FLUID VOLUME AND ELECTROLYTES Flashcards
The most common cause of hyponatremic hyperosmolality?
Hyperglycemia
What method should you use to treat hyponatremia related to SIADH?
3% hypertonic saline, calculated
What is a potential cause of hyperkalemia?
NSAIDS
Your patient has a Na of 128 and was treated with colloids 3 days ago. What is the treatment?
Restrict free water
A 68-year-old pt had Sx three days ago to repair an AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFTS are normal, no s/s CHF. The patient’s laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0.8 mg/dL, PaCO2 of 37 mmHg. Which is the most appropriate method to deliver nutrition?
enteral feeding to the duodenum via a nasogastric small-bore tube (NG tube)
Your patient has a serum osmolality of 268 mOsm/kg and a serum sodium of 134 mEq/L. His urine has Na+ less than 10 mEq/L. You know that all of the following are possible explanations except:
Diuretics (Na<10 is nonrenal cause. Diuretics are associated with renal cause, Urine Na >20)
A 61 yr old F c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating “abnormally” and she has been experiencing muscle spasms on occasion. You order and EKG and find decreased amplitude and broad T waves. Occasionally you also note prominent U waves. Of the following, which is the most likely Dx?
Hypokalemia
Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except
GI Bleed (this is enteral complication)
65 yo M with c/o N/V/constipation x several days and a 6 # wt loss. Pt s/p TKR several weeks ago and reports not getting off the couch. What electrolyte is altered?
Hypercalcemia secondary to immobility
Pt with s/s of ABD distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the pt has a fluid and electrolyte problem. Which of the following is he most likely experiencing?
Hyperkalemia
ABG reads high HC03 and pCO2 55mmhg. What electrolyte abnormality is most likely associated with these values?
Hypokalemia r/t metabolic alkalosis
Pt has a fever and tachycardia, and Hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status
extracellular dehydration deficit
Low serum Na and high serum osmolality:
hyperglycemia (Probably HHNK)
A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give
Normal saline
Low protein =
low BUN=hypoosmolar hyponatremia (probably edematous, expect edema in Albumin < 2.7)
A pt. who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The initial treatment is to:
replenish volume by infusing a 0.9% sodium chloride solution
Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse pt?
Hyponatremia
What electrolyte should be monitored prior to administering succinylcholine?
K+
ASA overdose: which electrolyte to monitor
K (if low, will prevent the alkalinization of urine, which is the mainstay of Tx)
What sx is associated with hepatotoxicity s/p acetaminophen toxicity?
Delirium
Pt at highest risk for hyperkalemia
NSAIDs then ACEi
Tube feed side effects
Decrease the osmolality of the Tube feeding
What pt requires labs to be monitored closely after initiating TF?
Alcoholic with decreased intake over the past 2-3 weeks
