fluid and electrolytes Flashcards
What body fluid is made up of K, Cl, Na, Ca, Mg, proteins, and HCO3?
extracellular fluid
What body fluids are made up of Na, K, Ca, Mg, Cl, HCO3, proteins, phosphate, and organic ion?
intracellular fluid
What type of IV fluids are made up of Na 154 and Cl 154?
NS
What type of IV fluids are made up of Na 130 and Cl 109?
lactated ringers
Lactated ringers prevents a____ from h___c___ when excessive r___ is needed
acidosis
hyperchloremia
resucitation
What type of IV fluids are made up of Na 513 and Cl 513?
hypertonic fluids
What type of fluids are made up of Na 77 + Cl 77 + Glucose 50?
D5 1/2 NA
What type of blood product is made up of Na 100-160 + < 120 Cl?
a____
albumin
Mild dehydration = ___ %
5
Mild dehydration presents with f____, normal ____, and refusal of o___ i____
fatigue
V/s
oral intake
Moderate dehydration = ___ %
10
Moderate dehydration presents with mild ___ changes, th____, re____, ir____, reduced te___, and d___ m___ m____
v/s changes
thirst
restless
irritable
tears
dry mucous membranes
severe dehydration = ___ %
15
severe dehydration presents with le____, ___ alterations, c__/m____ extremities, deep br____, and minimal to no o____
lethargy
v/s alterations
cool/mottled extremities
deep breathing
output
Isonatremic dehydration = ____ serum sodium ranging from ___-____
normal
135-145
hypernatremic dehydration = serum sodium > ____
145
hyponatremic dehydration = serum sodium < ____
135
Dehydration management
* replace ______ slowly
*correct fluid losses over ___-__ hours
*monitor strict __/___
*monitor ____ closely
electrolytes
24-48
I/Os
electrolytes
Severe hyponatremia is a serum sodium < ____
125
Hyponatremia is caused by
S____, ad___ i____, hy____, hy____, excessive w ____ intake
SIADH
adrenal insufficiency
hypervolemia
hypovolemia
excessive water intake
Severe hyponatremia will result in?
seizures
Correct hyponatremia at __ mEq/L/hr
0.5
If a patient with hyponatremia is experiencing seizures, correct hyponatremia with
1) n___ b___ at __ ml/kg
or
2)h____ s____ ___-___ ml/kg given centrally
NS bolus at 20
hypertonic saline 3-5 ml/kg
If hyponatrmia is corrected to quickly the patient is a risk for ce___ po____ de_____ of wh___ ma___
central pontine demyelination of white matter
—called osmotic demyelination syndrome (ODS)
Severe hypernatremia is a serum sodium > ____
160
hypernatremia is caused by f___ l____, de____, excess s___ i____, D___
fluid loss
dehydration
salt intake
DI
Hypernatremia complications include s___ and al___ me___ s____
seizures and
altered mental status
In a patient with hypernatremia, reduce sodium at ___ mEq/L/hr
—reducing too quickly will cause s____
0.5 mEq/L/hr
–seizures
hyperkalemia causes
increased in____
decreased ex____ d/t r__ f___, b___ b___ use, ac____, t___ l___, rha____, congenital ad___ hy____, and r___ t____ a_____
intake
excretion
renal failure, beta blocker, acidosis, tumor lysis, rhabdomyolysis, congenital adrenal hyperplasia, renal tubular acidosis
hyperkalemia s/s include
___ changes such as
–p___ ___ w___, depressed s___, wide q___, absent __ w____
EKG
peaked T waves
depressed ST
wide QRS
absent P wave
When mild hyperkalemia is present, ensure your sample is not h___ before treating
hemolyzed
Mild hyperkalemia management includes removing or stopping all?
