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Neo Board Review MAP > Fluid And Electrolytes > Flashcards

Fluid And Electrolytes Flashcards

1
Q

Total body water

A

Decreases with increasing gestational age

Diuresis in first 3 days from extracellular fluid compartment (ECF)

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2
Q

Increases insensible water loss (IWL)

A 
Lower GA and BW
Increased RR
Ambient temp above NTE
Fever
Radiant warmer use
Activity
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3
Q

Decreased IWL

A 
High relative humidity (esp <28 week)
Heat shield/double walled incubators
Plastic blankets
Clothing
Humidified inspired gases
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4
Q

Osmolality

A

Smaller molecules more osmotic than larger ones
Na > gluc > albumin
Stimulus of ADH secretion via osmoreceptors in hypothalamus

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5
Q

Electrolytes in stomach fluids

A

Na 20-80
K 5-20
Cl 100-150

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6
Q

Electrolytes in small intestine fluids

A

Na 100-140
K 5–15
Cl 90-120

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7
Q

Electrolytes in bile

A

Na 120-140
K 5-15
Cl 90-120

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8
Q

Electrolytes from ileostomy

A

Na 45-135
K 3-15
Cl 20-120

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9
Q

Electrolytes in diarrhea

A

Na 10-90
K 10-80
Cl 10-110

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10
Q

Fractional excretion of sodium

A

Proportion of Na excreted based on how much serum is filtered by kidney
Decreases with increasing GA

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11
Q

Hypernatremia

A 
Na > 150
Due to:
- dehydration (decreased free water)
- too much sodium
- congenital decreased ADH (seen after 2-3 days, rare)
- occasionally excess maternal Na
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12
Q

Hypernatremia and IVH

A

Hypernatremia over first several days after birth associated with severe IVH

Risk increased with concommitmenthyperglycemia

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13
Q

Hyponatremia

A 
Na < 130
Due to: 
- overhydration (too much free water)
- excess renal loss of sodium
- SIADH
- other losses
- use of indomethacin (potentiates ADH effect)
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14
Q

Causes of hyperkalemia (K>7)

A 
Sampling site
Acidosis (Shifts K extracellular)
Renal failure
Adrenal insufficiency
Excess intake
Spironolactone
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15
Q

Treatment of hyperkalemia

A

Stop all K
Consider bicarb (K into cell)
Can give sodium polystyrene sulfonate (will increase Na)
Peritoneal dialysis
Exchange transfusion
Maintain normal ionized calcium to stabilize heart

Use of glucose and insulin shifts K into the cell, doesn’t lower total body K


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16
Q

Causes of hypokalemia (K<3.5)

A 
Preterm infants with IUGR (DOL 1)
Increased G.I. losses
Renal losses
Drugs (amphotericin, aminoglycosides, beta agonists)
Restricted intake

Similar clinical signs, different EKG findings from hyperkalemia

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17
Q

Causes of hypocalcemia (Ca<8)

A 
Early - abrupt cessation of transplacental Ca passage
Elevated calcitonin
Decreased PTH
Decreased 25-OH vitamin D
DiGeorge
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18
Q

Risk factors for hypocalcemia

A 
Prematurity
Infant of diabetic mother
Perinatal stress/asphyxia
Intrauterine growth restriction
22q11 abnormalities
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19
Q

Causes of hypercalcemia (Ca>11)

A

Increased administration of Ca
Low Phos
Elevated PTH
Elevated vitamin D

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20
Q

Risk factors for hypercalcemia

A

TPN
Therapeutic hypothermia (fat necrosis)
Maternal hypoparathyroidism
Williams syndrome

21
Q

Hypophosphatemia

A

P < 4
Very common among preterm infants with IUGR
Worry about refeeding syndrome

22
Q

When is antidiuretic hormone secreted?

A
  • increased osmolality (osmoreceptors in hypothalamus)

- decreased plasma volume (pressure receptors in veins, atria, carotids)

23
Q

Overall effect of ADH secretion?

A

Increases water reabsorption by kidney

24
Q

Diabetes insipidus

A 
Decreased ADH
Nephrogenic or neurogenic
Signs:
- Polyuria
- Hypernatremia
- Increased thirst

Think about with holoprosencephaly or Septo optic dysplasia

25
Q

SIADH

A

Increased ADH
Hyponatremia
Concentrated urine (Uosm > Sosm without dehydration)
Normal or hypervolemia

26
Q

Diabetes insipidus treatment

A

Neurogenic - Desmopressin (DDAVP) = analog of ADH

Nephrogenic - hydrochlorothiazide increases proximal tubule reabsorption of sodium and water

27
Q

Aldosterone

A

Mineralocorticoid made in zona glomerulosa of adrenal cortex
Can cross placenta
Increases reabsorption of Na and water and secretion of K
Simulates renal secretion of H
Feedback loop to pituitary to release ADH

28
Q

Aldosterone stimulated by

A

Stretch receptors in atria of heart
Renin angiotensin aldosterone system
Hyperkalemia
Plasma acidosis

29
Q

Hypoaldosteronism

A

Hypotension
Hyponatremia
Hyperkalemia
Metabolic acidosis

Seen in CAH, adrenal insufficiency


30
Q

Hyperaldosteronism

A

Hypertension
Hypernatremia
Conn syndrome, Bartter syndrome
Extremely rare in neonates

31
Q

Causes of metabolic acidosis

A 
Lactic acidosis
Acute renal failure
Inborn errors of metabolism
Toxins
Diarrhea
CAH
TPN
Renal tubular acidosis
32
Q

Causes of metabolic alkalosis

A

Acid loss (vomiting, pyloric stenosis)
Diuretics (contraction alkalosis)
Compensation of chronic respiratory acidosis
Bartter syndrome (IUGR, polyuria, low K, low mag)
Exogenous bicarb
Increased aldosterone
Cystic fibrosis

33
Q

When is nephrogenesis complete?

A

34 weeks gestation

34
Q

Is urine concentrating ability increased or decreased at lower gestational ages?

A

Decreased

35
Q

How do antenatal steroids help the kidneys concentrate urine better?

A

Increased Na/K-ATPase and Na/H exchanger

36
Q

Clinical signs of hyperkalemia

A

Ileus
Muscle weakness
Cardiac arrhythmia

37
Q

Where is antidiuretic hormone made?

A

Hypothalamus

38
Q

Where is antidiuretic hormone stored?

A

Posterior pituitary

39
Q

How does ADH affect renin secretion?

A

Decrease

40
Q

How does ADH affect ACTH secretion?

A

Increase

41
Q

What does ADH do to the distal tubules of the kidney?

A

Increases permeability

42
Q

How does ADH affect V2 receptors?

A

Increase cAMP -> phosphorylation of aquaporin 2

43
Q

How does ADH affect renal mesagial cells?

A

Contraction - remove debris from glomerular basement membrane

44
Q

Management of SIADH

A

Water restriction

AVP receptor antagonist

45
Q

What pathologies is SIADH seen with?

A

HIE
IVH
Pulmonary air leaks

46
Q

What is the total body water in a newborn

A

75% of birth weight

47
Q

What can cause a transudative effusion?

A

Congestive heart failure
Cardiac arrhythmias
Hypoalbuminemia

48
Q

What can cause an exudative effusion?

A

Chylothorax

Meconium peritonitis

Neo Board Review MAP (18 decks)

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