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Internal Medicine > Fluid, Electrolytes and Acid Base Disorders > Flashcards

Fluid, Electrolytes and Acid Base Disorders Flashcards

1
Q

Normal urine output for adults

A

.5 to 1.0 mL/kg/hour
Low urine output could be a sign of volume depletion

Daily weights may be more accurate

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2
Q

Normal saline indications

A

dehydration or lost blood

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3
Q

D51/2NS indications

A

Standard maintenance fluid often with 20 mEq of KCl/L of fluid
Dextrose added to inhibit muscle breakdown

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4
Q

D5W indication

A

Sometimes used for hypernatremia

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5
Q

Lactated Ringer’s solution indications

A

Replacement of intravascular volume used for trauma resuscitation

Not used in hyperkalemia

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6
Q

Hypovolemia diagnosis and treatment

A

Diagnosis: Monitor urine output and daily weights
Critically ill (cardiac or renal dysfunction)-consider placing Swan Ganz catheter to measure CVP and PCWP
Elevated serum sodium, low urine sodium, and BUN/Cr ratio>20:1
Increased hematocrit

Treatment: use bolus to achieve euvolemia: normal saline or ringer’s solution
Maintain urine output at .5-1 ml/kg/hr
Replace blood loss with crystalloid at a 3:1 ratio

Maintenance fluid: D51/2NS with 20 mEq KCl/L

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7
Q

Hypervolemia diagnosis and treatment

A

Diagnosis: elevated CVP and PCWP, pulmonary rales
Low hematocrit and albumin concentration

Treatment: diuretics
Fluid restriction
Monitor urine output and daily weighs, consider Swan Ganz catheter

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8
Q

Hypotonic hyponatremia-hypovolemic causes and diagnosis

A

Low urine sodium less than 10-increaed sodium retention by kidneys to compensate for extrarenal losses
Diarrhea, vomiting, dipahoresis, burns, pancreatitis

High urine sodium: renal salt loss
Diuretics, Ace inhibs, ATN

Treatment: Na=120-130: restrict free water
Na=110-120: loop diuretics with saline
Na=less than 110 and symptomatic: hypertonic saline
Do not increase more than 8 mmol/L during first 24 hours

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9
Q

Hypotonic hyponatremia-euvolemic causes and diagnosis

A

SIADH, polydipisa, hypothyroidism, haloperidol, cyclophosphamide,

Urinary excretion of Na increased

Treatment: Na=120-130: restrict free water
Na=110-120: loop diuretics with saline
Na=less than 110 and symptomatic: hypertonic saline
Do not increase more than 8 mmol/L during first 24 hours

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10
Q

Hypotonic hyponatremia-hypervolemic causes and diagnosis

A

CHF, nephrotic syndrome, liver disease-urinary excretion of sodium decreased

RF: sodium urinary excretion increased

Treatment: Na=120-130: restrict free water
Na=110-120: loop diuretics with saline
Na=less than 110 and symptomatic: hypertonic saline
Do not increase more than 8 mmol/L during first 24 hours

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11
Q

Isotonic hyponatremia

A

An increase in plasma solids lowers the plasma sodium concentration but sodium in plasma is normal

elevated protein or lipid levels

Diagnosis: nromal (280-295) osmolality

Treatment: treat underlying disorder

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12
Q

Hypertonic (shrink) hyponatremia

A

osmotic shift of water out of the cell

Hyperglycemia, mannitol, glycerol, raidiocontrast agents

Diagnosis: high serum osmolality (>295)

Treatment: treat underlying disorder

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13
Q

Hypovolemic hypernatremia

A

Sodium decrease but water loss more
Renal loss: diutrics, osmotic diuresis (glycosuria), renal failure
Extrearenal loss: diarrhea, diaphoresis, respiratory losses

Diagnosis: low urine volume
urine osmolarity>800

Treatment: isotonic NaCl, hemodynamically stable then free water replacement

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14
Q

Isovolemic hypernatremia

A

Sodium stores normal, water loss
Diabetes insipidus, tachypnea

Diagnosis: low urine volume
urine osmolarity>800

Treatment: DI=vasopressin
oral fluids or D5W if they cannot drink

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15
Q

Hypervolemic hypernatremia

A

Iatrogenic
Exogenous glucocorticoids, cushigns, hyperaldosteronism

Diagnosis: low urine volume
urine osmolarity>800

Treatment: diuretics (furosemide), D5W to remove excess sodium
Dialyze if renal failure

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16
Q

Hypocalcemia treatment

A

Symptomatic: IV calcium gluconate
Long term management: oral calcium supplements (calcium carbonate) and Vitamin D

PTH deficiency: replacement therapy with Vitamin D plus high oral calcium intake
Thiazide diuretics

