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Fluid Balance Flashcards

1
Q

Complications HyperNa

A
  • hemorrhage due to shrinking of brain and shearing of essels
  • central pontine myelinosis
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2
Q

Most common causes hyperna due to water gain

A
  • iatrogenic
  • improper mixing of forumula
  • hyperaldo
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3
Q

Presentation Hyperaldo

A

hypernatremia with hypokalemia and hypertension

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4
Q

Common cuase hyperna due to water loss

A
  • diabetes insipidus

- intake defciency

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5
Q

What is factitious hyponatremia? Dilutional?

A
  1. triglycerides

2. glucose

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6
Q

Causes hyperna due to water loss > na loss

A
  • crhonic renal disuse
  • obstructive uropathy
  • osmotic diuresis
  • skin or GI losses
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7
Q

What is the most common cause of hypovolemic hyponatremia

A

AGE

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8
Q

Causes hypovalemic hyponatremia

A
  • GI, skin, third spacing, kidney
  • diuretics
  • cerebral salt wasting
  • hypoaldosteronism
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9
Q

pathophys of hypervolemic hyponatremia

A

increased in ADH due to decrease in effective blood volume (cardiac, third spacing) resulting in water retention
-also increase in Na retention due to RAAS

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10
Q

Causes hypervolemic hyponatremia

A
  • CHF, cirhrhosis, nephrotic

- renal failure

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11
Q

Causes Euvolemic hyponatremia

A
  • SIADH
  • water intoxication if kidneys cant eliminate
  • glucocorticoid deficiency
  • hypothyroidism
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12
Q

Lab Findings SIADH

A

serum Na < 135
serum osm < 280
Urine Na > 25 (dumps Na due to slight increase in ECF)
Urine osmol > 100

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13
Q

What causes normal anion gap metabolic acidosis?

A
  • diarrhea

- RTA

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14
Q

What causes anion gap metabolic acidosis?

A
  • ketoacidosis
  • lactic acidosis
  • renal failure (photphate, urate, sulfate)
  • drugs: salicylates, ethylene glycol,metahnol, toluene
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15
Q

Best test to determine causes of meatbolic alkalsois?

A

low or high urinary chloride (low is < 15, high is greater than 20)

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16
Q

Causes chloride responsive (low chloride urine) metabolic alkalosis?

A
  • gastric losses
  • chloride losing diarrhea
  • thirazides
  • loops
  • cystic fibrosis
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17
Q

Pathophys chloride responsive metabolic alkalosis?

A
  • volume depletion causes increased resportion of Na and HCO3 in proximal tubule
  • increase in aldosterone due to volume depletion causes increase in HCO3 and H+ absorption in collecting ducts; hypokalemia
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18
Q

How do you separate the two types of chloride unresponive (high urine chloride) metabolic alkalosis?

A

elevated blood pressure or not

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19
Q

High BP chloride resistance metabolic alkalosis

A
  • adrenal hyperplasia or adenomas

- cushing

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20
Q

Normal BP chloride resistance metabolic alkalosis?

A
  • renovascular
  • bartter / gittelmann
  • AD hypoparathyroidsm
  • iatrogenics
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21
Q

What causes metabolic alkalosis in CF?

A

-loss of NaCl in sweat with dehydration causing metabolic alkalosis with hypokalemia; also hyponatremia

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22
Q

What is Bartter / Gitelman Syndrome

A

-defect in NaCl in loop of henle -> dehydration –> secondary hyperaldo–>hypokalemic metabolic alkalosis

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23
Q

What drugs can cause hyperkalemia in renal patients

A
  • K sparing diuretics
  • NSAIDs
  • heparin
  • acetylcholinesterase inhibits
24
Q

ECG Findings with Hyperkalemia in order

A
  • Peaked T waves
  • prolonged PR
  • flat p waves
  • wide QRS
  • V fib or asystole
25
What can cause factitious hypokaelmia
leukocytosis
26
Non renal causes hypok
- diarrhea - laxatives - excessive sweat - anorexia / decreased intake
27
Renal causes hypokaelmia
- metabolic acidosis (DKA, RTA) - hypomagnesemia - metbolic alkalosis with contractions alkalosis - diuresis with obstructive nephropathy - tubulo interstitial
28
ECG findings hypok
- flattened T waves - depressed ST wave - U wave between T and P - v fib / torsades
29
Mild Dehydration on exam
- normal exam and tachycarida | - slight decrease UOP
30
Moderate Dehydration on exam (5 to 10 infant, older child 3 to 6%)
- lethargic, sunken eyes, sundken fontanelle - decreased tears and dry mucous membranes - decreased skin turgor - cap refill > 2 seconds - decreased UOP - tachy
31
Breastfeeding contraindicated if women have these diseases
- HIV (if formula available) - PKU - Galactosemia - hepatitis c - untreated active TB (can hand express)
32
When can a mom not breastfeed but can give expressed milk
varicella | -untreated TB (2 weeks treatment and documented egative first)
33
Mothers and substance use and breastfeeding
- c/i if cocained or PCP etc - alcohol: must wait 2 hours after one drink - smoking is not contraindicated
34
Contraindicated drugs breastfeedign
- lithium - retinoids - ergotamine - bromocriptin - cyclophosphamide and most chemo agents - MTX
35
Differences Milk and Cows milk proteins
- human is whey dominant | - cow milk is casein
36
When do we start iron fortification in babies?
4 to 6 months
37
When do we use elemental formulas lik eneocate?
short gut, severel malabsorption syndrome, severed IBD, fistulas
38
What nutrition deficiency are you at risk for for goat's milk?
folic acid
39
What vitamin deficiency are vegetarians at risk for?
vitamin b12
40
Low magnesium causes secondary ***
hypocalcemia due to decreased released of PTH and function
41
Zin Deficiency
- growth deficiency - delayed healing - diarrhea - skin lesions: acrodermatitis enteropathica (mouth, perianal
42
Copper deficiency
- microcytic anemia - neutropenia - neurologic dysfunction - osteoporosis - skin/hair depigmentation
43
Chromium Deficiency
-peripheral neuropathy 0encephalopathy -glucose intolerance
44
Vitamin A Deficiency
- night blindness - dry scaly skin - xeropthalmia (cannot make tears) - increased ICP
45
Hypervitaminosis A
- pseudotumor cerebri (diplopia, HA, papilledema, emesis) - yellow skin - hepatosplenomegaly - desquamation palms and soles - alopecia
46
Rickets Presentation
- craniotabes - rachitic rosary - widening of epiphysis and wrists and ankles - non traumatic fractures
47
Rickets on XR
- thick epiphyses - metaphyseal fraying with cupping (loss of sharp border with concave edge) - widening of distal metaphysis
48
Hyper Vitamin D
- hypercalcemia - constipation - pancreatitis - CNS findings - polyuria - nephrocalcinosis
49
Vitamin E Deficiency
- hemolytic anemia - neuro symptoms: cerebellar and posterior column - retinal issue
50
What factors are assd with vitamin K
II, VII, IX, X
51
B6 deficiency
- aka thiamine | - Beriberi (CNS, CV)
52
Niacin deficiency
- usually where corn is main staple | - peiroral dermatitis, dementia, diarrhea
53
Where is vitamin b 12 absorbed
terminal ilieum
54
What is strongest predictor of childhood obesity
parental obesity
55
Test for protein losing enteropathy
stool for alpha 1 antitrypsin

Kaplan (8 decks)

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