fluid and electrolytes Flashcards
unmeasured osmoles occurs in
poisoning
increased lipid and protein in the plama
pseudohyponatremia
accepted osmolal gap
10 mOsm/kg
Major intracellular cation
K
Major extracellular anion
Cl
Major intracellular anion
Phosphate
Major extracellular cation
Na+
predominant cation in plasma
Na
causes of edema
- Increased hydrostatic pressure
- Lowered plasma osmotic pressure
- Increased cap mem perm
- Lymphatic channel obstruction
components of maintenance therapy
water, glucose, Na, K
maintenance therapy provides how much of normal cal needs
20%
goals of maintenance fluids
Prevent:
- dehydration
- electrolyte d/o
- ketoacidosis
- protein degradation
If the child is under 6 months nd no yet taking solid food, what i your treatment plan? (no dehydration)
ORS solution or water rather than food based fluid
amount of zinc you should give in <6 mo old
10mg od for 10-14 days
amount of zinc you should give in > 6 mo old
20 mg od for 10-14 days
Rules in treatment plan A
- Give the child more fluids than usual to prevent dehydration
- Give supplemental zinc for 10-14 days
- Continue to feed the child to prevent malnutrition
- Take the child to health worker if there are signs of dehydration or other problems
Amount of ORS to be given in treatment plan B
Amount of ORS = weight (kg) x 75 to be given in 4 hr
what to do if there’s oral rehydration failure
ORS solution NGT
Ringer’s Lactatae (D5LR or plain LR) IV 75mL/kg for 4 hrs
rate of ORS given in Treatment Plan C
20 mL /kg for 6 hrs
signs that remain useful in diagnosing diarrhea
eagerness to drink cool and moist extremeties weak or absent radial pulse reduced or absent urine flow history of diarrhea
Most important ion in regulating water balance
Na
principal site of Na excretion
Kidney
Renal tubule Na reabsorption is affected by what hormones?
ADH
Aldosterone
Renin/angiotensin
hyponatremia with no evidence of
volume overload or depletion.
Euvolemic Hyponatremia
example of hypervolemic hyponatremia
CHF
cirrhosis
Nephrotic syndrome
Renal failure
treatment for Severe Hyponatremia
2 mEq/ml
formula for Na needed
Na needed = (desireed Na conc - actual) x Wt in kg x 0.6
complication of immediately raising serum lvl to the normal lvl
Central Pontine Myelinolysis
principal hormone regulator for secretion of K
aldosterone
K is mostly absorbed in
SI
Colon exchanges body potassium for
luminal sodium
drugs that can cause hyperkalemia
ACE inhibitors K sparing diuretics Cycloporin NSAIDs Trimethoprim
ECG changes in hypokalemia
Flattened T wave
Depressed ST wave
Appearance of a U wave
ECG changes in Hyperkalemia
Peaking of T waves Increased P-R interval Flattening of P wave Widening of GR complex progress to v-fib
3 forms of Calcium
Ionized
Albumin bound
Anion
what is a buffer
substance that reduces the change in free hydrogen ion concentration of a solution on the addition of an acid or base
increase in hydrogen ion conc
acidosis
decrease in H ion conc
alkalosis
3rd most common intracellular cation
Mg
