

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4
Q

Isotonic

A

275-290

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5
Q

Total osmolarity

A

osmolarity of IV solution + osmolarity of added electrolytes

-multiply electrolytes by mEq but do NOT multiply for more than 1L of solution

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6
Q

maintenance fluid requirement

A

30-40mL/kg/DAY

-divide by 24 for hourly rate
-use actual BW unless over 130% of IBW, then use IBW

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7
Q

Types of fluids

A

-crystalloids
-colloids

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8
Q

Crystalloid fluids

A

-any tonicity
-NS, D5W, LR, salt solutions
-provide water/sodium

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9
Q

Normal saline use

A

-RESUSITATION

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10
Q

Lactated ringers use

A

-resuscitation
-replace blood loss
-slay use this one over NS

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11
Q

1/2 NS use

A

-maintenance fluids

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12
Q

D5W

A

-free water replacement
-NOT resuscitative
-NOT MIVF by itself

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13
Q

Balanced salt solutions

A

-closer to physiologic levels
-LRs
-Normosol-R
-Plasma-lyte

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14
Q

NS composition

A

-154mEq of Na and Cl
-0 free water

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15
Q

1/2NS composition

A

-77mEq Na and Cl
-500mL free water

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16
Q

Colloid Solutions use

A

-inc plasma oncotic pressure
-inc molecular weight = longer halflife
-volume expansion
-hemorrhagic shock
-hypovolemic shock

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17
Q

Albumin

A

-colloid solution
-shock/burns
-blood product
-supportive/sx tx unless hypoproteinemia

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18
Q

Synthetic colloids

A

-heta and tetrastarch
-no good, dont use

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19
Q

pack RBCs use

A

-acute blood loss
-poor resuscitation from fluids alone
-low hemoglobin (1 unit RBCs inc by 1g/dL)

20
Q

most common MIVF

A

-D5W + 1/2NS + 20mEq/L KCl
-inc plama pressure

21
Q

signs of dehydration

A

-dry skin and membranes
-delayed capillary refill
-tachycardia and hypotension
-weak pulse
-dec urine output
-BUN/SCr > 20

22
Q

Sodium normal levels

23
Q

Serum Osmolality Calculation

A

(2*Na) + (BUN/2.8) + (glucose/18)

-high osmolality indicates smth else in blood

-Na is top left value on fishbone, BUN top right, glucose tail

24
Q

Pseudohyponatremia

A

-isotonic
-elevated lipids and proteins in plasma
-sodium appears low but still there
-measured serum osmolality not affected

25
Corrected Serum Sodium
-serum Na + 1.6([BG-100)/100]
26
Hypotonic hyponatremia
-most cases of hyponatremia -hypovolemic if TBW and Na are dec -isovolemic: TBW up Na normal -HYPERvolemic: TBW and Na up -mostly asx (Na>125)
27
HYPOvolemic HYPOtonic HYPOnatremia
-TBW and Na down -renal causes or from blood/GI loss -dehydration
28
ISOvolemic HYPOtonic HYPOnatremia
-TBW up and Na normal or up -caused by adrenal, hypothyroid, SIADH -psychosis, seizures, coma
29
SIADH
-inappropriate ADH release -most common cause of ISOvolemic HYPOtonic HYPOnatremia -caused by antipsychotics, carbamazepine, SSRIs, NSAIDs -tx: remove drugs. free water restriction, vaptans prn
30
HYPERvolemic HYPOtonic HYPOnatremia
-TBW and Na up -edema -seen in cirrhosis, HF
31
Acute hyponatremia sx
-nausea -weakness -HA -coma -seizures -respiratory arrest
32
Hyponatremia tx goal
-avoid rise in Na > 0.5 mEq/L/h or no more than 8-12 mEq/L/day
33
HYPOvolemic hyponatremia tx
-3% NS (hypertonic) for sx -NS (isotonic) for asx
34
Isovolemic hyponatremia tx
-furosemide and 3% NS for sx -NS for asx and water restriction
35
Hypervolemic hyponatremia tx
-furosemide and judicious 3% NS for sx -furosemide for asx
36
Chronic hyponatremia
->48 hours -minimal brain swelling -mild neurologic sx -brain herniation/death rarer than acute
37
Acute sx hyponatremia
-cerebral edema -neurologic probs (seixures) -brain herniation and death
38
Acute sx hyponatremia tx
-inc serum Na by 1-2mEQ/L/hr until sx resolve -serum Na goal = 120 -DO NOT CORRECT TO QUICKLY -total inc of 4-6 is usually good -max inc of 8-12 in first 24 hours
39
Demyelination risk
-overcorrecting of Na too quickly
40
Na defecit calculation
TBW = 0.6(wt) (0.5 in females) defecit= TBW * (goalNa - currentNa) -goal 122?
41
Na replacement
-half amount calculated by defecit over first 8 hours -then half the initial rate -example: 330mEq defecit -20.6mEq/h * 8hr, then 10.3 over 16 hr 20.6mEq/h*1000mL/154mEq = 124mL/hr *8h, then 67mL/hr*16h of NS
42
Hypernatremia
-always HYPERtonic -HYPOvolemic: dec TBW and Na -ISO: dec TBW and Na -HYPER: inc TBW and Na
43
HYPOvolemic HYPERnatremia tx
-restore volume first w NS -replace free water deficit
44
Free H2O deficit calc
NL TBW * [(Na/140)-1]
45

Therapeutics II (55 decks)

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