Fluid and Electrolyte Disorders (Part 1) Flashcards
Define hypovolemia
Reduced volume status
What abnormalities would signify that the patient is hypovolemic?
- Decreased skin turgor
- Tachycardia, orthostasis (reduced BP)
- Dry mouth, Dry skin
- BUN:SCr ratio > 20:1
- Acute weight loss
- Fever, chills, sweating, etc
Define hypervolemia
Increase in volume status
What abnormalities would signify that the patient is hypervolemic?
- Acute weight gain
2. Edema (ascites, pulmonary, peripheral, anasarca)
(T/F) - The fluid status of the patient is assessed FIRST and SECOND is assessing sodium levels
TRUE
What is the daily maintenance fluid equation?
1500 mL + 20 mL/kg for every kg > 20 kg
What are the normal serum sodium levels?
135 mEq/L - 145 mEq/L
What equals to the amount of sodium dissolved per liquid volume?
Osmolality
If osmolality is HIGH, what happens to the sodium and liquid concentration?
More sodium (more fluid), liquid is more concentrated
If osmolality is LOW, what happens to the sodium and liquid concentration?
Less sodium (less fluid), liquid is less concentrated
Define hyponatremia
< 135 mEq/L (most commonly occurred); mainly associated w/ the antidiuretic hormone; a disorder of water balance
(T/F) - Severe hyponatremia is defined as 125-129 mEq/L
FALSE - Moderate hyponatremia is defined as 125-129 mEq/L; Severe hyponatremia is defined as < 125 mEq/L
What classification of hyponatremia will it be from 130-135 mEq/L?
Mild hypokalemia
Acute hyponatremia vs. Chronic hyponatremia
Acute < 48 hrs
Chronic > 48 hrs
Are most patients with hyponatremia (especially chronic) symptomatic or asymptomatic?
Symptomatic
What symptoms can occur from hyponatremia?
- Malaise/lethargy
- Headache
- Nausea
- Restlessness
- Disoriented
- Coma
- Seizures
- Depressed reflexes
Hypovolemic/Hyponatremia is mainly caused by…
Diarrhea, sweating, diuresis
If the patient is hypovolemic/hyponatremic and they are SYMPTOMATIC and/or < 120 mEq/L, how are they treated?
3% NaCl
If the patient is hypovolemic/hyponatremic and they are ASYMPTOMATIC and/or > 120 mEq/L, how are they treated?
0.9% NaCl
How fast do you want to increase sodium levels in a hyponatremic patient?
< 10-12 mEq/L in 24 hours
What happens if you increase the sodium levels too fast in a patient who is hyponatremic?
Central pontine demyelination can occur (paralysis)
Euvolemic/hyponatremic is also known as…
SIADH (Syndrome of Inappropriate of Anti-Diuretic hormone)
Euvolemic/hyponatremic is mainly caused by…
- Drugs (carbamazepine, SSRIs, and vincristine)
- Lung cancers
- Pituitary tumors
- PNA
(T/F) - Euvolemic/hyponatremic is first treated by checking/removing the underlying cause
TRUE
Should euvolemic/hyponatremic patients have a restrictive fluid intake?
Yes, < 1 L/day for several days
What class of drugs can be given to euvolemic/hyponatremic patients?
Vasopressin receptor antagonists
What are the names of the vasopressin receptor antagonists that can be given for euvolemic/hyponatremic patients?
- Conivaptan
- Tolvaptan
(T/F) - Conivaptan is given in the hospital and only given to patients who have access to water
FALSE - Tolvaptan is given in the hospital and only given to patients who have access to water
(T/F) - Demeclocycline is an antidiuretic receptor antagonist that can be used in euvolemic/hyponatremic patients?
TRUE
Hypervolemic/hyponatremic is mainly caused by….
- Nephrotic syndrome
- Renal disease
- Liver failure
- Heart failure
(T/F) - Hypervolemic/hyponatremic is first treated by identifying underlying cause and shutting off fluids
TRUE
What is the restriction of fluids per day that should be given to a hypervolemic/hyponatremic patient?
< 1 L/day
What is the restriction of sodium per day that should be given to a hypervolemic/hyponatremic patient?
< 1-2 g/day
Would clinicians only restrict fluids or sodium, or would they do both in hypervolemic/hyponatremic patients?
BOTH
Define hypernatremia
> 145 mEq/L
What are the symptoms of hypernatremia?
- Lethargy
- Restlessness
- Confusion
- Weakness
- Irritability
What are the signs of hypernatremia?
- Consistent with volume status
- Increased or decreased output of urine that is diluted or concentrated (depends on the cause)
How is hypovolemic/hypernatremic caused by…
- Patient loses hypotonic fluids (diarrhea, sweat, urine)
- Patient isn’t able to replenish fluids (infant, elderly, intubated)
- Caregiver has not administered fluids to patient
(T/F) - For hypovolemic/hypernatremic patients, the first-line treatment would be to replenish hypotonic fluids
TRUE
What are the given hypotonic fluids in patients with hypovolemia/hypernatremia?
- 0.45% NaCl
- D5W
If a patient is hypovolemic/hypernatremic with hypotension, what should be given as treatment?
- 0.9% NaCl
How fast do you want to decrease sodium serum levels in hypernatremic patients?
< 10-12 mEq/L
If you decrease the sodium serum levels too fast of a hypernatremic patient, what could happen?
Cerebral edema
(T/F) - Diabetes insipidus (DI) decreases the antidiuretic hormone or decreases a renal response in ADH leading to euvolemic/hypernatremic
TRUE
What are the two types of DI that could happen in euvolemic/hypernatremic patients?
- Central DI
- Nephrogenic DI
To treat central DI in euvolemic/hypernatremic patients, what should be done or given?
Desmopressin (best to give intranasally)
To treat nephrogenic DI in euvolemic/hypernatremic patients, what should be done or given?
First - treat underlying cause
Second - restrict Na+ < 2 g/day
Third - provide HCTZ (thiazide diuretic)
What causes hypervolemic/hypernatremic in patients?
Excess fluid intake or hypertonic solutions
What is the class of drugs that could be treated in hypervolemic/hypernatremic patients?
Loop diuretics
What drug falls in the class of loop diuretics to be given in hypervolemic/hypernatremic patients?
Furosemide
(T/F) - Sodium restriction of = 10 mEq/L should be done in patients who are hypervolemic/hypernatremic
FALSE - it should be = 12 mEq/L
