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Pharmacology > Fluid Replacement > Flashcards

Fluid Replacement Flashcards

1
Q

Body water compostition

A

Infants (75-85%), adult men (50-60%), adult females (45-55%)

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2
Q

Fluid type composition

A

intracellular (2/3), extracellular (1/3)- interstitial (3/4), Plasma (1/4)

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3
Q

Maintenance requirements

A

Holliday-segar calculation- 100 mL/kg first 10 kg, 50 ml/kg first 10 kg, 20 ml/kg after; or estimate ~30 mL/kg

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4
Q

Two major types of fluid

A

crystalloids- normal saline (.9%NaCl), half normal saline (.45% NaCl), lactated ringers, Dextrose 5% in H2O; Colloid- albumin, hetastarch, plasmanate

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5
Q

Crystalloids

A

provide water and sodium to maintain the osmotic gradient between extravascular and intravascular spaces

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6
Q

Normal saline

A

.9 % NaCl, isotonic, used most common for fluid replacement, resuscitation in septic pt, can be used to correct Na or Cl deficiencies

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7
Q

1/2 Normal saline

A

.45% NaCl hypotonic, use for maintenance fluids for hypernatremic pt

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8
Q

Lactate ringers

A

approximates human plasma regarding electrolyte concentration, used for replacement of blood loss, mainstay in laboring women

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9
Q

D5W

A

used for free water replacement, not a resuscitative fluid, various concentrations; 5g dextrose in 100 ml, given in liters so there is 50 g in dose

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10
Q

NaCl 3%

A

hypertonic saline, rarely used for hypernatremia, inc ICP, dangerous! if not used appropriately, monitor very closely, give small volumes

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11
Q

Never give what as IV fluids

A

sterile H2O, this is LETHAL

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12
Q

Colloids

A

used to increase plasma oncotic pressure and move fluid from interstitial compartment to plasma compartment, use selectively for volume expansion during extreme situations like hemorrhagic shock

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13
Q

Colloid options

A

albumin, blood, hetastarch

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14
Q

Sodium

A

normal 135-145 mEq/L, extracellular cation needed to maintain cellular integrity and osmolar gradient to maintain fluid homeostasis throughout the different fluid compartments

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15
Q

Hyponatremia

A

most commonly encountered electrolyte disturbance in hospitalized pts, associated w/ significant morbidity and mortality

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16
Q

pseudohyponatremia

A

extreme elevations of lipid or proteins, osmolality is number of particles per liter H2O, measured serum osmolality is not sig affected, calc osmalitlity will be low

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17
Q

hypertonic hyponatremia

A

RARE, serum [Na] falls by 1.6 mEq/l for each 100 mg/dL incremental increase in blood glucose; by correcting glucose you will correct hyponatremia

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18
Q

hypotonic hyponatremia

A

more than 90% of cases, access ECF volume; hypovolemic, euvolemic, hypervolemic

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19
Q

hypovolemic hyponatremia

A

dehydration, caused by diuretics and salt losing nephropathy, treat w/ IV fluids, hypertonic NaCl in symptomatic pts or isotonic NaCl in asymptomatic

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20
Q

SIADH

A

syndrome of inappropriate antidiuretic hormone, water intake exceeds the capacity of the kidneys to excrete water, inability to concentrate urine

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21
Q

Causes of SIADH

A

tumors, CNS disorders, head trauma, stroke, meningitis, pituitary surgery, DRUGS

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22
Q

Drugs that induce SIADH

A

Despressin, oxytocin, carbamazepine, antipsychotics, TCAs, cyclophosphamides, chemo, NSAIDs, Morphine

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23
Q

Isovolemic hyponatremia

A

will likely appear as euvolemic, slight increase in ECF, caused by glucocorticoid deficiency, hypothyroidism, psychogenic polydipsia, SIADH

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24
Q

Treatment of isovolemic hyponatremia

A

furosemide +3% NaCL in symptomatic pts, isotonic fluids in asymptomatic pts, fluid restrictions (if correction needed quickly)

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25
Q

Hypervolemic hyponatremia

A

total body water increased, seen in CHF, liver failure, renal failure, nephrotic syndromes

26
Q

Treatment of hypervolemic hyponatremia

A

furosemide and judicious use of 3% NaCl in symptomatic pts, furosemide in asymptomatic

27
Q

When treating hyponatremia, NEVER…

A

Correct faster than .5 mEq/L/hr or 12 mEq/L/day, it can cause osmotic demylenation

28
Q

Vasopressin receptor antagonists

A

Tolvaptan (Samsca), Conivaptan (Vaprisol)

29
Q

Tolvaptan (Samsca)

A

only available PO, given 10-60 mg daily, $$$

30
Q

Conivaptan (Vaprisol)

A

only available IV, CI, 20 mg IV load, then 20 mg infused over 24 hrs, $$$

31
Q

MOA of vasopressin receptor antagonists

A

promotes excretion of free water w/o loss of serum electrolytes resulting in net fluid loss, increased urine output, decreased urine osmoloality and restoration or normal serum Na levels

