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Therapeutics P2 > Exam 1 lecture 2 > Flashcards

Exam 1 lecture 2 Flashcards

1
Q

normal range of sodium

A

135-145

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2
Q

most common disturbance in hospital patients

A

hyponatermia

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3
Q

too rapid of a correction of sodium leads to

A

demyelination

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4
Q

hyponatremia sodium levels

A

less than 135

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5
Q

serum osmolarity calculation

A

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

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6
Q

what is the use in calculating serum osmolarity in hyponatremic patients

A

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

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7
Q

Hypertonic hyponatremic is almost always due to

A

hyperglycemia (elevated blood glucose)

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8
Q

how to correct hypertonic hyponatremia

A

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

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

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9
Q

3 types of hypotonic hyponatremia

A

hypovolemic hypotonic hyponatremia
hypervolemic hypotonic hyponatremia
isotonic hypotonic hyponatremia

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10
Q

Effect of hypovolemic, hypotonic hyponatremia on TBW and Na levels

A

decreases TBW
Decreases Na drastically

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11
Q

effect of hypervolemic hypotonic hyponatremia on TBW and Na levels

A

increases TBW drastically,
increases na

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12
Q

Isovolemic hypotonic hyponatremia effect on TBW and Na levels

A

High TBW and same Na

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13
Q

most common hyponatremia

A

hypotonic

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14
Q

2 causes of hypovolemic hypotonic hyponatremia

A

renal
non-renal

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15
Q

renal cause of hypovolemic hypotonic hyponatremia

A

Excessive diuresis

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16
Q

Na levels in urine for renal cause of hypovolemic hypotonic hyponatremia

A

Na> 20 mEq/L

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17
Q

Na levels of non renal cause of hypovolemic hypotonic hyponatremia

A

Na<20 meq/L

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18
Q

non renal cause of hypovolemic hypotonic hyponatremia

A

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

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19
Q

effect of isovolemic hypotonic hyponatremia on TBW and Na

A

increase in TBW and same Na

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20
Q

Most common cause of isovolemic hypotonic hyponatremia

A

SIADH

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21
Q

What does SIADH stand for

A

Syndrome of inappropriate ADH release

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22
Q

Most common drugs that case SIADH

A

Antipsychotics, carbamazapine, SSRIs

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23
Q

1st line of treatment for SIADH induced isovolemic hypotonic hyponatremia

A

Free h20 restriction

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24
Q

Hypervolemic hypotonic hyponatremia effect on TBW and Na

A

Increase in Na and Drastic increase of TBW

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25
Q

clinical presentation of hypovolemic, hypotonic, hyponatremia

A

Dehydration (decreased skin turgor, orthostatic hypotension, tachycardia)

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26
Q

Clinical presentation of isovolemic, hypotonic hyponatremia

A

malaise, psychosis, seizure, coma

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27
Q

cllinical presentation of hypervolemic hypotonic hyponatremia

A

edema and weight gain

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28
Q

Avoid rise in serum sodium of no more than

A

8-12 mEQ/L/day

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29
Q

how to treat hypovolemic hypotonic hyponatremia

A

Give fluid

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

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30
Q

How to treat isovolemic hypotonic hyponatremia

A

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

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31
Q

how to treat hypervolemic hypotonic hyponatremia

A

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

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32
Q

Difference in how we treat acute vs chronic hyponatremia

A

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.

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33
Q

What time frame do we consider hyponatremia to be acute

A

Less than 48 hrs

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34
Q

What could acute hyponatremia lead to?

A

Cerebral edema, brain herneation

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35
Q

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

A

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

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36
Q

What is the short term goal for acute hyponatremia

A

Na concentration of 120

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37
Q

If sodium is corrected too quickly, it could lead to

A

demyelination

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38
Q

What are some risk factors for demyelination

A

Serum Na<105
hypokalemia
alcohol use/malnutrition

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39
Q

How do we treat acute symptomatic hyponatremia

A

3% NaCl with rule of 8s

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40
Q

What is the rule of 8s

A

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

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41
Q

TBW (total body water) calculations in males vs females

A

Males- 0.6 x wt
females- 0.5 x wt

42
Q

Na deficit calculation

A

TBW x (Na goal-current Na serum)

