Fluids and Electrolyte Therapy Flashcards
1
Q
as we age do you gain or lose water content?
A
Lose
2
Q
What has a bigger fluid distribution, intracellular or extracellular?
A
intracellular
3
Q
What are the primary intra cellular ions?
A
K and Mg and proteins and phosphates
4
Q
What are the primary extracellular ions?
A
Na, Cl, HCO3
5
Q
Why are serum levels misleading to the whole body store of electrolytes?
A
because the serum only contains 5% of the total body weight and only 10% of the total body water
6
Q
what are the three types of extracellular fluid?
A
intravascular/plasma, interstitial/extavascular/extracellular, nonfunctional extracellular fluid from 3rd spacing
7
Q
how can edema be one sided and what is pitting edema?
A
from a thrombosis; when you press down on the skin and it stays pressed in
8
Q
What is the normal fluid intake?
A
2000-2500ml/d
9
Q
What are the two types of sensible losses of fluids?
A
urine and GI (800-1500 and 250)
10
Q
What are some volume deficit symptoms?
A
thirst, hypotension, tachycardia, sunken in skull, tenting
11
Q
What are some reasons for volume excess
A
dec water excretion, ADH, excess water or isotonic salt solutions
12
Q
tx for volume excess?
A
water restriction, hypertonic saline, loop diuretics (inc solute excretion, inc free water excretion, once neg Na balance achieved)
13
Q
Fluid therapy goals
A
adequate fluid, provide electrolytes
14
Q
How do you calculate the normal water intake per day for someone?
A
1500ml + 20ml/kg over 20kg (or about 30-35 ml/kg)
15
Q
How do you calculate infusion rate over 24 hours?
A
ml/24 hours = rate (ml/hr)
16
Q
What is the difference between crystalloids and colloids and their distribution patterns?
A
Colloids are big proteins or polymers like Dextan that STAY in the intravascular space and shift fluid from the intersitial space to the intravascular spaces. Crystalloids are solutions where the solutes can go into the extravasular space and intersitial space
17
Q
What is the normal value of Na?
A
135-145 mEq/L
18
Q
What is the function of Na?
A
control of water distribution and serum osmolality
19
Q
Is Na intracellular or extracellular?
A
extracellular
20
Q
Can renal excretion of Na drop to zero? How?
A
Yes, Aldosterone
21
Q
What is more common excess Na or excess fluid loss with no loss of Na to give excess Na?
A
FLuid deficit in excess of Na losses
22
Q
What is the tx for hi Na with low water?
A
give fluid therapy
23
Q
what is the tx for hi Na with normal water?
A
give fluid and then furosemide to inc renal Na excretion
24
Q
What range is mild to moderate hyponatremia?
A
125-135
25
What range is severe hyponatremia?
<125
26
What are some durgs that can cause hyponatremia?
diuretics, SSRI, antiepileptic agents
| CHF, SIADH (syndrome of inappropriate antidiuretic hormone)
27
What can you cause if you infuse too fast into a hyponatremia pt?
osmotic demyelination syndrome
28
to minimize risk of osmotic demyelination syndrom how fast should you infuse?
not more than 1-2mEq/L per hours or not more than 12mEq/L per 24 hrs or 18mEq/L over first 48 hours
29
What should you do for hyponatremia?
tx underlying condition
restrict fluid intake
supplement Na
30
Can you give someone who is hyponatremic vasopressin receptor antagonists
yes, it flushes out water but hold onto Na, K
31
Should you use vassopressin in pts who are volume depleted?
no, instead use saline replacement therapy as primary therapy
32
Can Low mg cause low K?
Yes
33
Can high Mg cause high K?
No
34
Can cardiac problembs be caused by high or low K?
Yes
35
Does K contract smooth muscle?
yes
36
Does K help with protein and glycogen synthesis?
yes
37
Is K intra or extra cellular?
intracellular
38
what organ gets ride of K?
kidneys
39
Can the kidney reduce K excretion to zero if you are low on K?
No, but it can for Na thanks to aldosertone
40
What is factitious hyuperkalemia?
red blood cells that lyse and inc the serum conc of K giving a false hyperkalemia
41
Can salt subsititutes inc K?
yes
42
Can high doses of Penicillin G K cause inc K?
Yes
43
What are some meds that inc K through decreased excretion?
ACE, ARBs, spironolactone, NSAIDs, cyclosporine, tacrolimus
44
Can inc release of K from cells happen? How?
lysis, acidosis, medications
45
How do you tx hyperkalemia?
tx underlying condition, dec/eliminate K intake; then giving drugs depends on severity of hyperkalemia and if there are symptoms of EKG changes
46
What is severe hyperkalemia numbers?
