Exam 1 lecture 2 Flashcards by Matti Daniel

normal range of sodium

135-145

How well did you know this?

Not at all

Perfectly

most common disturbance in hospital patients

hyponatermia

How well did you know this?

Not at all

Perfectly

too rapid of a correction of sodium leads to

demyelination

How well did you know this?

Not at all

Perfectly

hyponatremia sodium levels

less than 135

How well did you know this?

Not at all

Perfectly

serum osmolarity calculation

(2xNa) + (BUN/2.8)+(glucose/18)

How well did you know this?

Not at all

Perfectly

what is the use in calculating serum osmolarity in hyponatremic patients

Lets us know if patient is isotonic, hypotonic or hypertonic hyponatremic

How well did you know this?

Not at all

Perfectly

Hypertonic hyponatremic is almost always due to

hyperglycemia (elevated blood glucose)

How well did you know this?

Not at all

Perfectly

how to correct hypertonic hyponatremia

Calculate corrected Na using (Na serum +1.6 ((BG-100)/100)

if Na is still hyponatremic after calculating corrected Na, use insulin.

How well did you know this?

Not at all

Perfectly

3 types of hypotonic hyponatremia

hypovolemic hypotonic hyponatremia
hypervolemic hypotonic hyponatremia
isotonic hypotonic hyponatremia

How well did you know this?

Not at all

Perfectly

Effect of hypovolemic, hypotonic hyponatremia on TBW and Na levels

decreases TBW
Decreases Na drastically

How well did you know this?

Not at all

Perfectly

effect of hypervolemic hypotonic hyponatremia on TBW and Na levels

increases TBW drastically,
increases na

How well did you know this?

Not at all

Perfectly

Isovolemic hypotonic hyponatremia effect on TBW and Na levels

High TBW and same Na

How well did you know this?

Not at all

Perfectly

most common hyponatremia

hypotonic

How well did you know this?

Not at all

Perfectly

2 causes of hypovolemic hypotonic hyponatremia

renal
non-renal

How well did you know this?

Not at all

Perfectly

renal cause of hypovolemic hypotonic hyponatremia

Excessive diuresis

How well did you know this?

Not at all

Perfectly

Na levels in urine for renal cause of hypovolemic hypotonic hyponatremia

Na> 20 mEq/L

How well did you know this?

Not at all

Perfectly

Na levels of non renal cause of hypovolemic hypotonic hyponatremia

Na<20 meq/L

How well did you know this?

Not at all

Perfectly

non renal cause of hypovolemic hypotonic hyponatremia

Hemorrhage/blood loss
burns, sweats, wounds
GI losses(vomiting, diarrhea)

How well did you know this?

Not at all

Perfectly

effect of isovolemic hypotonic hyponatremia on TBW and Na

increase in TBW and same Na

How well did you know this?

Not at all

Perfectly

Most common cause of isovolemic hypotonic hyponatremia

SIADH

How well did you know this?

Not at all

Perfectly

What does SIADH stand for

Syndrome of inappropriate ADH release

How well did you know this?

Not at all

Perfectly

Most common drugs that case SIADH

Antipsychotics, carbamazapine, SSRIs

How well did you know this?

Not at all

Perfectly

1st line of treatment for SIADH induced isovolemic hypotonic hyponatremia

Free h20 restriction

How well did you know this?

Not at all

Perfectly

Hypervolemic hypotonic hyponatremia effect on TBW and Na

Increase in Na and Drastic increase of TBW

How well did you know this?

Not at all

Perfectly

clinical presentation of hypovolemic, hypotonic, hyponatremia

Dehydration (decreased skin turgor, orthostatic hypotension, tachycardia)

Clinical presentation of isovolemic, hypotonic hyponatremia

malaise, psychosis, seizure, coma

cllinical presentation of hypervolemic hypotonic hyponatremia

edema and weight gain

Avoid rise in serum sodium of no more than

8-12 mEQ/L/day

how to treat hypovolemic hypotonic hyponatremia

Give fluid hypertonic Nacl (3%) if symptomatic Isotonic NaCl (0.9%) if asymptomatic

How to treat isovolemic hypotonic hyponatremia

-Stop SIADH -furosemide and 3% nacl if symptomatic 0.9% nacl if asymptomatic and water restriction

how to treat hypervolemic hypotonic hyponatremia

Furosemide and 3% NaCl in symptomatic patients furosemide in asymptomatic patoents

Difference in how we treat acute vs chronic hyponatremia

In chronic hyponatremia, our body is already acclimated to the low sodium levels. However, in acute hyponatremia we need to treat it expeditiously because it could kill us.

What time frame do we consider hyponatremia to be acute

Less than 48 hrs

What could acute hyponatremia lead to?

