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General Peds Boards > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q
  • Hyponatremia, hypochloremia
  • High urine osmolality and sodium (> 25)
  • Euvolemic/hypervolemic
  • Elevated BP
  • Low urine output, low BUN
A

SIADH

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2
Q

SIADH causes and treatment

A
  • CNS/pulm disorders, hypothyroidism, glucocorticoid deficiency, carbamazepime, SSRI/TCA, vincristine, cyclophosphamide, surgery (post-op)
  • Underlying problem is fluid retention not excretion of sodium
  • Tx: Fluid restriction is first line - can do furosemide and hypertonic saline if needed (if Na is < 120), demeclocycline (if over age 8)
  • *REMEMBER SIADH HAS LOW URINE OUTPUT**
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3
Q
  • Hyponatremia
  • High urine sodium (> 100)
  • Elevated urine output
  • Hypovolemic
A

Cerebral salt wasting

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4
Q
  • Hyponatremia, hypochloremia
  • Increased BUN and specific gravity
  • Low urine sodium (< 10)
  • Hypovolemic
A

Hyponatremic dehydration

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5
Q

Serum osmolality calculation

A

2Na + (BUN/2.8) + (Glucose/18)

Normal is 265-285

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6
Q

Acid base normal values

A
  • Bicarb > 25 = metabolic alkalosis, < 25 = acidosis

- pCO2 > 40 = respiratory acidosis, < 40 = alkalosis

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7
Q

Pyloric stenosis electrolytes

A

Hypochloremic hypokalemic metabolic alkalosis

  • High pH
  • Low: Na, K, Cl
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8
Q

Anion gap calculation

A

Na - (Cl + Bicarb)

Normal is 8-12

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9
Q

Normal anion gap acidosis causes

A

USEDCARP:

  • Ureterostomy
  • Small bowel fistula
  • Extra chloride
  • Diarrhea (most common)
  • Carbonic anhydrase inhibitor use
  • Adrenal insufficiency
  • Renal tubular acidosis
  • Pancreatic fistula
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10
Q

RTA basic symptoms

A
  • Failure to thrive, polyuria, constipation, metabolic acidosis with elevated chloride and normal anion gpa
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11
Q

Kidney Bicarb Function (Proximal vs Distal)

A
  • Proximal tubule Boxes Bicarb Back in

- Distal tubules Arranges for Acid to leave

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12
Q

Type 1 (Distal) RTA

A
  • Distal tubule is not properly excreting acid

- Urine will have a high pH (greater than 5.5) and can’t be acidified

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13
Q

Type 2 (Proximal) RTA

A
  • Inability for proximal tubule to reabsorb bicarb with excess bicarb in the urine but distal tubule still excretes acid so urine pH is less than 5.5
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14
Q

Type 4 RTA

A
  • Resistance to aldosterone so hyperkalemia
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15
Q

Causes of elevated anion gap acidosis

A

MUDPILES

  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Paraldehyde
  • Isoniazid
  • Lactic acid from organic acidemias
  • Ethanol/ethylene glycol
  • Salicylates
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16
Q

Daily requirement of sodium

A

3 mEq/kg/d

17
Q

Causes of hypernatremia

A

Na greater than 145

  • Sodium excess: improper formula mixing, ingestion of sea saltwater, excessive sodium bicarb after resuscitation, breast milk with excessive sodium, iatrogenic
  • Water deficit: DI, diarrhea
18
Q

Hypernatremia complications

A

Water follows Na so shifts out of intracellular compartment and leads to increased extracellular volume –> pulmonary edema

19
Q

DI labs

A
  • Due to central (lack of ADH) or nephrogenic (resistant to i)
  • Peeing a lot –> high serum osmolality with inappropriately dilute urine
20
Q

Nephrogenic DI

A
  • X linked (only in males)
  • Dilute urine
  • Fail to respond to exogenous vasopressin
21
Q

Renal failure causing hyponatremia

A
  • Increased fluid intake and decreased urine output
  • Elevated creatinine, edema, urine Na > 20
  • If oliguric and hemodynamically unstable give 20/kg isotonic fluids
22
Q