>7mEq/L
47
One treatment for hyperkalemia that doesnt effect plasma K levels or total body stores of K is ________. How does it work
Calcium Gluconate; it antagonizes cardiac and neuromuscleul toxicity of inc K; thus inc threshold protential; and stabilizes excitable cell membranes
48
What is the place in therapy of Calcium Gluconate?
Its 1st line for severe hyperkalemia with EKG changes, it helps give you time to prevent cardiac events while you figure out the underlying cause of the hyperkalemia
49
What is the dose and frequency of Ca gluconate for EKG abnormalities from K
10-20ml of 10% Ca gluconate IV over 2-5 mins
50
What drug must you be care with when giving Ca gluconate therapy?
Digoxin
51
What is a drug to move K back into the cells (intracellular shift?)
Insulin and dextrose
52
Insulin stimulate the _____ pump
Na-K-ATPase
53
is dextrose always needed when giving insulin to correct K levels?
no, not if they are hyperglycemic
54
What should you monitor when giving insulin to correct hyperkalemia? How many units insulin
K and glu; 10 U
55
What other drug moves K into the cells besides insulin?
Sodiuim bicarbonate
56
Is Ca compatible with sodium bicarbonate?
no monitor Ca, potential for hypocalcemic tetany
57
What electrolyte can you overflow when using Na bicar for hyperkalemia?
Na
58
How does albuterol lower K levels in the blood?
binds to beta 2 receptor --> cyclic AMP --> protein kinase A --> activates Na K ATPase --> influx of K into the cells with no reduction of TOTal body K
59
side effects and caution with who when using albuterol?
HR and BP inc (10-20mg) and caution in elderly with CV
60
What is Kayexalate used for? Where does it work?
Its Sodium polystyrene sulfonate and it exchanges Na for K in the colon and excretes K in feces
61
What do you monitor for in SPS?
intestinal necrosis and perforation
62
Can hemodialysis be used for hyperkalemia? When?
Yes, in renal failure, most effective
63
Can insulin cause hypokalemia?
yes
64
What is refeeding syndrome?
when you get food too fast after being starved, the body doesnt know how to react properly and you can die from cardiac problems
65
Can Na bicar cause hypokalemia?albutero?
yes, yes from ANKATPase pump activity
66
What are some symptoms of refeeding syndrome?
edema, respiratory, cardiac dysfunction, arrhythmias, death
67
can renal losses cause hypokalemia?
yes
68
Can you get hypokalemia from gi losses?
yes
69
Can low Mg contribute to low K?
yes
70
What is tx for hypokalemia?
Potassium supplementation (Cl, acetate, citrate, bicarb, gluconate, phosphate)
71
For every 0.3mEq/L dec the body is deficit about 100mEq
True
72
What is the preferred route of Potassium supplementation?
Oral; prevention 20mEq/day
| tx 40-100 mEq/day or more, PRN
73
What are the indications for parenteral potassium supplementation? What are the three types of parenteral potassium supplememntation? Why is it avoided?
WHY WOULD YOU NEVER GIVE IV PUSH OR IM of potassium?
oral not feasible, severe deficiencies, symptomatic, life-threatening
KCl, Kphos,KAcetate
painful!
IT CAN STOP THE HEART!
74
Why is it important to supplement Mg before doing K if the Mg stores are super low?
because if you have low mg you will have low K and it potentially wont repsond to K supplements until you restore the Mg
75
What is the normal fucntion of Ca?
nerve impluses, contraction of muscle, blood coagulation
76
What is the normal Ca levels in the serum?
8.5-10.3 mg/dL
77
Where is most of the Ca found in your body?
In the bone
78
About 50% of ECF Ca is ____ and thus active, the remainder is bound to ________.
active; proteins and anions (phosphate and citrate)
79
How is Ca excreted?
Kidney
80
What is the corrected Ca level equation?
Corrected Ca = measured serum Ca + 0.8(4-alb)
81
```
Where is Ca;
Absorped
Adsorption
Resorption
reabsorption
```
GI tract
to bone
from bone
from renal tublules after glomerular filtration
82
What enzyme increases when Ca is low?
ParaThyroid Hormone
83
What is the function of Parathyroid hormone?
it causes release of Ca and phosphate from the bones, it also causes Ca reabsorption by distal renal tubule
84
What is the function of calcitonin and when is it high?
it is high when Ca is high;
it inhibits tubular reabsorption of Ca so its pee'd out
it inhibits osteoclastic bone resorption
85
What is the function of calcitriol (Vit D)
inc intestinal absorption of Ca and phosphate
inc net bone resorption (inc osteoclasts)
inc bone formation
inc renal tubular reabsorption of Ca
86
What are some reasons for hypercalcemia?
vit d toxicity, vit a toxicity, thiazide diuretics, litium (inc PTH), hyperparapthyroidism, hyperthyroidism
87
tx for hypercalcemia?
tx underlying cause, dec Ca supplements
88
If you have hypercalcemia can you give Saline infusion? why?
