Fluid & electrolyte imbalance Flashcards
What are the symptoms of hypernatramia. (normal value = 133 - 146 mmol/L)
Convulsions Hypovolaemia - decreased volume of circulating blood in the body. Thirst Dehydration Oliguria - low urine output Postural hypotension Tachycardia
What are some drugs that cause hypernatraemia?
COC Corticosteroids Na bicarbonate Na content in intravenous Abx Li
Hypernatraemia caused by volume depletion, e.g. diabetes insipidus by IV gluclose
What are the symptoms of hyponatraemia (normal value = 133 - 146 mmol/L)
Drowsiness Confusion Convulsions N/V Headaches Cramps
What are some drugs that can cause hyponatraemia?
Antidepressants
Loop and thiazide diuretics
Carbamazepine
Desmopressin
What would you treat mild-moderate hyponatraemia.
ORAL NaCl / Na bicarbonate (add glucose if there is water depletion)
What would you treat sever hyponatraemia?
IV Saline (isotonic: via. peripheral vein OR concentrated: via central vein) Give slowly; risk of osmotic demyelination syndrome
What would you give to a person for REHYDRATION and they have an electrolyte imbalance?
- Oral rehydration therapy (K+, Na+, glucose)
This is given over 3 - 4 hours in diarrhoea
Over 12h in hypernatraemic dehydration, e.g. diabetes insipidus
What would you give a person for REHYDRATION if they have a water deficit?
- INTRAVENOUS GLUCOSE
Should not be given alone unless there is no significant loss of electrolytes, e.g. hypercalcemia or diabetes insipidus.
What would you use to treat metabolic acidosis (hyperchloraemia)?
Normal value (Cl-) = 103 mmol/L
- Na bicarbonate
- If caused by low K+ = K bicarbonate
What would you use to treat a Ca2+ imbalance? (Hypercalcaemia and hypercalciuria (secondary from high Ca2+)
Normal range = 2.10 - 2.58 mmol/L corrected
Hypercalcaemia = BISPHOSPHONATES or CORTICOSTEROIDS.
What would you use to treat hypercalcaemia of malignancy?
Calcitonin
What would you use to treat hypercalcaemia caused by hyperparathyroidism?
CINALCET reduces parathyroid hormone therefore Ca2+
PARACALCITOL - in chronic renal failure
What would you use to treat hypercalciuria?
BENDROFLUMETHIAZIDE - increase fluid intake and reduce dietary Ca2+
What would you use to treat milk-moderate hypocalcaemia?
Low Ca2+ can cause osteoporosis.
VITAMIN D & CA SUPPLEMENTS
What would you use to treat severe acute hypocalcemia or hypocalcaemic tetany?
SLOW IV CA GLUCONATE (too rapid = arrhythmias)
What would you treat for hypomagnesaemia?
Normal range = 0.7 - 1.05 mmol/L
IV/IM Mg sulphate
This is common in alcoholics.
Low Mg can lead to hypos in Ca2+, K+, and Na+
What would you use to treat hyperphosphatemia?
CALCIUM CONTAINING PREPS
(phosphate-binding agent) = e.g. Ca acetate with MgCO3; lanthanum for ppl with chronic renal failure; Ca acetate.
Normal range = 0.85 - 1.45 mmol/L
What would you treat patients with hypophosphataemia?
PHOSPHATE.
Give intravenously if moderate to severe.
What are the symptoms of hyperkalaemia?
Normal range = 3.5 - 5.3 mmol/L
Ventricular fibrillation
Cardiac arrest
What dugs can cause high K+?
Heparin ACEi ARBs Digoxin BB Eplerenone Amiloride NSAIDs Spironolactone
What would you use to treat mild-moderate hyperkalemia with no ECG changes?
CALCIUM RESONIUM
What would you use to treat acute, severe hyperkalemia > 6.5 mmol/L
SLOW IV CA GLUCONATE
- IV insulin, glucose and salbutamol can be given in addition
- Add Na bicarbonate to correct compounding acidosis. Don’t give via the same line; precipitation = thrombosis
What are the symptoms of hypokalaemia?
Muscle hypotonia = decreased muscle tone
Arrhythmias = abnormality of the heart’s rhythm
What are some drugs that can cause hypokalemia?
Diuretics Insulins B2 agonists Theophylline Corticosteroids
What would you use to treat mild hypokalemia?
ORAL SLOW KCL
- N/V cause poor compliance
- Smaller doses in renal impairment
- If caused by diuretic = K+-sparing diuretic preferred
What would you use for severe hypokalaemia?
IV KCL
- Don’t add glucose for initial K replacement as glucose causes hypokalemia
- KCL injection overdose is fatal = use read-mixed solution OR thoroughly mix concentrate
What is acute porphyrias?
This is a genetic defect in haem biosynthesis.
If certain drugs are taken haemolytic anaemia and acute porphyric crises can occur.
How would you treat acute porphyric crises?
Haem Arginate for moderate, severe or unremitting crises.
What is SPN?
Supplementary Parenteral Nutrition.
This is given in addition to PO/enteral feeds
What is TPN?
Total Parenteral Nutrition. This is the sole source of nutrition.
- Glucose is given via a central vein to avoid thrombosis
- Give enough phosphate to allow the phosphorylation of glucose
- Fructose and sorbitol are added to avoid hyperosmolar hyperglycaemia and nonketotic acidosis.
- Don’t add additives to fat emulsions unless compatibility known
