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Paige: Renal Module! > Fluid and electrolytes > Flashcards

Fluid and electrolytes Flashcards

1
Q

What three fluid issues can you have?

A

volume overload

volume depletion

dehydration

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2
Q

What is the MC cause of volume overload?

A

HF

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3
Q

What is the MC cause of volume depletion?

A

vom/diarrhea

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4
Q

What is the MC cause of dehydration?

A

diarrhea

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5
Q

What is HCO3 actually a measure of?

A

total venous CO2 volume

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6
Q

Which two lab results do we look at for renal function (glomerular filtration)?

A

Cr

BUN

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7
Q

What is Cr a breakdown product of?

A

muscle energy metabolism

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8
Q

What is BUN an end-product of?

A

protein metabolism

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9
Q

Which one gets secreted by the kidney, BUN or Cr?

A

BUN

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10
Q

What symptoms would a person be experiencing that you would want to order these labs? (one general word)

A

neuromuscular

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11
Q

Which electrolyte abnormality might cause weakness, delerium, and seizures?

A

hyponatremia

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12
Q

Which electrolyte abnormality might cause arrhythmias, weakness, and cramping?

A

hypokalemia

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13
Q

Which electrolyte abnormality might cause weakness and diarrhea?

A

hyperkalemia

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14
Q

Which electrolyte abnormality might cause cramping, arrhythmias, and seizues?

A

hypocalcemia

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15
Q

Which electrolyte abnormality might cause polyuria, constipation, and lethargy/confusion?

A

hypercalcemia

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16
Q

SO REVIEW.

Which three electrolyte issues cause muscle weakness?

A

high K, low K

low Na

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17
Q

Sooo which two electrolyte issues cause seizures?

A

low Na, low Ca

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18
Q

Sooo which two electrolyte issues cause cramping?

A

low K, low Ca

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19
Q

Anddd which two electrolyte issues cause arrhythmias?

A

low K, low Ca

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20
Q

What MC causes hyponatremia, a water imbalance or a sodium imbalance?

What causes this?

A

water imbalance

from increased ADH secretion

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21
Q

What gets secreted when there is an increased in the [Na]

( [] = concentration of )

A

ADH

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22
Q

What type of hyponatremia do you have if you have low Na with low ECF volume, and the total body Na/H20 is low?

A

hypovolemic hypotonic hypoNa

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23
Q

If you have hypovolemic hypotonic hypoNa, how will your body respond? Will it

a) excrete more water to maintain [Na]
b) increase ADH to maintain blood volume
c) decrease ADH to maintain [Na]
d) your body doesn’t respond because it can’t fix both at the same time

A

b - increases ADH to maintain blood volume, because this drive is greater than the drive to maintain [Na]

(this is the kind of bitch question we would get on the exam lol)

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24
Q

How do you treat hypotonic hypovolemic hypoNa

A

isotonic fluids + KCL

or gatorade + KCL (mild)

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25
Q

What type of hypoNa is it is you have low Na, high ECF volume, and the total body Na/H20 is increased?

A

hypervolemic hypotonic hypoNa

(see next slide)

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26
Q

If a pt has low na, high ECF volume, and high body na/h20, then why is he hypotonic?

A

Because both body H20 and Na are high (so it’s high but kind of diluted), so it actually turns out to be that the Na is still low overall

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27
Q

How do you tx hypervolemic hypotonic hypoNa?

A

tx underlying

restrict water

diuretics

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28
Q

What kind of hypoNa do you have with low Na, low serum [Na], and increased urine [Na]?

A

euvolemic hypotonic hyponatremia

29
Q

Which type of hypoNa is caused by inappropriate ADH secretion from tumors, lesions, drugs, etc?

A

euvolemic hypotonic hyponatremia

30
Q

Which type of hypoNa is caused by diuretics or vomiting/diarrhea?

A

hypovolemic hypotonic hypoNa

31
Q

Which type of hypoNa is caused by edema-related disorders?

A

hypervolemic hypotonic hypoNa

32
Q

What is it called when psychological meds cause patients to take >10L/day of water?

A

psychogenic polydipsia

33
Q

What imbalance can happen to patients postop?