Yes! it not only reestablishes fluid balance in the person but it also helps by having the Na inhibit tubular reabsorption of Ca, thus allowing you to pee out the excess Ca.
89
Can furosemide be used in hypercacemia?
Yes, it block Ca reabsorption also like Na
90
Should you use furosemide before or after you correct dysvolemia?
only use after, you could make dysvolemia worse
91
What is the dose of furosemide?
20-40mg Q2h IV after rehydration has been achieved to dec Ca
92
What should you monitor when giving Furosemide to dec hypercalcemia?
monitor K dec and Mg dec and supplement as needed
93
What type of diuretics should you AVOID in hypercalcemia? why?
thiazide diuretics; dec amount of Ca you excrete in your urine
94
What is Pamidronate, brand name, and why is it indicated for?
A bisphosphonate that dec osteoclastic bone resorption.
Aredia
hypercalcemia of malignancy
95
What is a severe high Ca level?
>13.5mg/dL
96
How do you reduce the renal toxicity of Pamidronate (Aredia)
inc infusion time (>2hr)
97
How long should you wait to start a new dose after giving Pamidronate?
7 days
98
What is Zometa? indication? What population is it aboided in?
bisphosphonate that dec osteoclastic bone resportion
generic name is Zoledronic acid
indication is hypercalcemia of malignancy (max dose of 4mg)
pts at risk of renal impairment
99
When pts are taking bisphosphonates they should be monitored for what electrolytes
hypo-kalemia,ma,phos,ca
100
What caution should be taken when using bisphosphonates and the kidnyes
use caution when taking with other nephrotoxic drugs, can progress to renal failure
101
are the other disphosphonates indicated for hypercalcemia?
No
102
what is the significat SE of the bisphosphonates?
osteonecrosis of the jaw, subtrochanteric and siaphyseal femoral fractures
103
What does salmon calcitonin do?
inhibits the osteoclastic bone resorption so that Ca stops getting released into the serum. it also inhibits renal tubular Ca reabsorption so that ca is excreted thus tx hypercalcemia
104
What are some side effects of salmon calcitonin?
N/V, tachyphylaxis, allergic rxn (test dose first), hypersensitivity
105
What is gallium nitrate used for?
hypercalcemia; blocks PTH effect on bone; inhibits bone resorption
106
What is the brand name of gallium nitrate?
Ganite
107
Can corticosteroids be used to tx hypercalcemia?
yes if its from cancer stuff i think
108
What is cinacalcet and how does it work?
It is a calcimimetic agent (Brand name: Sensipar) that increases sensitivity of Ca sensing receptor (Ca-R) to activation by extracellular Ca; when Ca of binds to the Ca-R it inhibits the release of PTH
109
In what pts is Sensipar indicated for?
pts with parathyroid problems
110
Should you take cincalcet with food?
yes
111
can you divide the cincalcet tablets?
no
112
What is the cutoff for initiating Sensipar therapy?
Should not initiate if serum Ca is less that 8.4mg/dL
113
What are some reasons for hypocalcemia?
dec PTH function (Furosemide or Cinacalcet); altered vit D metabolism (Phynytoin and phenobarbital; binding w/ Ca (phosphate Foscarnet, which chelates divalent cations)
114
Can Mg dec have an effect of Ca? what effect?
Yes, could cause low Ca by affecting secretion and skeletal response to PTH
115
Could hyperphosphatemia and massive blood transfusion cause hypocalcemia?
yes and yea from binding
116
What are the different salt forms of Ca supplementation?
Calcium Carbonate, glubionate, citrate, gluconate, lactate
117
Which Ca supplements are parenteral?
Calcium gluconate and calcium chloride
118
Why can't you mix calcium gluconate with bicarbonate or phosphate?
crystalization i think
119
What happens if you infuse Ca too fast?
vasodidlation, hypotension, bradycardia, cardiac arrest
120
What should you monitor when giving Ca and why should you not give CaCl2 IM or SQ?
EKG, BP, pts recieveing digoxin; Because of necrosis
121
Can you give vit D to help tx hypocalcemia?
yes
122
can you give Mag if its low to help with hypocalcemia?
yes
123
If you tx hyperphosphatemia why might that help with hypocalcemia?
because they bind together and could precipitate out
124
Where is Mg normally found?
intracellular
125
how is Mg excreted?
kidneys
126
What is the normal serum levels of Mg?
