Fluids and Electrolytes Flashcards
How to evaluate hyponatremia
look at osm first, then look at volume status if hypotonic
Hypertonic hyponatremia - common cause
elevated glucose - therefore use corrected Na equation
2 main causes of hypovolemic hypotonic hyponatremia
diuresis, blood loss,
How to treat symptomatic hypovolemic hypotonic hyponatremia
3% NaCl
How to treat asymptomatic hypovolemic hypotonic hyponatremia
0.9% NaCl
Common cause of Isovolemic hypotonic hyponatremia
SIADH
common causes of SIADH
carbamazepines; antipsychotics; SSRIs
How to treat symptomatic Isovolemic hypotonic hyponatremia
3% NaCl and furosemide
How to treat asymptomatic Isovolemic hypotonic hyponatremia
use isotonic NaCl and fluid restrict
causes of Hypervolemic hypotonic hyponatremia
Kidney failure/heart failure
how to treat symptomatic Hypervolemic hypotonic hyponatremia
3% NaCl and furosemide
how to treat asymptomatic Hypervolemic hypotonic hyponatremia
only furosemide
How to asses Hypernatremia
look at volume status
How to treat hypovolemic hypernatremia
give free water - use free water equation (rule of dosing is give 1/2 over first day, last 1/2 over next 1 -2 days)
how to treat isovolemic hypernatremia
(aka diabetes insipidus) give desmopression or vasopression
how to treat hypervolemic hypernatremia
stop hypertonic fluid or give diuretic
Common causes of hypokalemia
diuretics; metabolic alkalosis; Mg depletion
Infusion rate for K+
10 mEq/hr (max with no cardiac hook up)
common cause of hyperkalemia
metabolic acidosis
3 steps to take care of SEVERE HYPERKALEMIA ( >7)
1 - antagonize membrane effects
2 - decrease extracellular K+ concen (push K+ into cells)
3 - excrete K+ out of the body
Drugs that will help treat hyperkalemia - will antagonize membrane effects
calcium chloride
Drugs that will help treat hyperkalemia - will push K+ into cells
insulin/D5W; NaHCO3; albuterol
Drugs that will help treat hyperkalemia - will get K+ out of the body
furosemide; dialysis; patiromer; sodium polystyrene sulfonate
Hypomagnesemia is often associated with?
low Ca and low K
Common causes of hypocalcemia
Large volumes of blood products (citrate in it will bind to Ca2+); hypoalbunemia
when to use the corrected calcium equation
when albumin is low
2 IV ways to treat hypocalcemia
Calcium chloride or calcium gluconate
when to use: calcium chloride vs calcium gluconate
cl: more concentrated - during code…
gluconate - less concentrated - less risk for necrosis/extravasation
Possible ways to treat hypercalcemia
volume expansion/diuretics (push Ca out); calcitonin; bisphosphanates; glucocorticoids
3 main reasons hypercalcemia occurs
increased bone resorption; increased GI absorption; decreased kidney elimination
1 mMol of NaPhos has _____ mEq of Na and Phos
1.33
1 mMol of KPhos has _____ mEq of K and Phos
1.47
NaPhos or KPhos will effect an electrolyte level heavily?
K+
adverse effects of albumin
hypervolemia; azotemia
Common indications for Albumin uses
volume expansion; burns; shock; ARDS;
What does the hemoglobin level have to be at to use blood
7 - 8 g/dL
How much does a unit of RBC increase hemoglobin
1 g/dL
what is the “most common MIVF”
D5W + 1/2NS + 20mEq KCl
Treating Hypocalcemia - ACUTELY
100 - 300 mg elemental Ca IV over 5 - 10 min
Dont add bicarb or phos!!!!
Ways to treat hypercalemia
furosemide/volume expansion
glucocoritcoids
Calcitonin
bisphosphanates