43
Q

Review lecture 2 patient cases and calculations for fluid/lytes

44
Q

Hypernatremia is always associated with what tonicity

A

Hypertonicity

45
Q

What are the 3 types of hypernatermia

A

Hypovolemic hypernatremia
Isovolemic hypernatremia
Hypervolemic hypernatremia

46
Q

Effect of hypervolemic hypernatremia on TBW and Na levels

A

increase in h20 but drastic increase in Na

47
Q

Effect of hypovolemic hypernatremia on TBW and Na levels

A

Drastic decrease in H20 but a little decrease in Na

48
Q

Effect of isovolemic hypernatremia on TBW and Na levels

A

losing water but not h20

49
Q

How to treat hypovolemic hypernatremia

A

Lecture 2 slide 119

50
Q

how to treat hypovolemic hypernatremia

A

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

51
Q

How to calculate free water deficit

A

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

52
Q

What is the goal rate of decrease in hypovolemic hypenatremic pts

A

0.5 meq/hr

53
Q

isovolemic hypernatremia is usually due to

A

Diabetes insipidus

54
Q

How to treat isovolemic hypernatremia

A

Vasopressin or desmopressin

55
Q

WHat is hypervolemic hypernatremia caused by

A

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

56
Q

How to treat hypervolemic hypernatremia

A

Stop the fluid/cause
Diuretic

57
Q

Potassium range

A

3.5-5
usually found intracellularly

58
Q

Use of potassium in body

A

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

59
Q

Most common cause of hypokalemia

A

Diuretics

(another cause is albuterol)

60
Q

Why is magnesium depletion a cause of hypokalemia

A

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

61
Q

Treatment of hypokalemia

A

Give potassium

62
Q

K levels of 3.5-4 treatment

A

No therapy

63
Q

3-3.4 K levels treatment

A

Debatable
Po potassium for Pts with cardiac conditions

64
Q

less than 3 K level treatment

A

Always treat
PO for asymptomatic pts
IV for symptomatic pts

correct Mag deficiency aswell

65
Q

When to use IV Potassium

A

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

66
Q

warnings or precautions of IV potassium

A

Could cause arrythmias or cardiac arrest if given too quickly

67
Q

Administration rate of K IV

A

Without cardiac monitors- 10 mEQ/hr
with contionous monitoring- 20 meq.hr

40-60 during cardiac arrest

68
Q

Rank hyperkalemia interms of severity

A

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

69
Q

clinical presentation of hyperkalemia

A

Peaked T wave

70
Q

Steps to treat severe hyperkalemia

A

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
71
Q

WHat is the only case insluin is give IV push

A

Hyperkalemia

72
Q

Magnesium normal range

73
Q

Use of Magnesium

A

Co factor for many enzymes
Related to Ca & K metabolism

74
Q

If someone has hypomagnesemia they usually have what kind of disturbance

A

GI tract or kidney

75
Q

Drugs that cause you to lose mag

76
Q

How to treat hypomagnesemia

A

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

77
Q

How many Meq of Magnesium is 1 gram

A

8 meq=1 gram

78
Q

Calcium normal range

79
Q

hypocalcemia causes

A

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

80
Q

Why does hypoalbuminemia cause hypocalcemia

A

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

81
Q

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

A

Corrected Ca

82
Q

Formula for corrected Ca

A

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

83
Q

Ionized vs serum calcium accuracy

A

Ionized is more accurate

84
Q

how to treat hypocalcemia

A

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

85
Q

What are the two different forms of Calcium treatment

A

1 gm of CaCl or 3 Gm of Ca gluconate

86
Q

What are the calcium levels of the two calcium treatments

A

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

87
Q

How do we decide to gove CaCl or Ca gluconate

A

Symptomatic- CaCl
Asymptomatic- Ca gluconate

88
Q

What are the pros and cons of Ca gluconate

A

Pros- Lower% of Ca, less risk of necrosis

con- less predictable ris ein Ca

89
Q

Which Ca is preferred for PIV (Push IV)

A

Ca gluconate

90
Q

Usual administration rate for acute hypocalcemia

91
Q

What other element should be corrected for hypocalcemia

92
Q

How to treat chroncic hypocalcemia

A

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

93
Q

Phosphorous range

94
Q

Mild to moderate hypo PO4 concentration

95
Q

Severe hypophosphotemia range

A

LESS THAN 1

96
Q

Treatment of mild-moderate hypophosphatemia

A

Oral phosphate (phos-nak)

97
Q

Treatment of severe hypophosphatemia

A

IV PO4 either Naphos or Kphos

98
Q

When to use NaPhos and K phos

A

Use KPhos when K is less than 4

If 4 or above use Naphos

99
Q

Rate of Phos infusion

100
Q

Lets just make it 100

Therapeutics P2 (41 decks)

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