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Own peds boards > Fluids And Electrolyte > Flashcards

Fluids And Electrolyte Flashcards

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
Q

What are 3 major categories of causes for hyperkalemia?

A
  1. Transcellular shift
  2. Excess
  3. Decreased renal excretion
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26
Q

What are causes of transcelluar shift to cause hyperkalemia?

A 
B blockers
Acidosis
Hyperglycemia - insulin insufficiency
Succinylcholine
Digitalis
Arginine and lysine HCl
Sodium fluoride
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27
Q

What are cause of excessive K

A 
Tumor lysis
Consumption of exogenous
Stored blood
Hematoma breakdown
IV coagulopathy
Tissue necrosis
GI bleeding
Hemolysis
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28
Q

What are causes of decreased renal excretion?

A

Renal failure, decreased aldosterone, or decreased sensitivity to aldosterone by kidney

29
Q

What are causes of decreased aldosterone

A

Addison’s disease
congenital adrenal hyperplasia
ACE inhibitor usage
NSAIDs

30
Q

What are cause of decreased aldosterone sensitivity?

A

obstructive uropathy, SCD, SLE, K-sparing diuretics (spironolactone, amiloride, triamterene)

31
Q

What are signs of skeletal weakness from hypokalemia?

A

weakness, cramps, rhabdomyolysis, paralysis

32
Q

What are signs of smooth muscle weakness from hypokalemia?

A

gastric distension, ileus, constipation, urinary retention

33
Q

What are causes of transcellular shift to hypokalemia?

A

Extreme leukocytosis, treatment of severe anemia (make more RBCs), periodic paralysis (post-carb meal)

34
Q

What are causes of inadequate body stores?

A

If pt is acidotic

35
Q

You can lose K in urine - how hi does urine K have to be

A

> 20mEq/L

36
Q

If hypokalemic and renal loss is suspected, check serum pH, if acidic what is the cause, if alkalosis what is the cause

A

acid - RTA

alkalosis - diuretics, Bartter syndrome, Gittelman syndrome

37
Q

Low bicarbonate, serum <7.4

A

metabolic acidosis

38
Q

Low bicarbonate, serum >7.4

A

respiratory alkalosis

39
Q

Hi bicarbonate, serum <7.4

A

respiratory acidosis

40
Q

Hi bicarbonate, serum >7.4

A

metabolic alkalosis

41
Q

pH >7.4, low bicarbonate

A

respiratory alkalosis

42
Q

pH >7.4, high bicarbonate

A

metabolic alkalosis

43
Q

pH <7.4, low bicarbonate

A

metabolic acidosis

44
Q

pH <7.4, high bicarbonate

A

respiratory acidosis

45
Q

What are causes of respiratory acidosis?

A

retain a lot of CO2 - respiratory depression

46
Q

What are causes of respiratory alkalosis?

A

Stimulation of respiratory center, anxiety, drugs, fver, gram neg sepsis, liver insufficiency, CNS

47
Q

If you have metabolic alkalosis what else do you want to check?

A

Urine Chloride because K is usually lost with metabolic alkalosis and Cl is usually retained to try to save KCl

48
Q

If in metabolic alkalosis, urine chloride is lo what is the cause

A

extra-renal

49
Q

If in metabolic alkalosis, urine chloride is hi, what is the cause?

A

renal

50
Q

If renal metabolic alkalosis, what next to check

A

Blood pressure

51
Q

Met alk, renal (hi urine cl), normotensive - slightly hypo

A

pyloric stenosis, CF

52
Q

Met alk, renal, normotensive where is the problem

A

loop of Henle

53
Q

What are some causes, association with met alk, renal normtensive

A

Loop diuretics, Bartter’s syndrome, gittelman’s syndrome

54
Q

What are some causes of met alk, renal, hypertensive

A

excessive aldosterone - CAH, 11B-hydroxylase deficiency) RAS, Liddle’s syndrome

55
Q

Pattern: polyhydramnios, hypercalciuria, hearing loss

A

Bartter’s syndrome

56
Q

If metabolic acidosis then what next

A

calculate anion gap Na-Cl-HCO3

57
Q

what is considered anion gap

A

> 12

58
Q

What are cause of anion gap

A 
Methanol
Uremia
DKA
Paraldehyde
Isoniazid/iron
Lactic acidosis (dehydration, sepsis)
Ethylene glycol
Salicylates
59
Q

What are causes of non-gap acidosis

A 
GI losses (diarrhea, fistulas)
RTA
60
Q

Pattern: short stature, nephrocalcinosis, rickets

A

RTA

61
Q

Pattern: inability of distal tubule to excrete acid

A

RTAI

62
Q

Pattern: lowered proximal tubular bicarbonate excretion

A

RTA2

63
Q

What is the urinary pH in RTAI/RTA2

A

pH >5.5 (serum is acidotic)/pH <5.5 (serum is alkalotic)

64
Q

Pattern: renal wasting of phosphate, amino acids, bicarbonate, urate and glucose, cystinosis, rickets

A

Fanconi’s syndrome

65
Q

What drug can cause acquired RTA

A

Ifosfamide

66
Q

What is potassium status of RTA’s

A

HypoK RTAI and 2, hyperK RTAIV

67
Q

Disorder of distal nephron/inability to excrete acid

A

RTA IV

68
Q

Causes of RTAIV

A

Addison’s disease, obstructive uropathy

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