Fluids and Electrolytes

Question 1

Three components of extracellular fluid

Answer 1

interstitial fluid, plasma, lymphatic fluid

Question 2

Electrolytes of ECF

Answer 2

Na+, Cl-, HCO3-

Question 3

Electrolytes of ICF

Answer 3

K+, Mg, Phosphates

Question 4

What is the most important plasma osmolality factor?

Answer 4

Na+

Question 5

Saline equivalents

Answer 5

normal saline or lactated ringers

Question 6

Water equivalents

Answer 6

D5W

Question 7

What is the max amt you can give through perpheral line?

Answer 7

900 mOsm/L . 3% normal saline (1028mOsm/L) must be given centrally

Question 8

Pareneteral colloids given for intravascular problems

Answer 8

albumin, packed RBCs, FFP

Question 9

Cause of hyponatremia

Answer 9

excess water load either oral or IV. <120meq/L is very severe

Question 10

What happens to brain in chronic hyponatremia?

Answer 10

cerebral adaptation–> less cerebral edema

Question 11

Hyponatremia classification based on ECF status

Answer 11

Hypovolemic: GI losses; renal losses (thiazides)
Normovolemic: SIADH; low Na+ intake
Hypervolemic: CHF; cirrhosis

Question 12

treatment for non-critical hypovolemic hyponatremia

Answer 12

normal saline given as slow bolus

Question 13

treatment for hypervolemic hyponatremia

Answer 13

fluid/sodium restriction and loop diuretics

Question 14

Which of the following should be included in treatment of SIADH for severe hyponatremia: 3% hypertonic saline, furosemide, salt pills, fluid restriction, K+ administration?

Answer 14

everything is included except K+ administration

Question 15

T/F hypernatremia increases brain volume and can rupture cerebral veins

Answer 15

false hypernatremia decreases brain volume

Question 16

Treatment of hypernatremia

Answer 16

D5W

Question 17

treatment for central DI

Answer 17

Desmopressin 10 mcg/day and restrict fluid intake

Question 18

treatment for nephrogenic DI

Answer 18

Thiazide diuretic and sodium restriction

Question 19

what do you need to know to get a corrected Ca+?

Answer 19

serum albumin ((4.5 - serum albumin) x 0.8) + Ca = Corrected Ca)

Question 20

treatment for hypercalcmic crisis

Answer 20

saline and loop diuretics (2-3 mg/dL drop in 24-48 hours). If malignant etiology bisphosphonate. Osteoclast inhibitors

Question 21

ECG changes associated with hypocalcemia

Answer 21

QT prolongation and decreased myocardial contractility

Question 22

hallmark symptoms of hypocalcemia

Answer 22

tetany, paresthesias around mouth

Question 23

treatment of acute hypocalcemia and chronic hypocalemia

Answer 23

acute- IV admin of calcium salts. chronic- oral calcium supplements

Question 24

what should you avoid when treating hyperphosphatemia?

Answer 24

aluminum-containing antacids

Question 25

cardiovascular changes associated with hypomagnesemia

Answer 25

widened QRS, a fib, ventricular arrhythmias

Question 26

what can cause hypomagnesemia?

Answer 26

alcohol

Question 27

When are you most likely to see hypermagnesemia?

Answer 27

OB patient who is being treated for preeclampsia

Question 28

treatment of hypermagnesemia

Answer 28

IV Ca+. If renal failure hemodialysis. If normal renal function forced diuresis w/fluid and loops

Question 29

cardiac symptoms of hypokalemia

Answer 29

U wave

Question 30

EKG changes associated with hyperkalemia

Answer 30

sharp, peaked T wave

Question 31

treatment for hyperkalemia

Answer 31

calcium gluconate IV, if acidotic give bicarb. if in renal failure give sodium polystyrene sulfonate (kayexelate), loop diuretics