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Nephrology > Fluid Electrolyte Imbalances > Flashcards

Fluid Electrolyte Imbalances Flashcards

1
Q

Which electrolytes would you find in the ECF? ICF?

A

ECF: Na+, Cl-, HCO3-

ICF: K+, Mg, Phosphates

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2
Q

Total Body water volume is can be broken down into what compartments?

A

Intracellular fluid & Extracellular fluid.

*Interstitial fluid and plasma make up the extracellular fluid

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3
Q

Water movement from ECF to ICF regulated by?

A
  • Starling forces: hydrostatic pressure(capillary and interstitial) and osmotic pressures(plasma protein and interstitial protein).
  • Osmolality
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4
Q

By what route can you give 3% normal saline?

A

in central line only!! This will destroy peripheral veins. this is very hypertonic.

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5
Q

What are the IV solutions & what is in each?

A
  • D5W (sugar and water)
  • Normal Saline (water and NaCl)
  • Lactated ringers ( Na+, Cl-, lactate, Ca2+, K+)
  • Albumin
  • Blood Products:

–packed RBC

–FFP

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6
Q

Describe Na and Water balance in the following:
-hypervolemia

  • hypovolemia
  • hyponatremia
  • hypernatremia
  • edema
A

Hypervolemia:

  • too much water
  • too much Na+

Hypovolemia:

  • not enough water
  • too little Na+

Hyponatremia:

  • too much water
  • not enough Na+

Hypernatemia_

  • too little water
  • excess of Na+

Edema:
-too much Na+ w/ water retention in the interstitial space

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7
Q

Determing the severity of edema

A

PITTING

  • 2mm = +1
  • 4mm = +2
  • 6mm = +3
  • 8mm = +4

Skin Turgor
Dry mucous membranes
Tachycardia

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8
Q

Tx of Mild dehydration and moderate hypovolemia?

A

Dehydration:

  • fluids with some electrolytes
  • AVOID fluids with high sugar concentration (b/c draws fluid out_
  • stop activities that create ongoing loss.

Mod. Hypovolemia:
-get a full hx, sx, oral replacement

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9
Q

Sodium

  • normal value
  • considered hyponatremic
  • value to start tx
  • panic value
A

normal: 135-148meq/L
hyponatremic: less than 135meq/L

Start tx: 120-130 dependent upon sx and situation

Panic: less than 120meq/L

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10
Q

WHat is normal lab value:

  • serum osmolality
  • urine osmolality
  • sodium
  • cl
  • specific gravity
A

Serum Osmolality: 285-295mOsm/kg

Urine Osmolality: 24hr specimen=500-800mOsm/KgH20
random specimen= 50-1200mOsm/KgH20

Sodium: 135-145mEq/L

Cl: 95-105mEq/L

Specific Gravity: 1.003-1.030
high= dehydration
low= diabetes insipidus

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11
Q

Clinical Manifestations of Hyponatremia:

  • chronic
  • Acute
A

Chronic: fatigue, nausea, dizziness, confusion, lethargy, muscle cramps, gait disturbances, forgetfulness.
*Cerebral adaptation

Acute: fatigue, malaise, HA, lethargy, coma, seizures, resp arrest
*cerebral over hydration related to degree of hyponatremia. Neuronal cell expansion and cerebral edema….death.

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12
Q

What is one SE of correcting hyponatremia too fast?

A

osmotic demyelination

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13
Q

Hyponatremia may be further classified as:

  • Hypovolemic
  • Normovolemic
  • Hypervolemic

what are some causes of each volume status?

A

Hypo: GI losses, renal losses(thiazides)

Normo: SIADH, low Na+ intake

Hyper: CHF, cirrhosis

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14
Q

Hyponatremia may be caused by:

a. inability to suppress ADH
b. appropriate suppression of ADH secretion

…what are some examples of each.

A

inability to suppress b/c:

  • true volume depletion (GI/renal loss)
  • decreased tissue perfusion
  • syndrome of inappropriate ADH secretion

Appropriate suppression of ADH:

  • polydipsia*
  • low dietary solute intake
  • advanced renal failure.
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15
Q

Treatment of Hypovolemic Hyponatremia?

A

Tx: normal saline/isotonic saline

*usually volume replacement orally or IV if more severe.

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16
Q

Tx Hypervolemic Hyponatremia?

A
  • restrict fluids 1000-1200ml/day
  • restrict sodium 1000-1200 mg/day
  • utilize loop diuretics to remove excess fluid
17
Q

SIADH
-what is this?

  • describe the volume,tonicity, and Na concentration
  • causes
  • tx
A

What: too much anti-diuretic hormone

Describe: Hypervolemic hypotonic hyponatremia

Causes:
-drugs: carbamazepine, SSRIs, haloperidol, thorazine

-disease: Malignancies, CNS disorders, post surgery, pulm infections

Tx:

  • treat the underlying cause
  • fluid restriction is mainstay***
  • may use oral salt tablets
  • loop diuretics
18
Q

Tx of SEVERE Hyponatremia, what are they at risk for?

what are some tx precautions?

A

At risk for brain herniation!

Tx:

  • 3% hypertonic saline
  • measure Na every hour.

Precautions:
-develop osmotic demyelination if increase Na too quickly.

