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GI Exam 1 > Fluid and Electrolytes Water and Na > Flashcards

Fluid and Electrolytes Water and Na Flashcards

1
Q

Intacellular fluid comprises how much of the total BW

A

67%

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2
Q

Interstital fluid comprises how much of the total BW

A

20%

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3
Q

Intravascular fluid comprises how much of the total BW

A

8.3%

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4
Q

***Total BW for OLDER CHILDREN AND MEN LESS THAN 70

A

0.6 X body weight

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5
Q

***Total BW for WOMEN LESS THAN 80 AND MEN OVER 70

A

0.5 X body weight

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6
Q

***Total BW for WOMEN OVER 70

A

0.45 X body weight

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7
Q

Sodium maintenance needs

A

Closer to 2 mEq/kg

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8
Q

Potassium maintenance needs

A

Closer to 1 mEq/kg

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9
Q

5% loss Volume Depletion

A 
Decreased skin turgor
Dry membranes
Pale skin
Diminished urine output
Normal BP
Normal to increased HR
Flat fontanelle
Consolable CNS
Capillary refill >2 seconds
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10
Q

10% Volume Depleted

A 
Tenting skin turgor
Very dry membranes
Grey skin color
Severly decreased urine output
Normal to decreased BP
Increased HR
Soft fontanelle
Irritable CNS
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11
Q

15% Volume Depleted

A 
Tenting skin turgor
Parched mucous membranes
Mottled skin color
Azotemic urine output
Decreased BP
Significantly increased HR
Sunken fontanelle
Lethargic/coma CNS
Tilt test increase by 30 beats/min
Capillary refill >3 seconds
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12
Q

Tilt Test Procedures

A

BP and HR are recorded after pt has been supine for 2-3 minutes
BP/HR are recorded after pt has be standing for 1 minu

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13
Q

Positive Tilt Test

A

Increased HR by 30 beats per minute or more (15% volume loss)
Presence of sx of cerebral hypoperfusion

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14
Q

Capillary refill

A

Time for the nail bed to return to the normal color is counted in seconds
Less than 2 seconds is normal

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15
Q

Urine output is an indicator of:

A

Organ perfusion if pt has normal renal function

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16
Q

Normal urine output is:

A

More than 1.0 mL/kg/hr

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17
Q

Reduce urine output is:

A

0.5-1.0 mL/kg/hour

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18
Q

Severely reduced urine output is:

A

Less than 0.5 mL/kg/hr

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19
Q

Lab values in volume depleted:

A

Albumin will increase unless hypoalbuminemic
Hemoglobin will increase unless anemic
BUN:SCr will increase >20:1 in pre-renal azotemia
Serum lactate > 3 mmol?L = severe shock

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20
Q

Replacement Fluids 1st thing you do:

A

Initiate a 20 mL/kg bolus over 30 of NS and repeat until improved hemodynamics

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21
Q

Example of how to calculate percent of fluid loss

5% loss in a 70 kg 35 yo man

A

MF: 1500+ (20 50) = 2500
TBW: 0.670*0.05 = 2L

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22
Q

Replacement fluid rules

A

3/4 in the first 24 hours
Rest in the next 24-48 hours
Bolus is ALWAYS NS
RF can be 1/2 NS

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23
Q

Isotonic Crystalloids

A

Lactated Ringers
NS
100% extracellular

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24
Q

Hypotonic Crystalloids

A

Depending on osmolality fluid will move to intracellular space
D5W has no sodium or chloride
1/2 NS has some sodium and chloride
1/4 NS has even less sodium and chloride

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25
Q

Hypertonic Crystalloids

A

3% Saline

High sodium and chlroide

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26
Q

Isotonic Crystalloids

A

0.9% saline or NS

Has sodium and chloride

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27
Q

AE of Lactated Ringers

A

Hyponatremia
Hyperkalemia
Lactate –> bicarbonate (lactate will accumulate in liver disease)

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28
Q

D5W Uses

A

Uncomplicated dehydration or water deprivation

Dextrose is rapidly taken up by cells leaving free water

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29
Q

D5W AE

A

Hyponatremia

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30
Q

D10W

A

Not used in adults for replacement and is the last one able to be used in a peripheral line
- D35W has to be in a central line

31
Q

Crystalloid Advantages

A

Cheap
Long shelf-life
No infectious risk
No antigenic/allergenic

32
Q

Crystalloid Disadvantages

A

Not long lasting

2-4 times mor crystalloid is needed than colloid

33
Q

Protein Colloid Solutions:

A 
Albumin 5% or 25%
Plasmanate
Whole blood
PRBC
FFP
Cryoprecipitates
34
Q

Non-Protein Colloid Solutions

A

Hetastarch 6%

Pentastarch

35
Q

5% Albumin

A

Isotonic
Isooncotic with serum
2-4 potency of LF
Hypovolemic states

36
Q

25% Albumin

A

Isotonic
Hyperoncotic
**Hypovolemia with edema
Can pull fluids from intracellular to intravascular

