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Clin Med III Exam II > Fluid, electrolytes and imbalances > Flashcards

Fluid, electrolytes and imbalances Flashcards

1
Q

What are common anions in the body

A

Cl- and HCO3-

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2
Q

What are anions involved in? In which organs?

A

acid base regulation in the kidneys and lungs

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3
Q

What would you adjust sodium and bicarb levels based on

A

serum pH

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4
Q

What can the electrolytes tell you about a patient?

A
  • volume status
  • acid base status
  • renal function
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5
Q

What is osmolality measured in

A

mOsmol/L

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6
Q

What is omolality

A

concentration of solutes per liter of solution (sodium, potassium, glucose, urea)

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7
Q

What would increased serum osmolality suggest?

A

volume depletion and concentration of electrolytes

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8
Q

what would decreased serum osmolality suggest?

A

volume overload and dilution of electrolytes

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9
Q

What is normal intake/output of water in a normal adult

A

1600 in 1600 out

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10
Q

What controls the H2O balance in the body

A

antidiuretic hormone

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11
Q

Where is ADH secreted

A

posterior pituitary

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12
Q

What causes dysnatremias

A

malfunction of the feedback mechanism within the kidneys

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13
Q

What is third spacing

A

when there is a large volume of fluid from the intravascular compartment that shifts into an interstitial space

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14
Q

When is third spacing seen

A

trauma, burns, sepsis, ascites, pleural effusion

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15
Q

What are colloids? Where do they remain?

A

solutions that do not cross the cell membrane because they are too big so they remain in the intravascular compartment

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16
Q

What are examples of colloid solutions

A
  • albumin solutions
  • hypertonic starch
  • dextran
  • gelatin
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17
Q

What do colloid solutions do

A

expand the intravascular volume and draw fluid from the extravascular spaces via higher oncotic pressure

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18
Q

What are crystalloids

A

solutions that contain small molecules that easily pass through cell membrane

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19
Q

Where do crystalloid fluids increase fluid volume

A

both the intersitial and intravascular space

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20
Q

What is an isotonic solution

A

has the same concentration of solutes in the blood so the cells content stays the same

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21
Q

What are hypotonic solutions

A

has lower concentration of solutes so solution moves into cells causing them to swell

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22
Q

What are hypertonic solutions

A

have a higher concentration of solutes so solutions pull fluid from the cells so they shrink

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23
Q

What are the isotonic IV fluids

A
  • normal saline
  • lactated ringers
  • ringers solution
  • D5W
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24
Q

Indications for giving normal saline

A

LOW INTRAVASCULAR VOLUME

  • dehydration
  • severe vomiting/diarrhea
  • mild hyponatremia
  • hemorrhage
  • shock
  • metabolic acidosis
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25
Q

What is the only IV fluid that can be given with blood products

A

normal saline

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26
Q

What to lactated ringer mimic?

A

the blood and plamsa concentration

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27
Q

What electrolytes are in lactated ringers

A

sodium, potassium, chloride, bicarb

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28
Q

When are lactated ringers indicated?

A
  • diarrhea/vomiting
  • drainage from fistula
  • fluid loss due to burns
  • metabolic acidosis
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29
Q

When should you not give lactated ringers? Why?

A
  • liver disease (cant metabolize lactate)
  • lactic acidosis (contains lactate)
  • pH greater than 7.5
  • caution with renal impairment (contains K)
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30
Q

What is the difference between ringers solutions and lactated ringers?

A

presence of lactate

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31
Q

When would you give ringers solution?

A

-contraindication to giving lactated ringers

lactic acidosis, liver disease

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32
Q

What effect does D5W have on blood products

A

hemolysis

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33
Q

What happens to D5W when it gets metabolized

A

becomes hypotonic–>fluid shifts into cells

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34
Q

Which solutions are considered hypotonic

A
  • 2.5 dextrose
  • 0.45 normal saline (half normal)
  • 0.33/0.2 NaCl
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35
Q

When are hypotonic solutions indicated

A

-patients with conditions causing intracellular dehydration

hypernatremia, DKA, hyperosmolar hyperglycemia

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36
Q

When should you use cautions with hypotonic solutions

A
  • dehydration
  • hypotension/hypovolemia
  • liver disease
  • trauma
  • burns
  • increased risk for ICP
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37
Q