19
Q

Hypernatremia

  • common causes
  • describe whats happening in acute and chronic
  • tx
A

Common causes:

  1. loss of water**(insensible and sweat, GI losses)
  2. Addition of hypertonic solution
  3. Sodium overload (intake or admin of hypertonic Na solution)

Acute:
-rapid decrease in brain volume can rupture cerebral veins leading to SAH, demyelinating brain lesions

Chronic:
-brain adapts by pulling water from CSF and increasing the uptake of solutes by cells which also increases the amount of water in the cells.

Tx:
-replace free water with D5W (b/c if you gave them free water it would mess up their brain)

-*add normal saline IF hypovolemic

20
Q

Diabetes Insipidous

  • describe Na concentration
  • may be central or nephrogenic, describe the cause of each and the tx
A

Hypernatremia

Central:

Cause: not enough ADH
Tx: Desmopressin (ADH like activity) and fluid restriction

Nephrogenic:

Cause: kidney resistant to ADH.
Tx: Thiazide diuretic to decrease ECF and Na+, also sodium restriction.

21
Q

When deciphering calcium lab values what other lab value must you consider?

A

ALBUMIN!!!!!!!!

if albumin level is not normal you need to correct for that..

22
Q

Hypercalcemia

  • causes
  • sx
  • tx
A

Cause:
-cancer and primary hyperparathyroidism (Benign adenoma is MC cause)

-Drugs: thiazide diuretics, calcium supplements, lithium

Sx:

  • EKG changes
  • N/V, anorexia, constipation
  • Polyuria/dypsia
  • neuro/psych sx

-untreated manifestations:

–metastatic calcification

–nephrolithiasis

–renal failure

Tx: Hypercalcemic Crisis

  • saline and loop diuretics
  • bisphosphonates
  • osteoclast inhibitors: calcitonin
  • dialysis

*Tx of hyperparathyroidism is surgically remove the glands.

23
Q

Hypocalcemia

  • causes
  • sx
  • ekg changes
A

Causes:
-hypoparathyroidism, Vit D deficiency, loop diuretics, phosphates

Sx:
-tetany, paresthesias around mouth** hallmark sx

Ekg:
-QT prolongation

24
Q

Loop diuretics have what effects on Ca, Mg, and K…and Na.

A

Ca: decrease reabsorption…hypocalcemia

Mg: decrease reabsorption…hypomagnesemia

K: decrease reabsorption…hypokalemia

Na: decrease reabsorption…hyponatremia

25
Q

Tx Acute Symptomatic HypoCalcemia

A

IV calcium salts (elemental)

*magnesium if hypomagnesaemia present

26
Q

Tx Chronic Hypocalcemia

A
  • oral calcium supplements (1-3g elemental Ca/day

- if not responding add Vit D 1000 IU/ day

27
Q

Hyperphosphatemia

  • causes
  • tx
  • sx
  • emergent tx
A

Cause:
-decreased excretion d/t low GFR

-chemotherapy & rhabdo

Tx:

  • GI binders…IV calcium salts.
  • usually in renal failure:
  • -diet restriction
  • -phosphate binding gel (selvelamer)
  • -avoid alluminum containing antacids-can cause bone dz

Sx:

  • dysrhythmias, HTN
  • muscle cramps
  • seizures, tetany
  • N/V/D
  • acute renal failure, edema

Emergent: dialysis

28
Q

Hypophosphatemia

  • sx
  • Tx
A

Sx:
-rare, long term may have proximal muscle weakness and osteomalacia

Tx:
Severe/Symptomatic:

-IV phosphorus: sodium PO4, Potassium PO4

Mild/Mod:

  • Neutra-Phos
  • Neutra-Phos K
29
Q

Hypomagnasemia

  • causes
  • sx
  • EKG
  • Tx
A

Cause:
-increased excretion (diuretics,alcoholism)

  • Impaired absorption (GI dz)
  • Reduced Intake
  • drugs: aminoglycosides, cisplatin, cyclosporine

Sx:
-muscle cramps, tetany, seziures, coma, hypocalcemia

EKG: wide QRS, afib, ventricular arrhythmias

Tx: if symptomatic or less thatn 1.0mEg/Ml

  • IV MgSO4 if symptomatic/severe
  • Oral replacement if mild/mod.
30
Q

Hypermagnesemia

- Tx

A

IV calcium – strictly to antagonize neuromuscular and cardiovascular effects of magnesium.

  • renal failure: hemodialysis
  • normal renal function: diuresis w/ fluid and loop diuretics
31
Q

Hypokalemia
-causes
-EKG
-

A

Causes:
-Drugs: beta 2 agonists, loop diuretics, ACEi, thiazides, insulin, high dose PCN, amphotericin B

-Medical: metabolic acidosis, vomiting, diarrhea

EKG: U waves

32
Q

Hypokalemia Tx:
-loop/thiazide induced

-severe or symptomatic

A

Loop/thiazide:
-Potassium supplement oral

Sever/Symptomatic:
-IV K+ in saline bag

33
Q

Hyperkalemia

  • causes
  • sx
  • EKG
  • Tx
A

Causes:

  • increased K+ intake
  • decreased excretion
  • aldosterone resistance

Sx:
-ascending muscle weakness

EKG:
-eiffel tower peaked QT waves, shortened QT interval

as it becomes more severe… QRS & QT prolongation p waves may disappear..may lead to vfib or asystole

Tx:
-if abnormal EKG: Calcium gluconate IV,
D5W then insulin,
consider bicarb if acidotic

  • if renal failure:
  • -dialysis
  • -K+ binders (Sodium polystyrene sulfonate)

loop diuretic if not volume depleted and kidneys okay.

Nephrology (8 decks)

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