oral/IV potassium sources
Severe hyperkalemia management
*perform e___
*obtain c___, c___, a___, u___
*remove e___ p___ a____
EKG
CBC, CPK, ABG, UA
exogenous potassium administration
Severe hyperkalemia management
-Stabilize myocardium by giving-
*C__ (10 %): ___ mg/kg IV
or
*C__ g___: ___-___ mg/kg/dose (max 3 grams)
CaCl 10% 20 mg/kg IV
Calcium gluconate 60-100 mg/kg/dose
Severe hyperkalemia management
-Enhance movement of K into cells by-
*giving s__ b___: __-__ mEq/kg IV (best way)
or
*g___: __ g/kg + i____ ___-___ units/kg
sodium bicarb 1-2 mEq/kg IV
Glucose 0.5 g/kg + insulin 0.1-0.3 units/kg
Severe hyperkalemia management
-Remove K from the patient by giving-
*k____ ( __ g/kg) PO, NG, rectally
——-use this as a last resort
*can also give d___ such as f____
**In the most severe cases of hyperkalemia give d____
kayexalte 1g/kg
diuretics such as furosemide
dialysis
Hypoglycemia is defined as a blood glucose less than ___ mg/dl
50
Neonatal causes of hypoglycemia
–d___ m___, a___c____ d____, i____ e____ of m_____, and h___p______
diabetic mom
adrenocortical deficiency
inborn errors of metabolism
hypopituitarism
Neonatal causes of hypoglycemia
—can be t_____
—-are associated with a la___ of g___ su_____
transient
lack of glucose supply
childhood causes of hypoglycemia
—i____ e__, g___ de____, st____, h____ dysfunction, b___ b___ ingestion , inf____, and uncontrolled d____
inborn errors
GH deficiency
stress
hepatic dysfunction
beta blocker ingestion
infection
uncontrolled diabetes
hypoglycemia glucose replacement is ___-___ gram/kg (10% or 25%_
0.5-1 gram/kg
hypoglycemia s/s include
ir_____, ji____, se_____, vo____, he___
irritable
jittery
seizures
vomiting
headache
Before treating hypoglycemia, obtain the following labs STAT
-fr___ fa___ ac____, in____, be___ h___b___, cor____, acylcarnitine, la____, py____, gr___, a____, ur___ ke_____
free fatty acid
insulin
beta-hydroxybutyrate
cortisol
lactate
pyruvate
growth hormone
urine ketones
hypocalcemia causes
h__p____p___t_, di____, vi___ ___ deficiency, re____ insufficiency, massive tr_____, rh____, t___ ly____, et___/gl____ ingestion
hypoparathyroidism
DiGeorge
vitamin D
renal, transfusion
rhabdomyolysis
tumor lysis
ethanol/glycol
Hypocalcemia management caused by hypoalbuminemia
–correct Ca at ___ mg/dL for each __ g/dl the patients calcium is low
0.8 mg/dL
1 g/dL
Hypocalcemia management includes obtaining an e___
EKG
Replace calcium with either c___ c____ or c___ g___ IV slowly or via a central line
—–during replacement monitor for s____
calcium chloride
calcium gluconate
seizures
hypocalcemia s/s include
s____, tet____, m____ irritability, l__ q___, and par____
seizures
tetany
myocardial
long QT
paresthesias
for a child presenting with hypocalcemia, obtain p____ levels
parathyroid
in a newborn presenting with hypocalcemia, obtain f___ studies
FISH
If hypocalcemia is refractory to correction, ensure m____ levels are normal
magnesium
what acid-base imbalance is this?
Ph 7.5
PCO2 40
PO2 86
HCO3 36
metabolic alkalosis
Children with chloride-responsive metabolic alkalosis most often have the following diagnosis
-con____
-s/p di___ use
-s/p vo___
-s/p ga___ se____su____
-s/p st___ use
contractions
diuretics
vomiting
gastric secretion suctioning
steroid
Children with chloride-resistant metabolic alkalosis most often have the following diagnosis
—h___a____ state or
—severe ___ depletion
hyperaldosteronism
potassium
what acid-base imbalance is this?
