Fluid Imbalances (Various sources)

Question 1

Normal Sodium Values

Answer 1

Na+ 135-150

Question 2

Hyponatremia General Signs & Symptoms

Answer 2

#Neurological symptoms
# Malaise, nausea, confusion, lethargy, seizures, coma, & death

Question 3

Na+ 120-125 Symptoms

Answer 3

Acute: malaise, nausea
Chronic: none

Question 4

Na+ 110-120 Symptoms

Answer 4

Acute: headache, confusion, lethargy, nausea
Chronic: None, possibly mild confusion/lethargy

Question 5

Na+ < 110 Symptoms

Answer 5

Acute: Nausea, seizure, coma
Chronic: none, possibly greater confusion/lethargy

Question 6

Hypotonic hyponatremia

Answer 6

#Low serum osmolality
#Excess body water, diluting fluids

Question 7

Isotonic hyponatremia

Answer 7

#Normal serum osmolality
#Seen in extreme hyperlipidemia & hyperproteinemia

Question 8

Hypertonic hyponatremia

Answer 8

#High serum osmolality
#Dilution of Na+ when concentrations of other solutes pull water out of the cell

Question 9

Hypernatremia General Signs & Symptoms

Answer 9

Nausea, thirst/polydipsia, weakness, lethargy, confusion, stupor, coma

Question 10

Na+ 155-160 Symptoms

Answer 10

Aucte: Nausea, weakness, lethargy, confusion, irritability
Chronic: None, or mild CNS symptoms

Question 11

Na+ > 160 Symptoms

Answer 11

Acute: Stupor, coma.
Chronic: None, or possibly severe CNS symptoms

Question 12

Hyponatremia treatment

Answer 12

DO NOT OVERCORRECT OR RAPIDLY RAISE!
#SEVERE: Seizures/coma or Na+ < 110: 3% saline at rate to raise Na+ by 1-2 meq/L/hr until Na+ raises 12-15 or reaches 120

Question 13

Normal Potassium (K+) levels

Answer 13

3.5-5.2

Question 14

Normal serum Calcium levels

Answer 14

8.6 to 10.2

Question 15

What is the relationship between serum calcium & serum albumin?

Answer 15

A portion of total calcium binds to albumin, so...
#If albumin is below normal, assume the calcium is higher
#If albumin is above normal, assume the calcium is lower

Question 16

If albumin is decreased, how is the calcium corrected?

Answer 16

For every 1 g/dL below normal on the albumin, correct the measured calcium up by 0.8 mg/dL

Question 17

If albumin is increased, how is the calcium corrected?

Answer 17

For every 1g/dL above normal on albumin, correct the measured calcium down by 0.8 mg/dL

Question 18

Symptoms of hypocalcemia

Answer 18

#Mental changes: depression, anxiety, confusion
#Extrapyramidal changes: tremors, ataxia, dystonia.
#Tetany, seizures, weakness.
#Signs: Chvostek's, Trousseau's

Question 19

Symptoms of hypercalcemia

Answer 19

#Neuro: lethargy, coma, depression, memory impairment, personality changes.
#GI: N/V, constipation
#Musculoskeletal: proximal muscle weakness, bone pain
#Renal: polyuria/nocturia, renal colic
#Signs: depressed DTR

Question 20

Hypocalcemia EKG changes

Answer 20

T-wave changes, prolonged QT interval

Question 21

Hypercalcemia EKG changes

Answer 21

Shortened QT interval

Question 22

Normal serum magnesium levels

Answer 22

1.6 to 2.2

Question 23

Symptoms of hypomagnesemia

Answer 23

#Muscle weakness, Tremors, seizures
#Signs: Chvostek's, Trousseau's, muscle fasiculations

Question 24

Symptoms of hypermagnesemia

Answer 24

#Hypotension
#Diminished or absent DTR
#Weakness to flaccid paralysis (including respiratory!)

Question 25

Hypomagnesemia EKG changes

Answer 25

#Prolonged QT interval
#Ventricular arrhythmias
#Torsades, anyone?

Question 26

Hypermagnesemia EKG changes

Answer 26

#Lengthening PR
#Widening QRS
#Complete heart block

Question 27

Normal serum phosphate

Answer 27

2.5 to 5.0

Question 28

Symptoms of hypophosphatemia

Answer 28

Irritability, confusion, paresthesias, muscle weakness

Question 29

Symptoms of hyperphosphatemia

Answer 29

None or r/t secondary hypocalcemia