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Therapeutics II > Fluid/Electrolytes (Unfinished) > Flashcards

Fluid/Electrolytes (Unfinished) Flashcards

1
Q

Isotonic

A

-Same concentration of active solutes as extracellular fluid
-Prevents fluid shift between compartments
-(275-290 mOsm/L)

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2
Q

Hypotonic

A

-Less concentrated than extracellular fluid
-Fluid moves into the cell, causing increased cellular volume
-(< 275 mOsm/L)

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3
Q

Hypertonic

A

-More highly concentrated than extracellular fluid
-Fluid is pulled into bloodstream from cells
-(>290 mOsm/L)

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4
Q

Tonicity of crystalloids

A

Isotonic, hypotonic, hypertonic

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5
Q

Examples of crystalloids

A

-NS
-1/2 NS
-D5W
-LR
-Balanced salt solutions

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6
Q

Tonicity of colloids

A

Hypertonic

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7
Q

Examples of colloids

A

-Albumin
-Hetastarch
-Tetrastarch
-Blood
-Plasmanate

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8
Q

Functions of crystalloid solutions

A

Provide water and/or sodium

-Maintain osmotic gradient between intravascular and extravascular compartments

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9
Q

NS place in therapy

A

-Used for intravascular fluid replacement (resuscitation)
-Sodium and/or chloride replacement

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10
Q

1/2 NS place in therapy

A

Used for maintenance fluids (combination products)

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11
Q

Lactated ringers place in therapy

A

-Used for replacement of blood loss
-Approximates human plasma
-Used for resuscitation (trauma, burn, etc.)

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12
Q

D5W

A

-Used for free water replacement
-Not a resuscitative fluid
-Not a maintenance fluid by itself

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13
Q

Functions of colloid solutions

A

Used to increase plasma oncotic pressure

Move fluid from the interstitial compartment to the intravascular (plasma) compartment

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14
Q

What is the most common maintenance IV fluid?

A

-D5W+1/2NS+20mEq kCl/L
-Used to increase plasma oncotic pressure
-Similar composition to urine

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15
Q

Possible signs of dehydration

A

-Decreased skin turgor
-Dry mucus membranes
-Delayed capillary refill
-Tachycardia and hypotension
-Peripheral pulses weak
-Decreased urine output (<0.5 mL/kg/hr), dark urine
-BUN/SCr ratio > 20 (may mean dehydration)

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16
Q

Osmolarity of NS

A

154 mEq/L

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17
Q

Pseudohyponatremia (isotonic)

A

-Extreme elevations of lipids and proteins increase the total plasma volume
-Can be seen with hypertriglyceridemia or hyperproteinemia
-Leads to dilution effect
-Sodium appears low

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18
Q

Hypovolemic hypotonic hyponatremia

A

Decrease in both total body water and sodium

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19
Q

Hypovolemic hypotonic hyponatremia renal causes

A

-Diuretics/excess diuresis
-Adrenal insufficiency (mineralocorticoid deficiency)
-Salt losing nephropathy
-Cerebral salt wasting

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20
Q

Hypovolemic hypotonic hyponatremia non-renal causes

A

-Blood loss/hemorrhage
-Skin losses
-GI losses

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21
Q

Isovolemic hypotonic hyponatremia

A

-Increased TBW and normal or slightly increased total body Na+
-Slight excess of ECF
-No peripheral or pulmonary edema
-Clinically appears euvolemic

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22
Q

Isovolemic hypotonic hyponatremia causes

A

-Adrenal insufficiency (glucocorticoid deficiency)
-Hypothyroidism
-Psychogenic polydipsia
-SIADH

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23
Q

Drugs that can induce SIADH

A

-Antipsychotics
-SSRIs
-Carbamazepine

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24
Q

Treatment of SIADH

A

-Remove underlying cause if possible
-First line: free water restriction
-Vaptans may be beneficial if 24-48 hours of free H2O restriction fails “aquaretics”

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25
Q

Hypervolemic Hypotonic Hyponatremia

A

-Total body Na+ is increased but TBW increases even more
-Expanded ECF volume and edema

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26
Q

Clinical presentation of hypovolemic hypotonic hyponatremia

A

-Dehydration
-Decreased skin turhor
-Orthostatic hypotension
-Tachycardia
-Dry mucous membranes.

27
Q

Clinical presentation of isovolemic hypotonic hyponatremia

A

-Discomfort
-Psychosis
-Seizures
-Coma

28
Q

Clinical presentation of hypervolemic hypotonic hyponatremia

A

-Fluid overload
-Edema and weight gain

29
Q

Clinical presentation of acute hyponatremia (over 12 hrs or less)

A

-Nausea
-Discomfort
-Weakness
-Headache
-Disoriented
-Coma
-Seizures
-Respiratory arrest

30
Q

Goal of treatment for hypotonic hyponatremia

A

In most cases the goal is to avoid rise in serum sodium > 0.5 mEq/L/hr or no more than 8-12 mEq/L/day

31
Q

Treatment options for hypovolemic hypotonic hyponatremia

A

-3% NaCl if symptomatic
-0.9% NaCl if asymptomatic

32
Q

Treatment options for isovolemic hypotonic hyponatremia

A

-Furosemide and 3% NaCl if symptomatic
-0.9% NaCl if asymptomatic and water restriction

33
Q

Treatment options for hypervolemic hypotonic hyponatremia

A

-Furosemide and judicious 3% NaCl in symptomatic patients
-Furosemide in asymptomatic patients

34
Q

Acute hyponatremia

A

-<48 hours
-Brain swell with water
-Cerebral edema
-Severe neurological symptoms
-Brain herniation
-Death

