FEN Flashcards
Correction of free water deficit
Administer 4mL/kg for every 1meq/L increase over 145
Administer 3mL/kg for Na >170
Plasma osmolality
(2 x Na) + (glucose / 18) + (BUN / 2.8)
Extrarenal ADH effect
Arterial vasoconstriction stimulating renal mesangial cell contraction, decrease renin secretion, and increase ACTH secretion
Obstructive renal disorder can cause what with ADH
Nephrogenic DI because of the pressure which decreases aquaporin expression
SIADH management
Free water restriction
If Na <120, replace with NaCl
Consider furosemide
Diabetes insipidus management
Central - vasopressin/desmopressin
Nephrogenic - thiazides to increase urine concentrating ability
Na content in hypergylcemic state
Na decreased by 1.6meq/L for each 100 increase in glucose (mg/dL)
Hyponatremia bucket differential
Decreased weight - renal loss or extrarenal loss
Increased or normal weight
Hyponatremic renal losses differential
Na losing nephropathy
Diuretics
Adrenal insufficiency
Hyponatremic extrarenal losses
GI losses
Skin losses
Third spacing
Cystic fibrosis
Increased weight hyponatremia
Nephrotic syndrome CHF SIADH Acute or chronic renal failure Excess water infusion Cirrhosis
Na deficit equation
deficit=(desired Na -current Na)x0.6xwt
The 0.6 is the percent body water which should be higher in preterm
Hypokalemia differential buckets
Decreased stores: with hypertension or with normal BP
Normal K stores
Decreased K stores hypokalemia and HTN
Renovascular disease, excess renin, excess mineralocorticoid, Cushing syndrome
Decreased K stores normal BP
Renal: RTA, fanconi syndrome, bartter syndrome, antibiotics, diuretics, ampho B
Extrarenal: skin loss, GI loss, high carb diet, enemas, malnutrition