Fluid And electrolyte Imbalances

Question 1

What is the most common electrolyte abnormalities

Answer 1

Hyponatremia

Question 2

Urine sodium

Answer 2

10-20

Question 3

Serum osmolarity

Answer 3

Usually 2x Na

275-285

Question 4

Urine sodium >20

Answer 4

Renal salt wasting

Problem with the kidneys

Question 5

Urine sodium <10

Answer 5

Renal retention of sodium to compensate for extrarenal fluid losses
A problem other than the kidneys

Question 6

Isotonic Hyponatremia

Answer 6

Pseudo hyponatremia, serum osmolality 284 to 295

Occurs with extreme hyper lipidemia or hypoproteinemia
Body water is normal and the patient is asymptomatic
Treatment: cut down fat

Question 7

Hypotonic hyponatremia

Answer 7

Serum osmolality less than 280
State of body water excess deleting all body fluids clinical signs arise from water excess

Hypervolemic vS hypovolemic , if hypovolemic assess whether hyponatremia is due to extrarenal salt losses or Renal salt wasting

Question 8

Hypovolemic with urine NA < 10

Causes

Answer 8

Dehydration, diarrhea, vomiting

Question 9

Hypovolemic with urine NA >20
Low volume in kidneys cannot conserve sodium
Causes

Answer 9

Diuretics, ace inhibitors , mineralocorticoid deficiency

Question 10

Hypervolemic, hypotonic Hyponatremia

Causes

Answer 10

Dementia states, congestive heart failure, liver disease, advanced renal failure

Tx: fluid restriction

Question 11

Hypertonic hypo natremia

Answer 11

Serum osmolality greater than 290
Hyperglycemia usually from HHNK
Osmolality is high in the sodium is low

Question 12

Management of hyponatremia

Answer 12

Treatment based on cause
Three underlying condition
If hypovolemic give normal saline IV
If urine sodium is greater than 20 treat the cause
If hypervolemic implement water restriction
If patient is symptomatic give normal saline with a loop diuretic
If CNS symptoms are present consider 3% normal saline with loop diuretics

Question 13

Hypernatremia

Answer 13

Usually due to excess water loss always indicates hyper osmolality excessive sodium intake is rare

Question 14

Severe Hypernatremia with hypovolemia treatment

Answer 14

Give normal saline IV until there is an acceptable blood pressure then switch to half normal saline

Question 15

Hypernatremia with euvoleMia should be treated with

Answer 15

D5 W

Question 16

Hypernatremia with hypervolemia should be treated with

Answer 16

Free water and loop diuretics , may need dialysis

Question 17

Hypokalemia causes

Answer 17

Causes include chronic use of diuretics, gastrointestinal loss, excess renal loss and alkalisis
Elevated serum epinephrine and trauma patients make contribute to hypochonemia

Question 18

Signs and symptoms of hypokalemia

Answer 18

Muscular weakness, fatigue and muscle cramps, constipation or alias due to smooth muscle involvement, if severe less than 2.5 May see flaccid paralysis, tetany, hyporeflexia, and rhabdomyolysis

Question 19

Lab/Diagnostics of Hypokalemia

Answer 19

Decreased amplitude on EKG, broad T waves prominent U waves, PVCs, VTAch or V fib

Question 20

Management of Hypokalemia

Answer 20

Oral replacement if greater than 2.5mEq and no EKG abnormalities
If less than 2.5 MEQ or severe signs and symptoms are present, make a 40me Q/L/hour Iv check every three hours in institute continuous EKG monitoring
Magnesium deficiency frequently impairs potassium fraction

Question 21

Hyperkalemia causes

Answer 21

Causes include excess intake, renal failure, drugs, NSAIDs, hypo aldosteronism, and cell death.
Shifts of intracellular potassium to the extracellular space occur with acidosis
Potassium increases .7 mEq per liter with each 0.1 drop in potential hydrogen

Question 22

Signs and symptoms of hyperkalemia

Answer 22

Weakness, flaccid paralysis, abdominal distention, diarrhea

Question 23

Lab/diagnostics of hyperkalemia

Answer 23

50% of patients with potassium greater than 6.5 will not have EKG changes however tall, peaked T waves are a classic finding

Question 24

Management of hyper kalemia

Answer 24

Exchange resins(Kayexalate)
If greater than 6.5 or cardiac toxicity or muscle paralysis is present consider:
Insulin 10 units with one amp D 50 for emergencies

Question 25

Calcium

Answer 25

Is a major cellular ion an important as a mediator of neuromuscular and cardiac function

Question 26

Normal total calcium

Answer 26

2. 2-2.6 mmol/L

8. 5-10.5 mg/dl

Question 27

Ionized calcium

Answer 27

1. 1–1.4 MMOL/L

4. 5–5.5 MG/dl

Question 28

Hypocalcemia causes

Answer 28

 causes include hypo parathyroidism, hypo magnesemia, Pancreatitis, renal failure, severe trauma, and multiple blood transfusions

Question 29

Signs and symptoms of Hypocalcemia

Answer 29

Increase DTRs, muscle abdominal cramps, carpopedal spasm ( trousseaus sign) , convulsions, chvosteks sign, prolonged QT interval

Question 30

Management of hypocalcemia

Answer 30

Check blood pH look for alkalosis
If a cute give IV calcium gluconate
If chronic give oral supplements vitamin D and aluminum hydroxide

Question 31

Hypercalcemia causes

Answer 31

Causes include hyper parathyroidism, hypothyroidism, vitamin D intoxication, prolonged immobilization. Rarely, thiazide diuretics will promote hypercalcemia

Question 32

Signs and symptoms of hypercalcemia

Answer 32

Fatigue, muscle weakness, depression, anorexia, nausea and vomiting, constipation, coma and death

Question 33

Management of hypercalcemia

Answer 33

May need calcitonin impaired cardiovascular a renal function
May need normal Saline with loop diuretics
Dialysis in severe cases