Correct hypomagnsemia

17
Q

Hypercalcemia treatment

A

Initial treatment is IV normal saline
Diuretics: furosemide

Inhibit bone resorption in osteoclastic-bisphosphonates, Calcitonin

Glucocorticoids if Vitamin D related mechanisms and multiple myeloma

Hemodialysis in renal failure patients

18
Q

Hypokalemia causes, diagnosis and treatment

A

Causes: vomiting and nasogastric drainage, diarrhea, laxatives
diuretics, excessive glucocorticoids, hyperaldosteronism, insulin, bactrim and amphotericn, epinephrine

Diagnosis: arrhytmias (Cause of death), flattened or inverted T waves, U waves, (exacerbates digitalis toxicity)

Treatment: Oral KCl safest 
IV KCL if less than 2.5 or arrhythmia (monitor cardiac rhythm)
Max infusion 10 mEQ/hr if peripheral
Max infusion 20 mEQ/hr if central 
Can use lidocaine to reduce pain

Treat hypomagnesemia

19
Q

Hyperkalemia causes, diagnosis and treatment

A

Causes: renal failure, Addisons disease, Potassium sparing diuretics, hypoaldosteronism, ACe inhibs, blood transfusions, Acidosis, rhabdo, hemolysis, insulin deficiency, rapid administration of B blocker

Diagnosis: Arrhythmia : V fib of note
peaked T waves, prolonged QRS, PR interval prolongation, loss of P waves, sine wave pattern

Treatment: Hyperkalemia >7.0 or ECG changes present give IV calcium (watch in digoxin)-stabilizes cardiac membrane
Glucose and insulin
Sodium bicarbonate: emergency measure
Kayexalate: prevents reabsorption in GI tract
Hemodialysis: rapid and effective-reserved for intractable hyperkalemia or in renal failure

Diuretics: furoseide for moderate with saline infusion
B2 agonists

20
Q

Hypomagnesium: clinical, causes, diagnosis and treatment

A

Causes: malabsorption (steatorrhea), prolonged fasting, receiving TPN, alcoholism, SIADH, diuretics, gentamicin, amphotericin B, cisplatin, renal transplantation, postparathyrodectomy, DKA, thyrotoxisis

Clinical: muscle twitching, weakness, tremors, hyperreflexia, seizures, mental status changes

Concomitant: hypocalcemia (inhibits PTH and decreases effect of PTH on bone), hypokalemia

Diagnosis: prolonged Qt (torsades), T wave flattening

Treatment: mild oral Mg (mg oxide)
Severe-parenteral Mg (Mg sulfate)’
oxide is oral, sulfate is stabbed

21
Q

Hypermagnesium: clinical, causes, diagnosis and treatment

A

Causes: RF, early stage burns, massive trauma, surgical stress, severe acidosis, Adrenal insufficiency, rhabdo,

Clinical: Nausea, weakness, facial paresthesias,
progressive loss of deep tendon reflexes (first sign)
somlonence and coma-occur late
Death due to respiratory failure or cardiac arrest

Diagnosis: increased PR interval, widened QRS, elevated T waves

Treatment: IV calcium gluconate for emergent symptoms
Administer saline and furosemide
Dialysis for renal failure
Prepare to intubate

22
Q

Hypophosphatemia: causes, clinical, diagnosis and treatment

A

Causes: alcohol abuse, Vit. D deficiency, excessive use of antacids, TPN, starvation
Excess PTH, hyperglycemia, ATN, hypokalemia, hypomagnesia
respiratory alkalosis, steroids, hyperthermia, DKA

Clinical: asymptomatic if mild
if Severe:
encephalopathy, seixures, paresthesia, hemolysis, RBC/WBC/platelets dysfunction, cardiomyopathy-low ATP (cardiac arrest), rhabdo, anorexia

Treatment: mild (>1 mg): oral supplementation: neutra Phos capsules, K-Phos tablets, milk
severe or NPO: parenteral supplementation

23
Q

Hyperphosphatemia: causes, clinical, diagnosis and treatment

A

Causes: renal insufficiency, bisphosphonats, hypoparathyroidsm, Vit. D intoxication, rhabdo, cell lysis or acidosis

Clinical: metastatic calcification-tetany, neuromusclar irritability

Treatment: phosphate binding antacids containing aluminum hydroxide or carbonate-prevent its absorption
Hemodialysis

24
Q

Saline responsive metabolic alkalosis

A

ECF contraction and hypokalemia
vomiting or nasogastric suction
Diuretics
laxative abuse

Give Saline with potassium

25
Q

Saline resistant metabolic alkalosis

A

ECF expansion and hypertension, low Cl
Hyperaldosteronism, cushings, sever K deficiency, and diuretic abuse

Give spironolactone

26
Q

Higher than what PaCO2 level implies superimposed respiratory acidosis on metabolic alkalosis

A

PaCO2 >50-55

27
Q

Treatment of respiratory acidosis

A

if PaO2 less than 60=supplemental O2

Naloxone if morphine induced

Intubation:
severe acidosis
PaCO>60 or inability to increase O2
Deterioration of mental status 
Impending respiratory fatigue

Internal Medicine (17 decks)

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