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Therapeutics 2 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Ideal Body Weight (males)

A

50 + (2.3*inches over 60)

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2
Q

Ideal Body Weight (females)

A

45.5 + (2.3*inches over 60)

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3
Q

when to use nutritional body weight?

A

When actual body weight is > 130% of IBW

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4
Q

what is the range for isotonic fluids?

A

275-290 mosm/L

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5
Q

What is the range for hypotonic fluids

A

<275 mosm/L

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6
Q

What is the range for hypertonic fluids

A

> 290 mosm/L

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7
Q

What is the clinical estimate for maintenance IV fluids?

A

30-40 mL/kg/day
rate = divide total by 24

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8
Q

What are the crystalloids?

A

NS, 1/2NS, D5W, LR, and balanced salt solutions

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9
Q

What are uses for NS?

A

intravascular fluid replacement (resuscitation)
sodium/chloride replacement

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10
Q

What are uses for 1/2 NS

A

maintenance fluids

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11
Q

What are uses for lactated ringers?

A
  • replacement of blood loss
    -resuscitation (trauma, burn, etc)
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12
Q

What is use for D5W?

A
  • replacement for free water
  • not a resuscitative fluid
  • not a MIVF
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13
Q

What are the examples of balanced salt solutions?

A
  • Lactated Ringers
  • Normosol-R
  • plasma-lyte
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14
Q

What are colloid solutions used for?

A
  • Increase plasma oncotic pressure
  • move fluid from interstitial compartment to plasma compartment
  • Volume expansion; intravascular repletion
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15
Q

What is albumin used for?

A
  • Volume expansion (5%)
  • shock
  • burns
  • supportive/symptomatic treatment
  • fluid and sodium restricted patients (25%)
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16
Q

Adverse effects of albumin

A
  • Hypervolemia
  • Azotemia
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17
Q

Synthetic Colloids Example

A
  • hetastarch
  • tetrastarch
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18
Q

Indication for using Packed Red Blood Cells as a colloid

A
  • acute blood loss
  • low hemoglobin <7-8 g/dL
  • 1 unit of RBCs increases hemoglobin by 1g/dL
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19
Q

What is the most common maintenance IV fluid?

A

D5W + 1/2 NS +20 mEq KCl/L
- increase plasma oncotic pressure
- similar composition to urine

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20
Q

Signs of dehydration

A
  • tachycardia and hypotension
  • weak peripheral pulses
  • decreased urine output <5 mL/kg/hr
  • BUN/Scr Ratio >20
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21
Q

What is the goal range for sodium?

A

135-145 mEq/L

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22
Q

What is hyponatremia?

A

Sodium levels below 135 mEq/L

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23
Q

What is isotonic hyponatremia?

