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Pathophys- Fluid and Electrolytes > Fluid and Electrolyte Replacement > Flashcards

Fluid and Electrolyte Replacement Flashcards

1
Q

CM in volume depletion with 5% loss

A

thirst, dry mucous membranes

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2
Q

CM in volume depletion with 10% loss

A

tachycardia, oliguria

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3
Q

CM in volume depletion with 15-20% loss

A

hypotension, tachycardia, narrow pulse pressure

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4
Q

what is most sensitive indicator for volume loss?

A

heart rate- tachycardia

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5
Q

patient that is hypernatremic. You give fluids to get sodium level down. What is a good guideline for changing sodium levels?

A

do not change sodium levels more than 12 mOsm/24 hours

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6
Q

Types of volume depletion

A

water deficit with or without solute deficit

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7
Q

water deficit without solute deficit. Tx for calculating change in total body sodium

A

change in sodium = (140 - Patient’s Na level) X TBW (or wt. in kg x 0.6)

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8
Q

what fluid to use in hypernatremic patient that is stable and non-hypotensive?

A

D5W

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9
Q

what fluid to use in hypernatremic patient that is hypotensive?

A

use hypotonic soln (but will require more of it)

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10
Q

Tx in patient in hypovolemic shock

A

20 ml/kg bolus NS, then repeat bolus of 10-20 ml/kg until systolic pressure above 80 mmHg

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11
Q

Tx in patient with volume depletion from diuretic loss. Not in hypovolemic shock.

A

1 L NS over first hour, then 500-1000 ml NS second hour OR 10 ml/kg for every 1% dehydration. half given over 8 hours, remaining half given over 16 hours

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12
Q

Tx mild volume overload

A

Na restriction to less than 2 g Na/day (CHF patients)

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13
Q

tx severe volume overload

A

diuretic (lasix)

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14
Q

Hyponatremia tx if sodium more than 125 mEq/L

A

water restrict

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15
Q

Hyponatremia tx if sodium less than 125 mEq/L

A

Diuretics

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16
Q

In hyponatremia, should you correct all of the sodium deficit?

A

No, only half because also water restriting, using diuretics

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17
Q

equation for calcuting sodium deficit in hyponatremia

A

Na deficit per L= desired sodium - patients sodium. Total sodium deficit is that value x TBW

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18
Q

at what rate do you correct sodium deficit?

A

replace at 0.5 mEq/hr

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19
Q

how much sodium in 1.8% Nacl?

A

300 meq/l

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20
Q

how much sodium in 3% nacl?

A

513 meq/L

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21
Q

effect of potassium in acidic environment?

A

H ions will go into cells, and potassium will get kicked out, resulting in INCREASED levels- inc excitability of cells

22
Q

EKG in hypokalemia

A

prolonged PR interval, new wave after T

23
Q

EKG in hyperkalemia

A

prolonged PR interval, widened QRS, tall peaked T waves, sine waves

24
Q

most feared consequence of hyperkalemia

A

life threatning arrhythmias- PEA, asystole

25
Q

fake causes of hyperkalemia

A

Hemolysis, potassium infusion, check CBC- infection causing shifting of ions out of the cell

26
Q

EMERGENCY Rx Hyperkalemia

A

1-2, 10 ml ampules of 10% calcium gluconate over 2-5 minutes. also, Give 10U Regular Insulin IV push with 1 ampule D50 IV push. can also give albuterol, sodium bicarbonate, lasix (caution)

27
Q

Non emergent Tx hyperkalemia (if have more time to correct)

A

Kayexelate 30-60 gm PO (sodium polystyrene sulfonate)

28
Q

dangerous consequences of hypokalemia

A

arrhythmia, paralysis, rhabdomyolysis

29
Q

refeeding syndrome can result in what electrolyte abnormalities?

A

hypokalemia, hypophasphatemia, hypomagnesemia, and sometiems hypoglycemia

30
Q

refeeding syndrome triggered by

A

intense insulin secretion

31
Q

estimating K deficit

A

For every 100 mEq below normal, serum K drops by 0.3 mEq/L. Or for every 10 mEq below normal, serum K drops by 0.1 mEq

32
Q

after calculating K deficit in hypokalemia, what route do you choose to replace?

A

ORAL preferred- quicker, less SE, less dangerous

33
Q

In what situations do you choose IV K replacement in hypokalemic patients?

A

If NPO or have severe depletion, K at 2.7 or less. complete heart block

34
Q

preferred agent in hypokalemia replacement

A

KCL oral 60-80 meq

35
Q

replacing K in DKA patients

A

potassium phosphate

36
Q

replacing K in metabolic acidosis

A

potassium acetate, bicarbonate, citrate, or gluconate

37
Q

You decide to use IV KCL to restore potassium in your severely volume depleted patient. You do a “Piggyback” with 40-60 mEq K. What solution do you AVOID?

A

dextrose- triggers insulin, which causes K into cells. Use NS

38
Q

Lidocaine IV- caution

A

can cause arrhythmias so caution

39
Q

Lidocaine IV benefit

A

prevents phlebitis

40
Q

Severe hypokalemia patient. You decide to use combination of oral and IV. What doses/rates are used?

A

KCl PO 60-80 mEq BID or TID. KCl IV 10 mEq/hr

41
Q

gentle vs. aggressive tx in hypokalemic patients

A

DKA and IV diuretic patients- AGGRESSIVE. keep K above 4-4.5 in cardiac patients. Gentle in acute or chronic renal failure patients

42
Q

always check this electrolyte in cases of refractory hypokalemia

A

MAGNESIUM!

43
Q

Acidosis effect on calcium

A

increases free calcium

44
Q

alkalosis effect on calcium

A

more bound calcium (decreaesd free calcium). proteins give off H ions and bind calcium

45
Q

tx in hypocalcemia is only indicated in symptomatic patients. IV avoided.

A

1-3 grams of Calcium chloride depending on serum ionized calcium level

46
Q

tx in symptomatic patient (fatigue, weakness, kidney stones) with serum calcium level of 13 mg/dL

A

Hypercalcemia- NS 300-500 ml/hour, tapering to 200-250 ml/hr

47
Q

Hypercalcemic patient with level greater than 16 mg/dL tx:

A

NS load, calcitonin to promote osteoblasts to build bone, and bisphosphonates to prevent breakdown of bone

48
Q

Chvostek’s sign, Trousseau’s sign think

A

hypocalcemia

49
Q

Claudin-19

A

tight junction protein that allows for Mg and Ca reabsorption in kidney

50
Q

Mg is reabsorbed in ..

A

thick ascending loop of henle by passive diffusion based on sodium reabsorption. claudin-16 also plays a role in its reabsoption

51
Q

What 3 factors decrease Mg reabsorption

A

Increased plasma calcium, decreased pH, and low potassium

52
Q

food sources magnesium

A

green vegetables, legumes( beans and peas), nuts and seeds, unrefined grains, tap water

Pathophys- Fluid and Electrolytes (2 decks)

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