What are examples of hypertonic solutions

A
  • 3/5% NaCl

- concentrated dextrose >10%

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38
Q

What are the complications of giving hypertonic fluids

A
  • fluid overload

- pulmonary edema

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39
Q

When are hypertonic solutions indicated

A
  • severe hyponatremia

- dehydration

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40
Q

What do dysnatremias have to do with

A

hydration status more so than circulating sodium

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41
Q

When is hyponatremia considered severe

A

<120

42
Q

What is hyponatremia classified as moderate

A

120-129

43
Q

When is hyponatremia considered mild

A

130-134

44
Q

What are some causes of hyponatremia

A
  • heart failure
  • cirrhosis
  • renal failure
  • aggressive IVFs
  • hyperglycemia
  • hypertonic mannitol administration
  • SIADH
  • chronic ETOH
  • water intoxication
45
Q

Cut off for acute hyponatremia

A

48 hours

46
Q

Does acute or chronic hyponatremia have more complications

A

acute

47
Q

What are the most important determinants of the onset of hyponatremia sx

A

degree of hyponatremia and how fast it develops

48
Q

If Na+ falls below 125-130 what clinical signs will you see

A

nausea, malaise

49
Q

If Na+ falls below 115-120 what clinical signs will you see

A
  • HA
  • lethargy
  • obtunded/coma
  • seizures
  • respiratory arrest
  • pulmonary edema
50
Q

What can excess overcorrection cause in hyponatremic patients

A

osmotic demyelination syndrome

51
Q

What are the parameters for correction of sodium levels

A

raise serum sodium concentration by 4-6 mEq/L in a 24 hr period

52
Q

How do you correct a patient with an Na+ <130 and asymptomatic

A

30 mL bolus 3% saline and remeasure Na+ hourly

53
Q

How do you correct a patients with Na+ <130 and symptomatic

A

100 mL bolus of 3% saline, if sx persist 2 more 100 mL bolus in 30 minute period

54
Q

What is the most common cause of hypernatremia

A

volume depletion

55
Q

Disease states that can cause hypernatremia

A
  • diabetes insipidus
  • primary hyperaldostteronism
  • altered thirst mechanism (psych pts)
56
Q

Signs and sx of hypernatremia

A
  • AMS
  • ataxia
  • seizures
  • hyperreflexia
  • irritability
  • lethargy
57
Q

How do you manage a pt with hypernatremia

A

D5W 3-6 mL/kg/hr until Na+ <145

THEN
decrease infusion to 1 mL/kg/hr until 140

58
Q

Why do we need potassium

A

cell metabolism

neurologic and cardiac electrical transmission

59
Q

What are the main regulators of K+

A

kidney

60
Q

What are the most common causes of hypokalemia

A
  • diuretic therapy
  • diarrhea/vomiting
  • medications
  • hypomagnesemia
  • hyperaldosteronism
61
Q

Signs and sx of hypokalemia

A
  • muscle weakness/cramping
  • respiratory muscle weakness
  • palpitations
  • ileus/constipation
  • fatigue
62
Q

What do the sings and sx of hypokalemia typically manifest

A

K+ less than 3.0

63
Q

Hypokalemia on EKG

A
  • flat T waves
  • S T segment depression
  • formation of U waves
64
Q

Treatment of hypokalemia

A
  • mild treated with oral KCL

- severe and symptomatic IV drip no more than 10 mEq/hr

65
Q

If ___ is low it must be replaced before K+ replacement. Why?

A

magnesium, it plays a big role in regulation of the Na+K+ATPase pump

66
Q

What is the most common complication seen in renal disease

A

hyperkalemia

67
Q

What medications can cause hyperkalemia

A
  • ACE inhibitors
  • ARBs
  • aldosterone antagonists
68
Q

Clinical manifestations of hyperkalemia

A
  • muscle weakness/paralysis
  • parasthesias
  • cardiac conduction abnormalities
69
Q

Hyperkalemia on EKG

A
  • tall or peaked T waves
  • widened/bizarre QRS
  • flat P wave
70
Q

Treatment of hyperkalemia

A
  • IV calcium gluconate or chloride (FIRST)
  • IV hypertonic glucose w/ regular insulin
  • IV diuretic
  • dialysis
  • Kayexalate
71
Q

What are factors that can influence serum calcium concentration

A
  • PTH
  • vitamine D
  • calcium ion
  • phosphate
72
Q

Common causes of hypocalcemia

A
  • parathyroid disease
  • thyroid disease
  • thyroid or parathyroid ectomy
  • chronic renal failure
  • vitamin D deficiency
73
Q

What can cause pseudohypocalcemia? Why?

