Fluids and Electrolytes Flashcards
What is the normal sodium range?
135-145
What is the normal potassium range?
3.5-5
What is the normal Calcium range?
8.5-10.5
What is the normal phosphate range?
2.5-4.5
What is the normal magnesium range?
1.5-2.5
A patient is hypernatremic. What is the first thing you look at?
Volume status–are they hypovolemic, isovolemic, or hypervolemic?
A patient is hyponatremic. What is the first thing you look at?
Osmolarity
A patient has hypertonic hyponatremia. What now?
Is there blood glucose high? Calculate corrected Na status (Na + (glucose-100)/100). Treat hyperglycemia with insulin
A patient has isotonic hyponatremia. What now?
The patient has pseudohyponatremia. High lipids/proteins are causing an inaccurate lab reading
A patient has hypotonic hyponatremia. What now?
Assess the patient’s volume status (hypovolemic, isovolemic, hypervolemic)
What might cause isovolemic hypotonic hyponatremia?
SIADH,
What drugs can cause SIADH?
antipsychotics, antidepressents (sertraline and fluoxetine), carbamezapine
How do you treat isovolemic hypotonic hyponatremia?
- Stop administering the drug that you suspect is causing SIADH
- Administer Diuretic (furosemide)
- Administer vaptans, as secondary line of treatment
What is the characteristic TBW and Na of isovolemic hypotonic hyponatremia?
TBW is increased
Na is also increased, but not as high
What might cause hypovolemic hypotonic hyponatremia?
Dehydration, fluid loss, burns,
How do you treat hypovolemic hypotonic hyponatremia?
- Administer fluids–NS
Calculate sodium deficit to determine amount to administer
Do not correct by more than 12 mEq/day
Follow rule of 8’s: Half in first 8 hours, then a quarter in the next 8 and a quarter in the next 8
What causes hypervolemic hypotonic hyponatremia?
Fluid retention?
How do you treat hypervolemic hypotonic hyponatremia
Diuretics
A patient has has hypovolemic hypernatremia. What do you do?
Calculate FWD. (TBW(Naserum/140)-1)
Administer 1/2 the FW over the first 24 hours, and the remaining half in the next 1-2 days
What cause hypovolemic hypernatremia?
Fluid loss
A patient has hypervolemic hyponatremia. What do you do?
Diuretics
What do you do if a patient has hypokalemia and is asymptomatic?
Administer Potassium orally. Can come in liquid or solid dosage forms, as KCl, K acetate, etc.
How much does 10mEq of potassium increase serum potassium?
by 0.1 mEq
What do you do if a patient has hypokalemia and is symptomatic?
IV K+
Increase by no mare than 10mEq/hr
20mEq/hr if the patient is on continuous cardiac monitoring
What do you do if a patient has hypomagnesemia and is asymptomatic?
Administer Mag Orally.
Milk of Mag or Ox-Mag
What do you do if a patient has hypomagnesemia and is symptomatic
Administer Mag by IV.
If Mag is 1-2: 0.5 mEq/L
If mag is <1: 1 mEq/L
What do you do if a patient has hypermagnesemia?
- Administer CaCl
- If normal renal function: Forced diuresis and
- If renal dysfunction: Hemodialysis
What do you do if patient has hyperkalemia?
- Administer CaCl (to antagonize heart contractions)
- Administer Insulin/Dextrose/albuterol/NaHCO3 (to draw the K into the cell)
- Administer hemodialysis, diuretics, or polystyrene (to excrete K)
What do you do if a patient has chronic hyperkalemia?
Administer Promitene–to decrease potassium absorption from GI tract
What do you do if a patient has hypocalcemia?
- Fix underlying Magnesium problem
2. Administer Ca–Calcium gluconate preferred, CaCl possible if dire situation (administers faster–1 gm/3gm)
What do you do if a patient has hypercalcemia?
- Volume expansion/Loop diuretics
- Calcitonin (decrease bone resorption and renal tubular reabsorption)
- Bisphosphonate (decrease bone resorption)
- Glucocorticoids (decrease GI absorption)
What do you do if a patient has hypophosphatemia?
Administer phosphate:
NaPHO if K >4
KPhos if K <4
Follow potassium administration rules
What do you do if a patient has hyperphosphatemia?
Administer Ca gluconate
Reduce GI absorption of phosphate