A

Normal serum osmolality with low sodium levels
Serum osmolality =275-290 mosm

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24
Q

What causes isotonic hyponatremia

A
  • extreme elevations of lipids and proteins increase the total plasma volume
  • dilution effect on sodium
  • measured serum osmolality not affected; calculated Osm is low`
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25
What is hypertonic hyponatremia?
- High serum osmolality with low sodium levels - serum osmolality >290 mOsm
26
What causes hypertonic hyponatremia?
most frequently seen with elevated blood glucose
27
What is hypotonic hyponatremia?
- low serum osmolality <275 with low sodium levels <135
28
What are the types of hypotonic hyponatremia?
hypovolemic hypotonic hyponatremia, isovolemic hypotonic hyponatremia, hypervolemic hypotonic hyponatremia
29
What needs assessed when a patient has hypotonic hyponatremia
volume status
30
What is hypovolemic hypotonic hypernatremia
- decrease in both total body water and sodium - normally caused renally by excessive diuresis and high Na+ concentrations in urine - can also be caused by trauma, blood loss, burns, and GI losses
31
What is isovolemic hypotonic hyponatremia
- increased total body water and normal or slightly elevated Na+ - caused by SIADH (syndrome of inappropriate antidiuretic hormone release) - makes too much ADH; slight water retention; water intake exceeds capacity of kidneys to excrete water - drug induced
32
What drugs most commonly cause SIADH?
Antipsychotics, carbamazepine, SSRIs
33
Treatment of SIADH
- remove underlying cause (medications) - free H20 restriction - may require vaptans as second-line
34
What is hypervolemia hypotonic hyponatremia?
- increased Na+ but increased TBW even more - edema - heart failure, kidney failure, cirrhosis
35
Clinical presentation of hypovolemic hypotonic hyponatremia? Goal of treatment?
dehydration; restore volume deficit
36
Clinical presentation of hypervolemic hypotonic hyponatremia?
fluid overload/edema
37
General goal of treatment for hypotonic hyponatremia?
avoid rise in serum sodium >0.5mEq/L/hr or 8-12 mEq/L/day
38
treatment for hypovolemia hypotonic hyponatremia
Hypertonic Nacl (3%) is symptomatic Isotonic NaCl (0.9%) if asymptomatic
39
treatment for isovolemic hypotonic hyponatremia
- Furosemide and 3% NaCl if symptomatic - isotonic NaCl if asymptomatic and water restriction
40
treatment for hypervolemic hypotonic hyponatremia
Furosemide and 3% NaCl in symptomatic patients
41
acute vs chronic hyponatremia
acute more of a risk for brain herniation and death; not as urgent UNLESS symptomatic
42
Treatment of acute symptomatic hyponatremia
Increase serum Na by 1-2 mEq/L/hr until symptoms resolve; goal 120 mEq/L - maximum increase of 8-12 mEq/L in the first 24 hours
43
Risk factors for demyelination
Serum Na < 105 mEq/L Hypokalemia
44
Rule of 8s
Replace 1/2 of sodium deficit in 8 hours, then remaining deficit within 8-16 hours
45
What is hypernatremia?
Too much sodium (Na > 145 mEq/L)
46
What is hypernatremia associated with?
hypertonicity; impaired thirst response or patients without access to water
47
What is hypovolemic hypernatremia?
Loss of both H20 and Na+
48
What is isovolemic hyponatremia?
often caused by diabetes; loss of H20; Na+ can go up or down
49
What is hypervolemic Hypernatremia?
Fluid overload; mineralcorticoid excess increased total body water but also increased sodium
50
Hypovolemic hyponatremia treatment
- restore hemodynamic status (if needed) - may give 0.9% NaCl - Calculate free water deficit - provide free water using D5W - follow rule of 8's - goal of 0.5 mEq/L/hr decrease in Na serum
51
Treatment for isovolemic hypernatremia (caused by diabetes insipidus)
- Desmopressin - Vasopressin
52
Hypervolemic hypernatremia treatment
- stop hypertonic fluids/ cause - diuretic if needed
53
What is the goal lab values for potassium?
3.5-5mEq/L
54
Treatment for hypokalemia
3.5-4 mEq/L - may treat in ICU patients until lab value above 4 3-3.4 mEq/L - oral K+ for patients with cardiac conditions <3 mEq/L - always treat; PO route preferred - May use IV for symptomatic patients who cannot take PO - Attempt to correct Mg2+ deficit
55
How to give IV K+
- 10mEq/hr in 100mL of D5W (no cardiac monitoring) - 20 mEq/hr in 100mL of D5W (with cardiac monitoring) - Never give K+ IV push
56
Hyperkalemia
mild: 5.5-6 moderate: 6-7 severe: >7
57
Hyperkalemia treatment
C A BIG K Drop
58
Hyperkalemia treatment
1. Calcium 2. Albuterol 3. Bicarb 4. Insulin + glucose 5. Lokelma-- safer than Kayexalate 6. Diuretics (furosemide) 7. Dialysis
59
Chronic hyperkalemia treatment
Patiromer (Valtassa)
60
Normal Mg2+ labs
1.5-2.5 mg/dL
61
Mg2+ role in body
co-factor for enzymes related to Ca2+ and K+ metabolism
62
hypomagnesemia causes/ presentation
Diuretics (thiazide or loop) with other electrolyte abnormalities
63
hypomagnesemia treatment
- asymptomatic patients: PO - milk of mag/ mag-ox - symptomatic patients: IV 1g/hour
64
Calcium goal labs
8.5-10.5 mg/dL
65
hypocalcemia treatment
- ca chloride can be given IV push during code - calcium gluconate preferred for PIV administration - 1gm/hour = 3gm Ca gluconate - do not add to bicarb or phos solutions
66
chronic hypocalcemia treatment
1-3 g of elemental Ca2+/day calcitriol 0.25mcg po daily
67
Phosphorus goal lab values
2.5-4.5mg/dL
68
Hypophosphatemia treatment
use Kphos when K+ <4mEq/L Use NaPhos when K+ >4mEq/L

Therapeutics 2 (9 decks)

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