A

hypoalbuminemia because Ca+ is bound to albumin in serum

74
Q

What are the symptoms of hypocalcemia

A
  • parasthesias
  • hyperreflexia
  • tetany
  • muscle cramps/spasm
  • seizures
75
Q

Classic physical exam findings for hypocalcemia

A
  • Chvostek sign (facial spasm)

- Trousseau’s sign (hand spasm)

76
Q

Hypocalcemia on EKG

A

prolonged QT

77
Q

Treatment of hypocalcemia

mild and severe

A

-oral Ca+ if asymptomatic

If severe
-IV calcium gluconate 1-2 g over 20 mins followed by Ca+ infusion of 0.5-1.5 mg/kg/hr

78
Q

What are the most common causes of hypercalcemia

A
  • hyerparathyroid

- bone malignancy (multiple myeloma)

79
Q

Signs and sx of hypercalcemia

A
  • bone pain
  • muscle weakness
  • nephrolithiasis
  • lethargy
  • confusion
  • constipation
  • fatigue
  • depression
  • nausea
80
Q

Treatment of hypercalcemia

A
  • volume expansion with isotonic saline
  • salmon calcitonin w/ bisphosphenate
  • zoledronic acid
81
Q

What are magnesium levels regulated by

A
  • intestinal absorption

- renal excreption

82
Q

Causes of hypomagnesemia

A
  • chronic ETOH
  • reduced intestinal absorption
  • increased renal excretion
  • excessive GI loss
  • starvation/refeeding syndrome
83
Q

Signs and sx of hypomagnesemia

A
  • lethargy
  • confusion
  • tremors/convulsions
  • hyperrflexia
  • parathesisas
  • cardiac arrhythmias
84
Q

Hypomagnesemia on EKG

A
  • widened QRS

- ST segments prolongation and depression

85
Q

Treatment of hypomagnesemia. Mild and severe

A
  • mild: oral replacement with magnesium salts

- severe: 1-2 g of IV mag sulfate

86
Q

What can oral magnesium salts cause

A

osmotic diarrhea

87
Q

When is hypermagnesemia seen

A
  • renal failure patients
  • supratherapeutic replacement
  • antacid abuse
88
Q

Signs and sx of hypermagnesemia

A
  • decreased deep tendon reflexes
  • bradycardia
  • hypotension
  • flaccid paralysis
  • cardiac arrest
  • nausea/headache
  • hypocalcemis
89
Q

Hypemagnesemia on EKG

A
  • tall T’s
  • widened QRS
  • irregular conduction
  • escape beats
90
Q

Treatment of hypermagnesemia

A
  • dietary restriction
  • elimination of mag containing meds
  • saline + loop diuretics
  • dialysis
91
Q

When is BUN increased? Decreased?

A

Increased: high protein diet, decrease in GFR, CHF

Decreased: liver disease, SIADH

92
Q

Is BUN or creatinine a better indication of kidney function? Why?

A

Creatinine because it is excreted only by the kidney

93
Q

Normal serum pH

A

7.35-7.45

94
Q

What levels classify respiratory acidosis

A

pH <7.35 and PaCO2>45 mmHg

95
Q

Treatment for respiratory acidosis

A

improve ventilation

96
Q

What classifies respiratory alkalosis

A

pH >7.45 and PaCO2 <35mm Hg

97
Q

What causes respiratory alkalosis? Treatment?

A

d/t hyperinflation

Tx depends on underlying cause

98
Q

What classifies metabolic acidosis

A

pH <7.35 and HCO3 22 mEq/L

99
Q

What causes metabolic acidosis? Tx?

A

d/t gain of acid of loss of base (excessive GI loss)

Tx by correcting the metabolic defect

100
Q

What classifies metabolic alkalosis

A

pH >7.45 and HCO3 >26 mEq/L

101
Q

What causes metabolic alkalosis? Tx?

A

d/t loss of acid and gain of base (vomiting, gastric suction)

Tx by correcting metabolic defect

Clin Med III Exam II (11 decks)

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