32
Q

Safety concerns w/ vasopressin receptor antagonists

A

risk of correcting too fast, must be initiated in hospital, must lift fluid restriction, most places only allow nephrologist to use

33
Q

Hypervolemic hypernatremia

A

caused by excessive hypertonic saline resuscitation, NaCHO3 administration, excessive table salt

34
Q

Treating hypervolemic hypernatremia

A

stop hypertonic fluids and give diuretics

35
Q

hypovolemic hypernatremia

A

treatment by restoring hemodynamic status first, can replace with NS even though the pt is hypernatremic

36
Q

Potassium

A

hypo and hyperkalemia associated w/ fatal arrythmias, each 1 mEq/L decrease in K

37
Q

factors affecting serum [K]

A

kidneys, arterial pH, insulin, B agonists, Na/K pumps

38
Q

hypokalemia caused by

A

diuretics, vomiting, NG drainage, magnesium depletion

39
Q

Goal for replacement in hypokalemia

A

4mEq/L, oral route preferred, less risk of overshoot; K= 3-3.9 mEq/L; 10 mEq K supplement will increase [K] by .1 mEq/L; K

40
Q

It is impossible to correct K if

A

mag is low, so correct mag first, then address K

41
Q

IV KCl

A

preferred if pt symptomatic or NPO, rate IV replacement limited if pt has only a peripheral IV (10 mEq/hr max), central IV can run at 20 mEq/hr, Dangerous!

42
Q

Hypokalemia w/ 3.2 mEq/L, not symptomatic

A

add 30 mEq KCl to IVF, or give 40 mEq PO q6hrs x3

43
Q

hypokalemia w/ 2.7 mEq/L and sympomatic

A

give KCl 40 mEq IV q4h x 3, and KCl liquid 40 mEQ PO x1 dose bolus

44
Q

Hyperkalemia

A

more consequential and more rare than hypokalemia, mild 5.5-6 mEq/L. mod 6-6.9 mEq/L, severe >7; some may not have symptoms if really high, still treat!

45
Q

Management of hyperkalemia

A

calcium gluconate (1 gm IVPx1 dose), Humulin R (10 units IVPx1), sodium bicarb 50 mEq IVPx1, albuterol (10 mg continuous neb), hemodialysis (4 hr session), sodium polystyrene (Kayexalate, 30 gm POx1); can do combo

46
Q

which management of hyperkalemia only stabilizes pericardium, inc threshold

A

calcium gluconate

47
Q

Which management of hyperkalemia has to be given w/ dextrose and works quickly?

A

Humulin R

48
Q

which management of hyperkalemia works quickly by driving K back into the cells

A

sodium bicarb and albuterol

49
Q

which management of hyperkalemia has fastest onset

A

hemodialysis

50
Q

which management of hyperkalemia has slower onset, works by a resin exchange of Na for K

A

sodium polystyrene

51
Q

Magnesium

A

needed for stabilizing macromolecule structures such as DNA/RNA and related to Ca and K metabolism; regulated by intake and kidney excretion

52
Q

Hypomagnesemia

A

associated w/ disorders of the GI tract or kidneys, decreased intestinal absorption, can be caused by chronic EtOH, amphotericin, diuretics, aminoglycosides

53
Q

Treatment of hypomagnesemia

A

asymptomatic- PO, milk of mag, or mag ox, will cause diarrhea; symptomatic- IV mag sulfate, 1 gram Mag sulfate= 8 gEq magnesium, infuse each gram over 1 hour, exceeding this results in renal excretion (level 1-2 give .5 mEq/kg, if

54
Q

Calcium, organs involved w/ metabolism

A

bone, kidneys, intestines

55
Q

hypocalcemia

A

correct for albumin, accounts for protein binding, if low albumin likely have norm Ca; if mag low fix that first

56
Q

hypocalcemia treatment

A

100-300 mg Ca IV over 10 mins, 1 g CaCl or 2-3 g Calcium gluconate

57
Q

Difference in CaCl and gluconate

A

CaCl contains more Ca, harder on veins; CaGL contains less Ca, easier on veins

58
Q

Hypercalcemia

A

seen in CA pts and hyperparathyroidism, caused by dec renal elimination, inc bone resorption, inc GI absorption

59
Q

Hypercalcemia tx

A

calcitonin, most common, loop diuretic, short term (lasix inc urinary excretion), bisphosphonates- pamidronate (Aredia-IV infusion over several hours, short term only, very effective)

60
Q

Phosphorus

A

critical for protein, fat and carb metabolism, modulates O2 carrying capacity of hemoglobin

61
Q

hypophoshatemia

A

1mmol=1.33 mEq sodium and 1.47 Eq potassium, replace orally or enteraly w/ neutra phos packet or Kphos tab q6-8h, also NaPhos/Kphos parenterally

62
Q

Hypophoshatemia levels/treatment

A

mild (2.3-3 mg/dL)- .32 mM/kg q4-6h; mod (1.6-2.2 mg/dL)- .64 mM/kG q4-6h; severe (

Pharmacology (61 decks)

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