Fluid and Electrolytes Flashcards
What are signs of hypervolemia?
Increased BP
Low BUN, Hct
Full peripheral pulses
What are symptoms of hypervolemia?
- Pitting edema (extremities, eyelids, facial)
- Muscle weakness
- Pulmonary edema (increased respiratory rate, shallow respirations, shortness of breath, moist crackles)
- Distended neck veins
How is hypervolemia treated?
Loop diuretic (Ethacrynic Acid, Furosemide, Bumetanide, Torsemide)
Fluid restriction (~1-2 L/day)
What is hypovolemia mostly caused by?
- hyperglycemia
- high urea
- diuretic induced
What are symptoms of hypovolemia?
- fatigue
- thirst
- orthostasis
- chest pain
- confusion
What are signs of hypovolemia?
- diminished skin turgor
- orthostatic tachycardia (women)/ orthostatic hypotension (men)
- Increased BUN, SCr
- Bicarbonate loss (diarrhea)
- urine osmolality > 450 mOsm/kg
What is the tretment for hypovolemia?
- normal saline
- colloids
- hypotonic solution (dextrose in water/ 1/2 NS) if hypernatremia
What is the rate of maintenance fluids?
25-30 mL/kg/day
What are the rates of fluids when hypovolemic?
- above 30mL/kg/day
- 500mL bolus if hypotensive
What are symptoms of severe hypernatremia?
seizures, coma, death (>180 mEQ/L)
What are symptoms of mild hypernatremia?
lethargy, weakness, restlessness, twitching (>145 mEQ/L)
What is the most common type of hypernatremia?
hypovolemic hypernatremia
How is hypernatremia treated?
free water replacement
What drugs can induce hyponatremia?
- Thiazide diuretics
- Psych meds (SSRI, SNRI, TCA)
- carbamazepine and oxcarbazepine
How can the cause of hyper/ hypo natremia be diagnosed?
urine osmolality
How much sodium per day should be given to treat hyponatremia?
NO MORE THAN 12 mEQ/L/day
What could happen if you overcorrect sodium by too much?
osmotic demyelination syndrome
What is considered hyperkalemia?
K> 5mEq/L
When should you not react to a hyperkalemia value?
- no symptoms
- single lab value
- hemolyzed sample
What are causes of hyperkalemia?
- AKI
- drug-induced
- supplementation
- acidosis, insulin deficeincy
What drugs can induce hyperkalemia?
- ACE/ ARB
- aldosterone antagonists
- Lithium
- calcineurin inhibitors
- trimethoprim
- potassium-sparing diuretics
When does hyperkalemia need to be treated?
- chronically above normal
- EKG changes (peaked T waves)
When does hypokalemia become symptomatic?
< 2.5 mEQ/L
What are symptoms of hypokalemia?
- palpitations
- EKG changes
Caution in patients with hx of CV disease
What are causes of hypokalemia?
- abnormal GI/renal losses
- lack of Mg absorption
- drug induced
What drugs can cause hypokalemia?
- diuretics
- laxatives
- Amphotericin B
How is hypokalemia treated with Mg?
- give 10 mEq for every 0.1 mEq/L
- if more than 20mEq needed separate by at least 2 hours
- remove underlying cause
- prn K+ supplements
What are symptoms of mild hypercalcemia?
- weakened bones
- GI issues
What are symptoms of severe hypercalcemia?
- EKG changes
- mental status changes
- severe sedation
What are treatments for hypercalemia?
- fluids +/- furosemide
- IV bisphosphonates/ RANKL inhibitors
- Calcitonin
What are symptoms of severe hypocalcemia?
- mental status changes
- seizures
- coarse hairs
- brittle nails
- dry skin
How do you treat severe hypocalcemia?
100-300 mg elemental Ca IV
