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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

A

135-145

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
Q

Corrected Serum Sodium

A

-serum Na + 1.6([BG-100)/100]

26
Q

Hypotonic hyponatremia

A

-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
Q

HYPOvolemic HYPOtonic HYPOnatremia

A

-TBW and Na down
-renal causes or from blood/GI loss
-dehydration

28
Q

ISOvolemic HYPOtonic HYPOnatremia

A

-TBW up and Na normal or up
-caused by adrenal, hypothyroid, SIADH
-psychosis, seizures, coma

29
Q

SIADH

A

-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
Q

HYPERvolemic HYPOtonic HYPOnatremia

A

-TBW and Na up
-edema
-seen in cirrhosis, HF

31
Q

Acute hyponatremia sx

A

-nausea
-weakness
-HA
-coma
-seizures
-respiratory arrest

32
Q

Hyponatremia tx goal

A

-avoid rise in Na > 0.5 mEq/L/h or no more than 8-12 mEq/L/day

33
Q

HYPOvolemic hyponatremia tx

A

-3% NS (hypertonic) for sx
-NS (isotonic) for asx

34
Q

Isovolemic hyponatremia tx

A

-furosemide and 3% NS for sx
-NS for asx and water restriction

35
Q

Hypervolemic hyponatremia tx

A

-furosemide and judicious 3% NS for sx
-furosemide for asx

36
Q

Chronic hyponatremia

A

->48 hours
-minimal brain swelling
-mild neurologic sx
-brain herniation/death rarer than acute

37
Q

Acute sx hyponatremia

A

-cerebral edema
-neurologic probs (seixures)
-brain herniation and death

38
Q

Acute sx hyponatremia tx

A

-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
Q

Demyelination risk

A

-overcorrecting of Na too quickly

40
Q

Na defecit calculation

A

TBW = 0.6(wt) (0.5 in females)

defecit= TBW * (goalNa - currentNa)

-goal 122?

41
Q

Na replacement

A

-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/hr16h of NS

42
Q

Hypernatremia

A

-always HYPERtonic
-HYPOvolemic: dec TBW and Na
-ISO: dec TBW and Na
-HYPER: inc TBW and Na

43
Q

HYPOvolemic HYPERnatremia tx

A

-restore volume first w NS
-replace free water deficit

44
Q

Free H2O deficit calc

A

NL TBW * [(Na/140)-1]

45
Q
A

Therapeutics II (55 decks)

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