Fluids And Electrolyte Flashcards

(68 cards)

1
Q

Who has more water, adults, kids, full-term, pre-term?

A

Preterm

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2
Q

Mild dehydration sx

A

poor skin turgor, sunken fontanel, lack of tears and saliva, lethargy, and tachycardia

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3
Q

Moderate dehydration sx

A

orthostatic hypotension, tachycardia, oliguria, deepening lethary

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4
Q

Severe dehydration sx

A

shock

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5
Q

Percentage of water loss in infant/child for mild

A

5% and 3%

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6
Q

Percentage of water loss in infant/child for moderate

A

10% and 6%

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7
Q

Percentage of water loss in infant/child for severe

A

15% and 9%

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8
Q

How do you correct for dehydration?

A

isotonic 20cc/kg to restore blood volume, replete 1st 50% in first 8 hours, remainder in next 16

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9
Q

Oral hydration

A

5-10cc every 5 to 10 min

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10
Q

Serum osmolality calculation

A

Na x 2 + K x 2 + glucose/18 + BUN/3

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11
Q

If hyponatremic, what would you check next?

A

serum osmolality

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12
Q

Hyponatremia, serum osmolality normal; what are the causes

A

factitious, hyperglycemia, hyperlipidemia

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13
Q

Hyponatremia, serum osmolality low; what is the cause

A

SIADH

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14
Q

Pattern: anorexia, headache, muscle cramps, seizure, obtundation, coma, cerebral edema

A

SIADH

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15
Q

What are Na and Posm numbers for SIADH

A

Na <130mEq/L

Posm <280

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16
Q

What are causes of SIADH

A

nausea/vomiting, pain/stress, pulmonary disease, surgery, Cytoxan, vincristine, opiates

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17
Q

Pattern: thirsty, doughy skin, irritability, high fever, high pitched cry, convulsions, stupor, paralysis death

A

hypernatremia

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18
Q

Rx rate for lowering serum sodium

A

0.5 to 1mEq/hr

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19
Q

What do check next if pt is hypernatremic?

A

Urine

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20
Q

Hypernatremic + concentrated urine

A

non-renal

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21
Q

Hypernatremic + diluted urine

A

renal

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22
Q

What are cause of non-renal hypernatremia?

A
GI (diarrhea, vomiting)
Insensible losses (fever, high ambient temp)
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23
Q

What are causes of renal hypernatremia?

A

Can’t concentrate urine - central DI or nephrogenic DI

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24
Q

What are causes of central DI?

A

trauma, CNS infection, pituitary infarction or pit pit/hypothalamic tumors

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25
What are 3 major categories of causes for hyperkalemia?
1. Transcellular shift 2. Excess 3. Decreased renal excretion
26
What are causes of transcelluar shift to cause hyperkalemia?
``` B blockers Acidosis Hyperglycemia - insulin insufficiency Succinylcholine Digitalis Arginine and lysine HCl Sodium fluoride ```
27
What are cause of excessive K
``` Tumor lysis Consumption of exogenous Stored blood Hematoma breakdown IV coagulopathy Tissue necrosis GI bleeding Hemolysis ```
28
What are causes of decreased renal excretion?
Renal failure, decreased aldosterone, or decreased sensitivity to aldosterone by kidney
29
What are causes of decreased aldosterone
Addison's disease congenital adrenal hyperplasia ACE inhibitor usage NSAIDs
30
What are cause of decreased aldosterone sensitivity?
obstructive uropathy, SCD, SLE, K-sparing diuretics (spironolactone, amiloride, triamterene)
31
What are signs of skeletal weakness from hypokalemia?
weakness, cramps, rhabdomyolysis, paralysis
32
What are signs of smooth muscle weakness from hypokalemia?
gastric distension, ileus, constipation, urinary retention
33
What are causes of transcellular shift to hypokalemia?
Extreme leukocytosis, treatment of severe anemia (make more RBCs), periodic paralysis (post-carb meal)
34
What are causes of inadequate body stores?
If pt is acidotic
35
You can lose K in urine - how hi does urine K have to be
>20mEq/L
36
If hypokalemic and renal loss is suspected, check serum pH, if acidic what is the cause, if alkalosis what is the cause
acid - RTA | alkalosis - diuretics, Bartter syndrome, Gittelman syndrome
37
Low bicarbonate, serum <7.4
metabolic acidosis
38
Low bicarbonate, serum >7.4
respiratory alkalosis
39
Hi bicarbonate, serum <7.4
respiratory acidosis
40
Hi bicarbonate, serum >7.4
metabolic alkalosis
41
pH >7.4, low bicarbonate
respiratory alkalosis
42
pH >7.4, high bicarbonate
metabolic alkalosis
43
pH <7.4, low bicarbonate
metabolic acidosis
44
pH <7.4, high bicarbonate
respiratory acidosis
45
What are causes of respiratory acidosis?
retain a lot of CO2 - respiratory depression
46
What are causes of respiratory alkalosis?
Stimulation of respiratory center, anxiety, drugs, fver, gram neg sepsis, liver insufficiency, CNS
47
If you have metabolic alkalosis what else do you want to check?
Urine Chloride because K is usually lost with metabolic alkalosis and Cl is usually retained to try to save KCl
48
If in metabolic alkalosis, urine chloride is lo what is the cause
extra-renal
49
If in metabolic alkalosis, urine chloride is hi, what is the cause?
renal
50
If renal metabolic alkalosis, what next to check
Blood pressure
51
Met alk, renal (hi urine cl), normotensive - slightly hypo
pyloric stenosis, CF
52
Met alk, renal, normotensive where is the problem
loop of Henle
53
What are some causes, association with met alk, renal normtensive
Loop diuretics, Bartter's syndrome, gittelman's syndrome
54
What are some causes of met alk, renal, hypertensive
excessive aldosterone - CAH, 11B-hydroxylase deficiency) RAS, Liddle's syndrome
55
Pattern: polyhydramnios, hypercalciuria, hearing loss
Bartter's syndrome
56
If metabolic acidosis then what next
calculate anion gap Na-Cl-HCO3
57
what is considered anion gap
>12
58
What are cause of anion gap
``` Methanol Uremia DKA Paraldehyde Isoniazid/iron Lactic acidosis (dehydration, sepsis) Ethylene glycol Salicylates ```
59
What are causes of non-gap acidosis
``` GI losses (diarrhea, fistulas) RTA ```
60
Pattern: short stature, nephrocalcinosis, rickets
RTA
61
Pattern: inability of distal tubule to excrete acid
RTAI
62
Pattern: lowered proximal tubular bicarbonate excretion
RTA2
63
What is the urinary pH in RTAI/RTA2
pH >5.5 (serum is acidotic)/pH <5.5 (serum is alkalotic)
64
Pattern: renal wasting of phosphate, amino acids, bicarbonate, urate and glucose, cystinosis, rickets
Fanconi's syndrome
65
What drug can cause acquired RTA
Ifosfamide
66
What is potassium status of RTA's
HypoK RTAI and 2, hyperK RTAIV
67
Disorder of distal nephron/inability to excrete acid
RTA IV
68
Causes of RTAIV
Addison's disease, obstructive uropathy