Ph 7.1
PCO2 30
PO2 96
HCO3 10
Metabolic acidosis
Children with metabolic acidosis, try to compensate via h_____
—exhibited by low ____
—–seen in patient with d____
hyperventilation
—-CO2
—–DKA
Children with metabolic acidosis will experience bi___ lo____
bicarbonate losses
In children with metaboic acidosis
—monitor for ___ and ____ abnormalities
potassium
sodium
Anion gap normal level
___ +/ __ mEq/L
12 +/2 mEq/L
The anion gap calculation is
___ - ( ___ + ___)
Na - (Cl + HCO3)
In nongap acidosis
–gap will be b___ n___
below normal
in gap acidosis
–gap will be a___ n___
above normal
NonGap Metabolic Acidosis medication causes
-sp____, pr____ in____, triamterene, amiloride, pe____, tri___, cyc____
spironolactone
prostaglandin inhibitors
pentamidine
trimethoprim
cyclosporine
Enteral nutrition
–nutrients via E___ or f___ to g__ t___
EBM or formula to GI tract
Start enteral nutrition within __-__ hours of l___ or a____
24-48 hours of life or admission
enteral nutrition has been shown to decrease h___ l___ of s___, improves o____, decreased i____, and improved i____
hospital length of stay
outcomes
infection
immunity
enteral nutrition contraindications
–b___ o____, recent g___ s____, U___ b___
bowel obstruction
recent GI surgery
UGI bleeding
In a child on vasopressors, enteral feeds should be ____ ___
slow drip
nutrition labs include
p__-a____
g___
ph____
and s___ st____
pre-albumin
glucose
phosphorus
stool studies
nutrition monitoring
*track w___
*calculate daily c___ i___
*calculate f___ needs
weights
caloric intake
fluid
Parenteral nutrition =
TPN
Begin parenteral nutrition when meeting n___ needs with e___ f____ is c____
nutritional needs
enteral feeds
contraindicated
Children on parenteral nutrition must have reliable access, ___ ___ preferred
Central line
Parenteral nutrition macronutrients ==
pr___, gl___, fa___
protein, glucose, fat
parenteral nutrition micronutrients ==
e___, m___, v____
electrolytes, minerals, vitamins
parenteral nutrition should be adjusted ___ and based on ___
daily
needs
Parenteral nutrition’s long-term effects
-th___ formation, in____, cho____, bo___ disease, li___ disease especially in infants, and ac___ impairment
thrombosis
infection
bone
liver
activity
obesity if a BMI > ___% due to excess c___ i___
95%
caloric intake
obesity acute care concerns
–medication d____, d____, decreased wo___ he___, decreased pu___ mechanics, decreased gl____ control
dosing
DVT
wound healing
pulmonary
gluco0se
obesity labs
-c___ panel
-f___ g____
-H___ ___
-i___ level
cholesterol panel
fasting glucose
Hgb A1C
insulin level
Bulimia
-c___ r____ leading to excess h___/b___ and resultant self i___ v____
*weight may be?
calorie restriction
hunger/binge
induced vomiting
normal
Children with bulimia may use
l___, d___ or e____
laxatives
diuretics
enemas
Bulimia will eventually lead to e____ abnormalities
electrolytes
Bulimia + Anorexia management
*stabilize f___ status
—s/s include h___ and t____
*correct e____
—most often low _____
*obtain ___ evaluation
fluid status
–hypotension + tachycardia
electrolytes
—phosphate
psychiatric
Bulimia complications
*c___ a___
*severe h____p___
*a__/b__ disturbances
*de___ problems
cardiac arrhythmias
severe hypophosphatemia
acid/base
dentition
Anorexia nervosa = c__ r____
—body weight will be < ___%
calorie restriction
85%
Anorexia nervosa s/s inclue
e____ imbalances
i___v____ v___ depletion
m___ a_____
electrolytes
intravascular volume
metabolic acidosis
Anorexia complications
c___ a____, severe h__p_____,
a___/b___ disturbances, severe b_____
cardiac arrhythmias
hypophosphatemia
acid/base
bradycardia
90% of FTT is inorganic d/t
*inadequate c___ i___
*inadequate a____
*excessive m__ d____
caloric intake
absorption
metabolic demands
Refeeding syndrome
—hallmark lab finding =
hypophosphatemia
+ low mag and K
In refeeding syndrome monitor for c___ and a____
CHF and arrhythmias
What nutritional lab reflects the last 24-48 hours of nutrition?
Pre-albumin
obtain a pre-albumin level during acute n___ changes
nutritional
Children with glycogen storage depletion will have l___ intolerance and p___ catabolism
lipid
protein