Cerebral edema, brain herneation

By how much should we increase Na+ every hour for acute hyponatremia

Increase by 1-2 meq every hour (keep in mid we can only increase up to 8-12 meq per day)

What is the short term goal for acute hyponatremia

Na concentration of 120

If sodium is corrected too quickly, it could lead to

demyelination

What are some risk factors for demyelination

Serum Na<105 hypokalemia alcohol use/malnutrition

How do we treat acute symptomatic hyponatremia

3% NaCl with rule of 8s

What is the rule of 8s

Replace half the deficit in 1st 8 hours, the remaining over 8-16 hours

TBW (total body water) calculations in males vs females

Males- 0.6 x wt females- 0.5 x wt

Na deficit calculation

TBW x (Na goal-current Na serum)

Review lecture 2 patient cases and calculations for fluid/lytes

Hypernatremia is always associated with what tonicity

Hypertonicity

What are the 3 types of hypernatermia

Hypovolemic hypernatremia Isovolemic hypernatremia Hypervolemic hypernatremia

Effect of hypervolemic hypernatremia on TBW and Na levels

increase in h20 but drastic increase in Na

Effect of hypovolemic hypernatremia on TBW and Na levels

Drastic decrease in H20 but a little decrease in Na

Effect of isovolemic hypernatremia on TBW and Na levels

losing water but not h20

How to treat hypovolemic hypernatremia

Lecture 2 slide 119

how to treat hypovolemic hypernatremia

Restore hemodynamic status first if needed, use 0.9 NaCl. Then calculate the free water deficit and give D%W or free water using rule of 8s

How to calculate free water deficit

TBW x [(Na serum/140)-1]

What is the goal rate of decrease in hypovolemic hypenatremic pts

0.5 meq/hr

isovolemic hypernatremia is usually due to

Diabetes insipidus

How to treat isovolemic hypernatremia

Vasopressin or desmopressin

WHat is hypervolemic hypernatremia caused by

Too much saline. This makes us hold on to to much sodium, leading to holding too much fluid

How to treat hypervolemic hypernatremia

Stop the fluid/cause Diuretic

Potassium range

3.5-5 usually found intracellularly

Use of potassium in body

Helps maintain the action potential across cardiac cell membrane, so people with potassium issues have cardiac issues

Most common cause of hypokalemia

Diuretics (another cause is albuterol)

Why is magnesium depletion a cause of hypokalemia

Mag is a cofactor for that sodium-potassium ATP-ase. No mag= no transport

Treatment of hypokalemia

Give potassium

K levels of 3.5-4 treatment

No therapy

3-3.4 K levels treatment

Debatable Po potassium for Pts with cardiac conditions

less than 3 K level treatment

Always treat PO for asymptomatic pts IV for symptomatic pts correct Mag deficiency aswell

When to use IV Potassium

Severe hypokalemis (2.5-3) exhibiting symptoms (ECG changes, muscle spasms) unable to tolerate PO

warnings or precautions of IV potassium

Could cause arrythmias or cardiac arrest if given too quickly

Administration rate of K IV

Without cardiac monitors- 10 mEQ/hr with contionous monitoring- 20 meq.hr 40-60 during cardiac arrest

Rank hyperkalemia interms of severity

Mild- 5.5-6 moderate- 6.1-6.9 severe > or equal to 7

clinical presentation of hyperkalemia

Peaked T wave

Steps to treat severe hyperkalemia

C ABIG KDROP 1. Calcium (antagonizes cardiac membrane) 2. Albuterol, Bicarb, Insulin+glucose 3. Kayexelate (lokelma) [diuretics that excrete K] Diuretics (furosemide) Renal unit for dialysis

WHat is the only case insluin is give IV push

Hyperkalemia

Magnesium normal range

1.5-2.5

Use of Magnesium

Co factor for many enzymes Related to Ca & K metabolism

If someone has hypomagnesemia they usually have what kind of disturbance

GI tract or kidney

Drugs that cause you to lose mag

Diuretics

How to treat hypomagnesemia

asymptomatic pts with mg>1 mg/dl- Milk of mag or mag ox symptomatic ots mg- 1-2- IV at 0.5 meq/kg mg<1- IV at 1 meq/hr

How many Meq of Magnesium is 1 gram

8 meq=1 gram

Calcium normal range

8.5-10.5

hypocalcemia causes

Mag deficiency large volume of blood products (Ca is used in clotting) hypoalbuminemia

Why does hypoalbuminemia cause hypocalcemia

Calcium binds to albumin, low albumin levels might show low calcium levels even if Ca kevels are normal

How to tell if low calcium is caused by actually low ca or low albumin levels?

Corrected Ca

Formula for corrected Ca

Measured Ca + [(4-measured albumin x 0.8)]

Ionized vs serum calcium accuracy

Ionized is more accurate

how to treat hypocalcemia

100-300 mg of calcium IV over 5-10 min

What are the two different forms of Calcium treatment

1 gm of CaCl or 3 Gm of Ca gluconate

What are the calcium levels of the two calcium treatments

1gm CaCl= 3gm of Ca gluconate = 270 gms

How do we decide to gove CaCl or Ca gluconate

Symptomatic- CaCl Asymptomatic- Ca gluconate

What are the pros and cons of Ca gluconate

Pros- Lower% of Ca, less risk of necrosis con- less predictable ris ein Ca

Which Ca is preferred for PIV (Push IV)

Ca gluconate

Usual administration rate for acute hypocalcemia

1 gm/hr

What other element should be corrected for hypocalcemia

How to treat chroncic hypocalcemia

1-3 gm of Ca PO per day Tums 650 mg po QID

Phosphorous range

2.5-4.5

Mild to moderate hypo PO4 concentration

1-2

Severe hypophosphotemia range

LESS THAN 1

Treatment of mild-moderate hypophosphatemia

Oral phosphate (phos-nak)

Treatment of severe hypophosphatemia

IV PO4 either Naphos or Kphos

When to use NaPhos and K phos

Use KPhos when K is less than 4 If 4 or above use Naphos

Rate of Phos infusion

7mmol/hr

Lets just make it 100

Yes