Fluid & electrolyte disturbances Flashcards
hyponatremia- Sx
- Nausea, malaise, HA, disorientation
- Seizure
- Coma
- Brain damage
- Resp arrest
- Brainstem herniation
- Often due to H2O inbalance rather than Na
hyponatremia- Dx
- Serum electrolytes
- creatinine,
- osmolality,
- urine sodium
hyponatremia- Tx
- Restrict water
- Isotonic fluids
- Diuretics
- Discontinue meds
- Vasopressin antagonists
Hypernatremia- Sx
- Orthostatic hypotension
- Oliguria
- Lethargy, irritability, weakness
- hyperthermia, delirium, seizures, coma
- May not be specific in elderly
Hypernatremia- Dx
- Urine osmolality
- Serum osmolality
Hypernatremia- Tx
- Correct fluid loss with dextrose & saline water over 48 hrs
- Add K & phosphate as needed
Hypokalemia- Sx
- Muscular weakness, muscle cramps
- Hyporeflexia, hypercapnia, tetany, rhabdomyolysis
- Hypertension
Hypokalemia- Dx
- ECG- U waves
- Serum & urine concentration
- TTKG
- Hypomagenesmia
Hypokalemia- Tx
- Dietary to IV K
- Mg required to replete
Hyperkalemia- Sx
- Abd distension & diarrhea
- Musc weakness, flaccid paralysis, ileus
- Cardiac arrythmias
Hyperkalemia- Dx
- Plasma potassium
- Creatinine, lytes
- ABG
ECG- peaked T waves
Hyperkalemia- Tx
- Withhold K
- Insulin, bicarb, beta agonists to shift K into cells
- IV Ca++ to stabilize myocardium
- Hemodialysis
Hypocalcemia- Sx
- Extensive spasm- cramps & tetany
- Laryngospasm with stridor
- Covulsions, paresthesias, abd pain
- Trousseau sign
- Chvostek sign
Hypocalcemia- Dx
- Serum calcium
- Elevated serum phosphate
- PTH
- Low serum Mg
- Vit D levels
- ECG- Prolonged QT interval
Hypocalcemia- Tx
- Calcium infusion over 4-6 h
- Oral/ IV Ca++ carbonate
- Vit D
Thiazide diuretic to reduce renal loss
Hypercalcemia- Sx
- GI, kidney & neuro fxn
- Constipation & polyuria
- N/V
- Hematuria
- Depression, stupor, lethargy
Hypercalcemia- Dx
- Serum & ionized Ca
- Urine Ca
- PTH
Hypercalcemia- Tx
- Establish euvolemia to induce renal excretion
- dialysis
- Bisphosphonates
Hypophosphatemia- Sx
- Resp failure
- Encephalopathy
- Arrhythmia
- Anorexia
- Fracture
- Hemeolytic anemia- petechea
Hypophosphatemia- Dx
- Urine phosphate
- PTH
Hypophosphatemia- Tx
- Oral phoshate replacement
Hyperphosphatemia- Sx
- Symptoms of underlying disease
- Extraosseous calcification of soft tissue/ vasculature
- Acute kidney injury
- Secondary hyperparathyroidism
- Renal osteodystrophy
Hyperphosphatemia- Dx
Serum phosphate
Hyperphosphatemia- Tx
- Tx underlying disorder
- Calcium carbonate
- Decreased intake- dairy, meats, processed foods
Hypomagnesemia- Sx
- Neuromuscular & nervous system hyper irritability
- Termors
- Babinski response
- Nystagmus
- HTN, tachycardia, ventricular arrhthymia
- Weakness & cramping
Hypomagnesemia- Dx
- Serum magnesium
- Urine excretion
- Low PTH
- Hypo kalemia, calcemia
Hypomagnesemia- Tx
- IV Mg sulfate
Hypermagnesemia- Sx
- Decreased DTR
- Confusion & weakness
- Mental obundation
- Resp muscle paralysis, cardiac arrest
Hypermagnesemia- Dx
- Serum Mg
- Elevated- BUN, Serum creatinine, uric acid
Hypermagnesemia- Tx
- Calcium chloride as antagonist
Hyponatremia w/ high plasma osmolality
- Hyperglycemia
Hyponatremia w/ normal plasma osmolality
- Hyperlipidemia
- Hyperproteinemia
- Commonly due to lab error
Hyponatremia w/ low plasma osmolality
- Most common
- Hypovolemia
- Euvolemia
- Hyper volemia
Hyponatremia w/ low plasma osmolality- Hypovolemia
Thiazides, hypoaldosterone, renal salt wasting, V/D, blood loss, 3rd spacing
Hyponatremia w/ low plasma osmolality- Euvolemia
Most common
- SIADH
- Hypothyroid
- Adrenal insufficiency
- primary polydipsia
Hyponatremia w/ low plasma osmolality- Hypervolemia
HF, cirrhosis, liver failure, nephrotic syndrome