37
Q

Albumin should be used FOR SURE in:

A

Cirrhosis because that is the only place it is shown to decrease mortality

38
Q

Normal Sodium

A

135-145 mEq/L

39
Q

***Serum sodium never reflect:

A

TOTAL BODY STORES OF SODIUM

40
Q

If your tank size increases, then

A

You are really hypervolemic and hypernatremic but your levels can show hyponatremic

41
Q

If your tank size decreases, then

A

You are really hypovolemic and hyponatremic but your levels can show hypernatremic (because you have a higher salt to water ratio even though your salt didn’t increase)

42
Q

120-130 mEq/L of Na symptoms

A

N/V malaise

43
Q

115-120 mEq/L of Na symptoms

A

Headache
Tremors
Loss of coordiantion**

44
Q

Less than 115 mEq/L of Na

A

Seizures and coma**

45
Q

Severity of hyponatremia is absed on:

A

Absolute decrease in sodium

Rapidity of onset

46
Q

Hyponatremia Assessment Steps

A

Determine volume status

Calculate serum osmolality

47
Q

Normal serum osmolality:

A

275-290 mOsm/kg

48
Q

Causes of Hypertonic Hyponatremia

A

Hyperglycemia (need to correct sodium for elevated glc)

Mannitol or toxic alcohols

49
Q

Pseudohyponatremia

A

If you have really high lipids (TG), then our serum sodium will be falsely lowered

50
Q

Causes of Isotonic Hyponatremia

A

Hyperproteinemia
Hyperlipidemia
Bladder irrigation
Pseudohyponatremia

51
Q

Causes of Hypotonic Hyponatremia

A

(↓ Na and ↓ osmolality)

Must consider volume status

52
Q

Hypotonic Hyponatremia + Hypervolemic

A

HF
Cirrhosis
Renal insufficiency

53
Q

Hypotonic Hyponatremia + Hypovolemic

A

Consider urinary sodium concentration

  • Less than 20 = extra-renal causes such as sweating, diarrhea, vomiting
  • Greater than 20 = renal causes typically diuretics
54
Q

Hypotonic Hyponatremia + Euvolemic

A

Syndrome of Inappropriate ADH (SIADH)
Cancer –> SIADH
Hypothyroidism

55
Q

Hypertonic and Isotonic HYPOnatremia Treatment

A

Underlying cause and consider fluids

56
Q

Hypotonic Hypovolemic Hyponatremia Treatment

A

Calculate volume depletion and correct with NS or 3% if severely sympotomatic

57
Q

***Sodium Rate of Corrects

A

0.33 mEq/L/hr or 8 mEq/L in 24 hours

58
Q

Hypotonic Hypervolemic Hyponatremia Treatment

A 
Underlying condition (diuretic for cirrhosis or CHF)
Fluid restriction to less than 1500 mL/day
59
Q

Hypotonic Euvolemic Hyponatremia Treatment

A 
Fluid restriction
IV 3% saline if severe symptoms
Demeclocycline
AVP receptor antagonists
Conivaptan (vaprisol)
60
Q

Demeclocycline

A

Inhibits actiono f ADH in kidneys
Delay in onset so only good for chronic
- Nephrotoxicity, photsensitivity, hepatotocitiy

61
Q

AVP Receptor Antagonists

A

Conivaptan
Lixivaptan
Tolvapatan

62
Q

Conivaptan

A

$$$
Inhibits ADH
- Infusion site rxns, thirst, headache, vomiting
IV only

63
Q

Asymptomatic Na Correction Rate

A

Less than 6 mEq/24 hrs

0.5-1 mEq/h

64
Q

What happens if you correct hypo too fast?

A

Osmotic Demyelination Syndrome ODS

65
Q

What happens if you correct hyper too fast?

A

Urical herniation (stop breathing)

66
Q

Hypernatremia Symptoms

A

Anorexia, muscle weakness, restlessness N/V

67
Q

Hypernatermia SEVERE symptoms

A

Altered mental status
Lethargy
Irritability
Coma

68
Q

Hypernatremia + Hypovolemia Causes

A

Dehydration
Dermal: swaeting/burns
GI: vomiting/diarrhea
Diuretics

69
Q

Hypernatremia + Hypervolemia Causes

A

Hypertonic saline
Tube ffeding
Sodium containing antibiotics

70
Q

Hypernatremia + Euvolemia Causes

A

Low urine osmolality = diabetes insipidus

71
Q

Hypernatremia Treatment Steps

A

Decrease Na by 0.33 mEq/hr

Determine water deficit and use 1/2 or 1/4 NS

72
Q

Saline options for hypovolemic/hyponatremia

73
Q

Saline options for hypovolemic/ severe hyponatremia

74
Q

Saline options for hypovolemic/hypernatremic

A

1/2 NS (still with a bolus of NS)

GI Exam 1 (8 decks)

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