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Supporting Life > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

Describe the relationship of fluids
Describe the relationship of electrolytes balance and distribution

Normal Na range
Normal K range
Normal HCO3 range

A

Fluid balance
Input=Output

Electrolyte balance
Total cations=Total anions

Electrolyte distribution
-intracellular and extracellular concs vary

Na 135-145mmol
K 3.5-5.5mmol
HCO3 22-26

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2
Q

What are the 3 mechanisms that control fluid balance

Describe them

A

RAAS-dehydration and hypovolemia

  • decreased GFR => RENIN
  • Liver angiotensinogen =renin=> Ang1
  • Ang1 =lung ACE=> Ang2
  • VC of vessels (short term)
  • Increased aldosterone => Na, water retention

ADH-dehydration and hypovolemia

  • hypothalamic osmoceptors, aortic/carotid baroceptors
  • ADH from neurohypophysis
  • VC of vessels
  • water retention

Natriuresis-fluid overload

  • ANP, BNP => VD
  • Increased GFR => decreased renin => decreased Ang2, Ald
  • Increased diuresis
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3
Q

What are the 5 main types of fluids that we could use

A 
0.9% saline
5% dextrose solution
0.18% saline 4% dextrose
Hartmann solution/lactate ringer solution
Colloids
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4
Q

How would you use 0.9% saline

A

Isotonic
Equilibrates in IV, IS
But excess => Cl excess

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5
Q

How would you use 5% dextrose solution

A

Hypotonic
Dextrose and water
Equilibrates in IV, IS, IC
Hydrate without electrolytes, only for maintenance

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6
Q

How would you use 0.18% saline, 4% dextrose

A

Hypotonic

Hydrate with electrolytes for maintenance

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7
Q

How would you use Hartmann solutions/Lactated ringer solution

A

Isotonic
Na K Cl Ca Lactate=>HCO3

Equilibrates in IV, IS

Maintenance and resuscitation

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8
Q

How would you use colloid

A

Maintain high oncotic pressure to keep fluid in IV

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9
Q

How would you do a fluid balance assessment for hypovolemia

  • pulse
  • BP
  • turgor
  • Gi, GU
  • neuro
A 
Pulse: fast, weak
BP: postural drop
Turgor: loss, dry mucus membranes
GI, GU: GI loss, thirst, oliguria
Neuro: confusion
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10
Q

How would you do a fluid balance assessment for hypervolemia

  • pulse
  • BP
  • turgor
  • resp
  • neuro
A 
Pulse: fast, bounding
BP: high, increased JVP
Turgor: edema, ascites, 
Resp: SOB
Neuro; confusion
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11
Q

What are the sources of electrolyte and fluid changes

A 
NG aspirate
Vomit
Drains
Skin
Blood
Urine
Diarrhea
Stoma
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12
Q

What is the procedure for maintenance fluids

A

Keep euvolmeia and [electrolytes] if oral intake decreases/lost

25-30ml/kg/day + compensate for physiological loss

  • saline
  • dextrose saline

If for 3+ days, NG feed

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13
Q

What is the procedure for replacement fluids

A

Maintenance + fluid, electrolytes to replace ongoing loss

MUST MONITOR REGULARLY

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14
Q

What is the procedure for resuscitation fluids

A

Fast IV test bolus of crystalloid, see if BP rises
Reassess, ABCDE
If bleeding, use blood

Rapid restoration of IVF

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15
Q

What are the 3 main causes of hyponatraemia

What are the causes?

A

Hypovolemic

  • burns, GI loss
  • diuretics
  • Addisons

Euvolemic

  • polydipsia
  • excess IV hypotonic sol
  • SIADH

Hypervolemic

  • CCF
  • ascites
  • nephrotic syndrome
  • CKD
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16
Q

What are the 4 categories and associated symptoms of hyponatraemia

A

Mild- asymptomatic
Moderate- cramp, weak, nausea
Severe- tired, headaches, confused
Severe+rapid- seizure, coma, resp depression

17
Q

How would you treat hyponatraemia

  • hypovolemia
  • euvolemia
  • hypervolemia

Why would you want to treat this slowly

A

Hypovolemia
-Na crystalloid

Euvolemia

  • fluid restriction
  • find underlying cause

Hypervolemia
-same as euvolemia + diuretics

Risk of central pontine myelinolysis due to rapid brain shifts

18
Q

What are the 2 main causes of hypernatraemia

What are the causes

A

Fluid loss

  • GI loss, sweat, reduced intake
  • central/nephrogenic DI

Na excess

  • hypertonic IV
  • Conns
19
Q

How would you treat hypernatraemia

  • acute
  • chronic
A

Acute

  • hypotonic fluid
  • reduce Na slowly to reduce CPM risk

Chronic
-same as acute + treat underlying cause

20
Q

What are the 3 main causes of hypokalemia

What are the causes

A

Increased cell entry

  • alkalosis
  • excess insulin
  • excess b agonist
  • hypothermia
  • drugs

Increased GI loss

  • vomit, diarrhoea, laxatives
  • increased sweat
  • decreased intake

Increase urine loss

  • diuretics
  • MC excess
  • renal tubular acidosis I
  • drugs
21
Q

How would you treat hypokalaemia

A

Mg levels
K replacement
Underlying caus

22
Q

What are the 2 main causes of hyperkalaemia

What are the causes

A

Increased cell release

  • metabolic acidosis
  • decreased insulin, increased glucose => osmolarity
  • increased tissue catabolism
  • increased Bb
  • exercise

Decreased urine loss

  • AKD, CKD
  • decreased MC/response
  • drugs
  • renal tubular acidosis 4
23
Q

How would you treat hyperkalaemia

A

Ca glucoronate
Insulin+dextrose
K out of body/into cells

MONITOR AND TREAT CAUSE

24
Q

How would you recognize hypokalaemia, hyperkalaemia on ECG

A

Hypokalaemia

  • increased PR, QT interval
  • ST depressed
  • Flat T
  • U wave

Hyperkalaemia

  • flat/no P
  • increased PR,
  • wide QRS
  • Tall T
25
Q

What is metabolic acidosis

What in the kidneys normally controls pH balance

A

Academia + decreased HCO3 (22-26)

Balance of HCO3, H

  • NaH exchange
  • NaHCO3 symport
  • Carbonic anhydrase
26
Q

What is the anion gap

What is the equation

A

CATIONS=ANIONS
But measured cations>measured anions

(Na+K)-(Cl+HCO3)=12-20

27
Q

What is the cause of a normal anion gap

What is the mechanism behind this

A

If HCO lost, replaced by Cl

GI, renal loss

28
Q

What is the cause of an increased anion gap

What is the mechanism behind this

A

If H increases, buffered by HCO3 => decrease of HCO3
Lactic/DK acidosis
Renal failure

29
Q

How would you manage central diabetes insipidus
How would you manage peripheral diabetes insipidus

How may DI present

A

Desmopressin
Thiazides, low Na/protein diet

Polyuria/poly dips is

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