Dilutional hyponatremia labs/treatment

A
  • Due to water intoxication (polydipsia or excessive dilution of formula), hypotonic IV fluids, glucocorticoid deficiency, hypothyroidism
  • Total body sodium is normal but urine Na is > 100
  • Seizures can occur due to cerebral swelling
  • Infants will have seizures, respiratory insufficiency, and hypothermia
23
Q

Third spacing of fluids vs dilutional hyponatremia

A
  • Urine Na is high in dilutional hyponatremia
  • Urine Na is low in 3rd spacing of fluids
  • 3rd spacing occurs after extensive surgery due to endothelial damage/leakage, hypoalbuminemia and low oncotic pressure
24
Q

Causes of pseudohyponatremia

A
  • Elevated triglycerides or glucose –> sodium level in circulation is really normal
  • Edema (nephrotic syndrome) –> total sodium level is actually elevated
25
Q

Daily requirement for potassium

A

2 mEq/kg/d

26
Q

Symptoms of hypokalemia

A
  • Muscle pain, weakness, paralysis, constipation and ileus or polyuria
  • EKG changes: flattening of T waves, ST depression, PVCs, U wave
27
Q

Electrolyte abnormalities with muscle weakness and EKG changes

A
  • Hypocalcemia: prolonged QT interval

- Hypomangesemia: prolonged PR or QT interval, can also have diarrhea

28
Q

EKG changes for hyperkalemia

A

Peaked T waves and then eventually absence of P waves and widened QRS complex

29
Q

Treatment of hyperkalemia

A 
C BIG K
- Calcium
- Beta agonist (albuterol)
- Insulin
- Glucose
- Kayexelate
Can also use lasix or sodium bicarbonate
30
Q

Potassium shifts with alkalosis and acidosis

A
  • Alkalosis: K moves to the IC fluid and H moves out resulting in lower serum potassium but total body potassium is unchanged
  • Acidosis: H moves in and K moves out resulting in high measured serum potassium
31
Q

5% dehydration symptoms and treatment

A
  • Tachycardia, decreased tears, decreased urine output
  • Down 50 mL/kg so add this to the normal maintenance rate –> give the first half over 8 hours and the remainder over the next 16 hours
32
Q

10% dehydration symptoms and treatment

A
  • Tachycarida, sunken eyes, poor skin turgor, sunken fontanelle
  • Down 100 mL/kg so add this to normal maintenance rate –> give 20 mL/kg over an hour then take whatever is left and give half over the next 7 hours and the remainder over the next 16 hours
33
Q

15% dehydration symptoms and treatment

A
  • Shock, delayed cap refill time
  • Down 150 mL/kg
  • Give 20 mL/kg boluses until some clinical improvement then give half of what is left over the next 7 hours and remainder over the final 16 hours
34
Q

Oral rehydration solutions

A
  • Needs to include glucose so it can cross the microvilli of the GI tract
35
Q

Sodium correct and CNS issues

A
  • Low to High your Pons will Die - correcting hyponatremia too fast will lead to pontine demyelination
  • High to Low your Brain will Blow - correcting hypernatremia too fast will lead to cerebral edema
36
Q

Hyponatremic dehydration symptoms and treatment

A
  • Can present with seizures, often are more symptomatic (poor skin turgor)
  • Rehydration: NS boluses, if not improving then can give hypertonic saline
  • (Desired sodium - measured sodium) x weight x 0.6 –> add that to maintenance sodium (3 mEq/kg/d) and that is how much you need to replace over 24 hours
37
Q

Hypernatremic dehydration symptoms and treatment

A
  • Irritable, lethargic, doughy skin, high pitched cry, seizures
  • Water tends to go into the ECF so clinically they don’t look dehydrated but you should assume 10% dehydration
  • Intracellular dehydration can lead to shrinkage of brain cells, tearing of bridging blood vessels, and intracranial hemorrhage
  • Correct the sodium SLOWLY (over 2-3 days), no more than 10-12 mEq change per day
38
Q
  • Hypernatremia, hyperchloremia
  • Elevated BUN
  • Decreased specific gravity
A

Diabetes insipidus

39
Q

Electrolyte changes with loop and thiazide diuretics

A
  • Metabolic alkalosis
  • Hyponatremia
  • Hypochloremia
  • Hypokalemia
  • Hyperuricemia

General Peds Boards (24 decks)

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