A

increased ADH secretion (from pain) –> hyponatremia

34
Q

What are the s/s of postop hyponatremia?

A

pt was most likely on hypotonic fluids

nausea, HA, seizures

35
Q

How do you treat postop hyponatremia?

A

pain control with isotonic fluids

36
Q

Which type of Na imbalance is seen in diabetics?

A

hypertonic hyponatremia

37
Q

What’s the cause/patho of this diabetic hypertonic hyponatremia?

A

a significant rise in hyperglycemia causes increased [glucose]

so H20 goes from cells into the ECF and causes a dilution of Na

38
Q

Why is hyponatremia common in HIV/Aids (patho)

A

combination of GI fluid, electrolyte loss, inappropriate ADH secretion

39
Q

what imbalance are you going to get if you’re stranded in a desert/lost at sea?

A

hypernatremia and concentrated urine

40
Q

What imbalance causes orthostatic hypotension, dehydration, and oliguria?

A

hypernatremia and concentrated urine

41
Q

If you have hypernatremia with concentrated urine, will ADH be high or low?

42
Q

What’s the treatment of someone who is lost in the desert?

A

replace volume, h20, electrolytes

43
Q

For someone who is dehydrated, you should replace water quickly or slowly?

Why?

A

SLOWLY over 48-72 hours.

to avoid cerebral edema

44
Q

what disease is associated with hypernatremia and diluted urine?

A

diabetes insipidus

45
Q

Which of the following is not a type of diabetes insipidus?

a) central
b) nephrogenic
c) congenital
d) peripheral

A

peripheral DI is not a thing.

46
Q

How is K regulated?

A

by cells and the kidneys

(Oral K in = renal K out)

47
Q

remember those symptoms of hypokalemia I told you about earlier?

Well handler changed his mind about the symptoms.

So this says s/s = weakness, cramps, fatigue, constipation.

A

school is awesome.

48
Q

What will you see on EKG for someone with hypokalemia?

(2 changes, 1 condition)

A

NSST-T changes*

U waves

PVCs

49
Q

How does one become hypokalemic?

A

vom/diarrhea

increased aldosterone +/or diuretics

50
Q

How do you treat hypokalemia?

A

mild: KCL oral
severe: KCL IV

dietary supplement

51
Q

What might coexist with mild hyperkalemia?

A

metabolic acidosis

(due to H/K exchange)

52
Q

What will a hyperkalemic EKG look like?

A

peaked T waves*

wide QRS

increased intervals

no p waves

53
Q

Whats the treatment of hyperkalemia?

A

infusion of glucose + insulin

54
Q

Why does glucose + insulin help with hyperkalemia?

A

insulin drives glucose into cells and K follows

55
Q

If you think someone has hyperkalemia, what should you assess?

A

renal function*

56
Q

What arrhythmia are people at risk for with K >7, and especially with K > 8.1?

57
Q

What’s the MC cause of hypocalcemia?

A

chronic renal failure

58
Q

what 2 signs will be + if a person has hypocalcemia?

A

trosseau’s sign

chvostek’s sign

59
Q

What will an EKG look like with hypocalcemia?

A

prolonged QT interval*

arrhythmias

60
Q

How do you treat a symptomatic patient with hypocalcemia?

A

IV Ca gluconate via bolus and infusion

61
Q

How do you treat an asx patient with hypocalcemia?

A

oral Ca and Vit D

62
Q

What are the MC causes of hypercalcemia?

A

hyperparathyroidism

malignancy

63
Q

What will you see on EKG in someone with hypercalcemia?

A

shortened QT interval

PVCs

64
Q

How do you treat hypercalcemia?

A

tx underlying

infuse 0.9% saline and IV furosemide

65
Q

What drug should you avoid in hypercalcemia?

A

thiazides!

66
Q

So other than postop hyponatremia, what imbalance is super common in hospitalized patients on IVF?

A

hypomagnesemia

67
Q

What imbalance does hypomagnesemia mimic?

A

hypocalcemia

68
Q

Can hypomagnesemia be associated with hypokalemia?

A

Yes and this is dangerous (increased risk of vfib)

69
Q

How do you treat hypomagnesemia?

A

IV or oral MgSO4

Paige: Renal Module! (4 decks)

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