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Renal > Fluid and Electrolyte Disorders (Part 1) > Flashcards

Fluid and Electrolyte Disorders (Part 1) Flashcards

1
Q

Define hypovolemia

A

Reduced volume status

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2
Q

What abnormalities would signify that the patient is hypovolemic?

A
  1. Decreased skin turgor
  2. Tachycardia, orthostasis (reduced BP)
  3. Dry mouth, Dry skin
  4. BUN:SCr ratio > 20:1
  5. Acute weight loss
  6. Fever, chills, sweating, etc
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3
Q

Define hypervolemia

A

Increase in volume status

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4
Q

What abnormalities would signify that the patient is hypervolemic?

A
  1. Acute weight gain

2. Edema (ascites, pulmonary, peripheral, anasarca)

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5
Q

(T/F) - The fluid status of the patient is assessed FIRST and SECOND is assessing sodium levels

A

TRUE

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6
Q

What is the daily maintenance fluid equation?

A

1500 mL + 20 mL/kg for every kg > 20 kg

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7
Q

What are the normal serum sodium levels?

A

135 mEq/L - 145 mEq/L

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8
Q

What equals to the amount of sodium dissolved per liquid volume?

A

Osmolality

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9
Q

If osmolality is HIGH, what happens to the sodium and liquid concentration?

A

More sodium (more fluid), liquid is more concentrated

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10
Q

If osmolality is LOW, what happens to the sodium and liquid concentration?

A

Less sodium (less fluid), liquid is less concentrated

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11
Q

Define hyponatremia

A

< 135 mEq/L (most commonly occurred); mainly associated w/ the antidiuretic hormone; a disorder of water balance

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12
Q

(T/F) - Severe hyponatremia is defined as 125-129 mEq/L

A

FALSE - Moderate hyponatremia is defined as 125-129 mEq/L; Severe hyponatremia is defined as < 125 mEq/L

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13
Q

What classification of hyponatremia will it be from 130-135 mEq/L?

A

Mild hypokalemia

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14
Q

Acute hyponatremia vs. Chronic hyponatremia

A

Acute < 48 hrs

Chronic > 48 hrs

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15
Q

Are most patients with hyponatremia (especially chronic) symptomatic or asymptomatic?

A

Symptomatic

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16
Q

What symptoms can occur from hyponatremia?

A
  • Malaise/lethargy
  • Headache
  • Nausea
  • Restlessness
  • Disoriented
  • Coma
  • Seizures
  • Depressed reflexes
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17
Q

Hypovolemic/Hyponatremia is mainly caused by…

A

Diarrhea, sweating, diuresis

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18
Q

If the patient is hypovolemic/hyponatremic and they are SYMPTOMATIC and/or < 120 mEq/L, how are they treated?

A

3% NaCl

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19
Q

If the patient is hypovolemic/hyponatremic and they are ASYMPTOMATIC and/or > 120 mEq/L, how are they treated?

A

0.9% NaCl

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20
Q

How fast do you want to increase sodium levels in a hyponatremic patient?

A

< 10-12 mEq/L in 24 hours

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21
Q

What happens if you increase the sodium levels too fast in a patient who is hyponatremic?

A

Central pontine demyelination can occur (paralysis)

22
Q

Euvolemic/hyponatremic is also known as…

A

SIADH (Syndrome of Inappropriate of Anti-Diuretic hormone)

23
Q

Euvolemic/hyponatremic is mainly caused by…

A
  • Drugs (carbamazepine, SSRIs, and vincristine)
  • Lung cancers
  • Pituitary tumors
  • PNA
24
Q

(T/F) - Euvolemic/hyponatremic is first treated by checking/removing the underlying cause

A

TRUE

25
Q

Should euvolemic/hyponatremic patients have a restrictive fluid intake?

A

Yes, < 1 L/day for several days

26
Q

What class of drugs can be given to euvolemic/hyponatremic patients?

A

Vasopressin receptor antagonists

27
Q

What are the names of the vasopressin receptor antagonists that can be given for euvolemic/hyponatremic patients?

A
  • Conivaptan

- Tolvaptan

28
Q

(T/F) - Conivaptan is given in the hospital and only given to patients who have access to water

A

FALSE - Tolvaptan is given in the hospital and only given to patients who have access to water

29
Q

(T/F) - Demeclocycline is an antidiuretic receptor antagonist that can be used in euvolemic/hyponatremic patients?

A

TRUE

30
Q

Hypervolemic/hyponatremic is mainly caused by….

A
  • Nephrotic syndrome
  • Renal disease
  • Liver failure
  • Heart failure
31
Q

(T/F) - Hypervolemic/hyponatremic is first treated by identifying underlying cause and shutting off fluids

A

TRUE

32
Q

What is the restriction of fluids per day that should be given to a hypervolemic/hyponatremic patient?

A

< 1 L/day

33
Q

What is the restriction of sodium per day that should be given to a hypervolemic/hyponatremic patient?

A

< 1-2 g/day

34
Q

Would clinicians only restrict fluids or sodium, or would they do both in hypervolemic/hyponatremic patients?

A

BOTH

35
Q

Define hypernatremia

A

> 145 mEq/L

36
Q

What are the symptoms of hypernatremia?

A
  • Lethargy
  • Restlessness
  • Confusion
  • Weakness
  • Irritability
37
Q

What are the signs of hypernatremia?

A
  • Consistent with volume status

- Increased or decreased output of urine that is diluted or concentrated (depends on the cause)

38
Q

How is hypovolemic/hypernatremic caused by…

A
  • Patient loses hypotonic fluids (diarrhea, sweat, urine)
  • Patient isn’t able to replenish fluids (infant, elderly, intubated)
  • Caregiver has not administered fluids to patient
39
Q

(T/F) - For hypovolemic/hypernatremic patients, the first-line treatment would be to replenish hypotonic fluids

A

TRUE

40
Q

What are the given hypotonic fluids in patients with hypovolemia/hypernatremia?

A
  • 0.45% NaCl

- D5W

41
Q

If a patient is hypovolemic/hypernatremic with hypotension, what should be given as treatment?

A
  • 0.9% NaCl
42
Q

How fast do you want to decrease sodium serum levels in hypernatremic patients?

A

< 10-12 mEq/L

43
Q

If you decrease the sodium serum levels too fast of a hypernatremic patient, what could happen?

A

Cerebral edema

44
Q

(T/F) - Diabetes insipidus (DI) decreases the antidiuretic hormone or decreases a renal response in ADH leading to euvolemic/hypernatremic

A

TRUE

45
Q

What are the two types of DI that could happen in euvolemic/hypernatremic patients?

A
  • Central DI

- Nephrogenic DI

46
Q

To treat central DI in euvolemic/hypernatremic patients, what should be done or given?

A

Desmopressin (best to give intranasally)

47
Q

To treat nephrogenic DI in euvolemic/hypernatremic patients, what should be done or given?

A

First - treat underlying cause
Second - restrict Na+ < 2 g/day
Third - provide HCTZ (thiazide diuretic)

48
Q

What causes hypervolemic/hypernatremic in patients?

A

Excess fluid intake or hypertonic solutions

49
Q

What is the class of drugs that could be treated in hypervolemic/hypernatremic patients?

A

Loop diuretics

50
Q

What drug falls in the class of loop diuretics to be given in hypervolemic/hypernatremic patients?

A

Furosemide

51
Q

(T/F) - Sodium restriction of = 10 mEq/L should be done in patients who are hypervolemic/hypernatremic

A

FALSE - it should be = 12 mEq/L

Renal (4 decks)

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