1.7-2.3
127
What are some causes of hypermagnesemia?
dec renal excretion, inc gi absorption, supplementation (drugs)
128
What are some tx for excess Mg?
stop supplementation, saline solution diuresis, loop diuretics, intravenous Ca (enhances renal secretion of Mg), hemodialysis
129
What are some causes of hypomagnesemia?
inadequeate intake, intracellular redistribution (refeeding syndrome), Gi losses (diarrhea, laxatives, enema, malabsorption)
130
What are some drugs that contribute to the renal loss of Mg?
Amphotericin B, Cisplatin, Carboplatin, aminoglycosides, loop and thiazide diuretics, osmotic diuresis
131
How does Foscarnet lower Mg levels?
its chelates divalent cations
132
What is a side effect from enteric supplementation of Mg?
Diarrhea
133
What is a painful form of parenteral Mg?
IM
134
What is the normal level of phosphate?
2.5-4.5
135
What ion plays a major role in renal exretion of H ions?
phosphate
136
Where is phosphate usually found?
intracellular
137
80% of phosphate is located in
bone
138
What are some causes of hyperphosphatemia?
dec renal excretion, tumor lysis syndrome from chemotherapy, phosphate supplements, Foscarnet
139
What is the level of CaxP supposed to be?
<55
140
What does a phosphate binder do?
reduces Gi absorption of Phosphate by binding to phosphate
141
Al hydroxide and Al carbonate are used as what? What level are they saved for?
phosphate binders; >7 mg/dL (only for 4 wks)
142
Can Ca salts be used to dec P absorption? How?
yes, form insoluble Ca-P excreted in feces
143
What is PhosLo?
Ca acetate
144
What is PhosLo indicated for?
control of hyperphos in ESRD
145
What is Phoslyra? What is it indicated for?
Calcium acetate; reduction of serum phos in pts w/ ESRD
146
Can PhosLo cause hyperCa?
Yes
147
Could PhosLo dec %F of TCNs?
Yes
148
Should Calcium acetate be given to pts on digitalis?
no, may precipitate cardiac arrhythmias
149
What is Sevelamer used for?
control of serum phos inp ts w/ CKD on dialysis
150
What is the brand name of Sevelamer?
Renagel hydrochloride
151
What is the starting dose of Renagel?
1 or 2 800mg or two to four 400mg tabs TID with meals
152
What is Revela?
Sevelamer carbonate
153
Can you just switch gram for gram among sevelamer formulations?
yes
154
What is sevelamer contraindicated with?
bowel obstruction
155
What are some side effects of Sevelamer?
dyspepsia, N,V,D, constipations, fecal impaction, ileus, bowel obstruction, bowel perforation
156
What does Sevelamer do to Cirop %F?
Dec by 50%
157
administer Cipro _ hours before or _ hours after sevelamer.
1, 3
158
What is Lanthanum carbonate brand name and what is it used to tx?
Fosrenol, used to tx hyperphophatemia
159
What is Fosrenol contraindicated in?
bowel obstruction, ileus, fecal impaction
160
What are some side effects of Fosrenol?
N/D abdominal pain, vominiting, constipation, dyspepsia, allergic skin rxns, hypophosphatemia, tooth injury
161
Compounds that bind to _______ antacids such as ____ ____ ____ should not be taken withing 2 hours of Fosrenol
cationic; Ca, Mg, Al
162
Dec _______ %F so you should administer at least 1 hr before or 4 hours after Fosrenol
Cipro (quinolones)
163
What must you do with levothyroxine when taking Fosrenol?
take 2 hrs before or 2 hrs after fosrenol and monitor the TSH levels
164
What can cause hypophosphatemia?
inadequate intake, refeeding syndrom, reduced absorption from phosphate binders (Al containing products, Sucralfate, Ca salts, Sevelamer, Lanthanum), Renal wasting, High Ca, Foscarnet, respiratory alkalosis and hypercentilation
165
What is the tx for hypophosphatemia?
tx underlying condiction, give phosphate supplementation.
166
what should you first assess before starting phosphate supplementation?
renal fucntion and monitor Ca levels because you could dec Ca or you could exceed the CaxP <55
167
What dosage form should phosphate never be given as?
Never IV push or IM like potassium
168
Can you give oral, gastric, enteric? what should you monitor for?
Yes, monitor for hyperkalemia from the K containing products (also causes diarrhea)
169
How do you determine which to use: NaPhos or KPhos?
you tx with which ever other lab value is low
170
What are the IVPB phos forms indicated for?
sever hypophosphatemai (<1mg/dL), symptomatic hypophosphatemia or cannot take oral
171
What are some symptoms of hypophosphatemia?
muscle weakness, acute respiratory failure
172
What should you monitor when giving IVPb phosphate?
inc phos, inc K, rapid infuction can cause dec Ca, tetany, hypotension, metastatic calcifications