35
Q

Chronic hyponatremia

A

-Brain cells extrude solutes
-Minimal brain swelling
-Mild neurological symptoms
-Brain herniation is rare
-Death is rare

36
Q

Treatment of acute symptomatic hyponatremia

A

-Increase serum Na+ by 1-2 mEq/L/hr until symptoms resolve
-Reasonable short-term Na+ goal = 120 mEq/L
-Complete correction is unnecessary
-If corrected too rapidly it will lead to diffuse demyelinating lesions
-Generally, an increase of 4-6 mEq/L is sufficient to reverse most acute manifestations
-Maximum increase of 8-12 mEq/L in the first 24 hours
-Treat with 3% saline and replace half of sodium deficit in 8 hours then other half with 8-16 hrs

37
Q

Hypovolemic hypernatremia

A

Loss of H2O and Na+

38
Q

Isovolemic hypernatremia

A

Loss of H2O

39
Q

Hypervolemic hypernatremia

A

Gain of H2O and Na+

40
Q

Hypovolemic hypernatremia treatment

A

-Restore hemodynamic status first if needed (maybe with 0.9% NaCl)
-Once intravascular volume has been restored calculate free water deficit

41
Q

Isovolemic hypernatremia treatment

A

-Desmopressin
-Vasopressin

42
Q

Hypertonic hypernatremia treatment

A

-Stop the hypertonic fluids/cause
-Rapidly excreted
-Diuretic if needed

43
Q

Factors that affect potassium levels

A

-Na/K ATPase pump
-Kidneys
-Arterial pH / acid-base status

44
Q

Causes of hypokalemia

A

-Diuretic loss (potassium-wasting)
-Beta-agonist medications
-NG drainage
-Metabolic alkalosis
-Diarrhea
Magnesium depletion

45
Q

Clinical presentation of hypokalemia

A

-Nonspecific and highly variable
-Weakness
-Nausea/vomiting
-Changes in cardiac function / arrhythmias
-Cramping
-Impaired muscle contraction
-Cardiac patients may be at higher risk (HTN, MI, HF)

46
Q

Goals of therapy for hypokalemia

A

-Prevent and treat serious complications, cardiac arrhythmias
-Normalize serum potassium concentration
-Identify and correct underlying cause
-Prevent overcorrection/hyperkalemia

47
Q

Treatment when potassium level is 3.5 – 4 mEq/L

A

-No therapy generally recommended
-Goal in ICU is often greater than or equal to 4 mEq/L

48
Q

Treatment when potassium level is 3 – 3.4 mEq/L

A

-Treatment debatable
-PO potassium for patients with cardiac conditions

49
Q

<3 mEq/L

A

-Always treat
-PO route is preferred in asymptomatic patients
-IV for symptomatic patients or patients who cannot take PO

50
Q

IV K+ warnings/precautions

A

-Thrombophlebitis and pain at infusion site
-Higher risk of leading to hyperkalemia/overcorrection
-Arrhythmia or cardiac arrest if given too quickly

51
Q

IV K+ administration

A

-Generally each 10-20 mEq is diluted in 100 mL of D5W
-Infusion rate without cardiac monitoring: 10 mEq/hr
-With continuous cardiac monitoring:
-20 mEq/hr
-40-60 mEq/hr if emergent with severe hypokalemia

52
Q

Hyperkalemia clinical presentation

A

Peaked T wave at 5.5-6 mEq/L

53
Q

Steps to treat severe hyperkalemia

A
  1. Antagonize the membrane actions
  2. Decrease extracellular K+ concentrations
  3. Remove K+ from the body
54
Q

C A BIG K DROP

A

-Calcium
-Albuterol
-Bicarb
-Insulin + glucose
-Kayexalate/Lokelma
-Diuretics
-Renal unit for dialysis of patient

55
Q

Treatment for chronic hyperkalemia

A

Patiromer (Valtassa)

56
Q

Drugs that can cause hypomagnesemia

A

-Amphotericin
-Aminoglycosides
-Diuretics (thiazide or loop)
-Cyclosporine
-Alcohol

57
Q

Which other electrolyte abnormalities is hypomagnesemia associated with?

A

-Hypocalcemia
-Hypokalemia

58
Q

Treatment of asymptomatic hypomagnesemia patients

A

PO
-Milk of mag
-Mag-Ox

59
Q

Treatment of symptomatic hypomagnesemia patients

A

IV
-When Mg2+ 1-2 mg/dL: 0.5 mEq/kg
-When Mg2+ < 1 mg/dL: 1 mEq/kg
-Infuse 1 gram per hour
-Also use for patients who cannot tolerate PO

60
Q

Acute treatment of hypocalcemia

A

-100-300 mg elemental Ca2+ IV over 5-10 min
-Usual administration rate is 1 gm/hr
-Do not add to bicarb or phos solutions
-Correct hypomagnesemia

61
Q

Is chloride or gluconate better for IV push administration?

A

Gluconate is preferred for IV push but chloride can still be used during code

62
Q

Chronic treatment for hypocalcemia

A

-PO calcium such as Tums
-Vitamin D supplementation such as Calcitriol

63
Q

Mild to moderate hypophosphatemia treatment

A

-Oral PO4
-Phos-NaK
-Fleets Phospho-Soda
-Give PO doses as divided

64
Q

Treatment for severe hypophosphatemia

A

-IV PO4
-Use KPhos when K+ < 4 mEq/L
-Use NaPhos when K+ is greater than or equal to 4 mEq/L
-Infuse IV doses no faster than 7 mMol/hr

Therapeutics II (33 decks)

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