Fluids And Electrolytes Flashcards
Which dysrhythmia is associated with hyperkalemia?
Hyperkalemia may produce sinus bradycardia
Which hormone makes the renal collecting tubules more permeable to water?
ADH
Administration of a hypotonic solution, such as 0.45% normal saline solution, produces which effects?
a hypotonic crystalloid, 0.45% normal saline solution shifts water into intracellular spaces. This action decreases blood viscosity and may promote hypovolemia and cerebral edema when fluid moves from the intravascular space into the cells.
Causes of extracellular volume excess may include
7
Extreme intake of isotonic or hypotonic IV fluids
Heart failure
Renal failure
Primary polydipsia
SIADH
Cushing syndrome
Long term use of corticosteroids
S/S of water deficiency include
7
Thirst, loss of turgor, flushed skin, increased temperature, tachycardia, delirium, coma
Whole blood
What does it contain?
(5)
Is administered over how long?
Contains plasma, red blood cells, WBC, platelets, and clotting factors
Is administered over 2 to 4 hours
Whole blood
May be infused ____ is the need is urgent
Requires monitoring for ____emia and hyper____, anaphylactic reactions, hemo____ reactions
Whole blood
May be infused rapidly is the need is urgent
Requires monitoring for hypocalcemia and hypersensitivity, anaphylactic reactions, hemolytic reactions
Water excess is characterized by
9
Weight gain, pulmonary and peripheral edema, hyperventilation, confusion, coma, convulsions, muscle twitching and cramps
Water excess is Treated with what?
Treated with diuretics and fluid restrictions
Ventricular dysrhythmias may result from these two electrolyte imbalances.
hypokalemia or hypercalcemia
Cardiac arrest may occur as a result from this electrolyte imbalance
Cardiac arrest may occur in hyperkalemia
Torsades can result from what electrolyte imbalances?
Torsades can result from hypomagnesemia or hypocalcemia
Atrioventricular block may occur in this electrolyte imbalance
Atrioventricular block may occur in hypermagnesemia
____ block may occur in hypermagnesemia
Atrioventricular block may occur in hypermagnesemia
Anion Gap
To calculate the balance between positive and negative electrolytes, use the anion gap formula
Na+ - (Cl - HCO3-)
The reference range for the anion gap is __ to __ mEq/L. Inaccuracies in the anion gap measurement may be the result of ____, ____, and ____.
4
10
hypoalbuminemia, hyponatremia, and hypernatremia
Causes of high anion gap metabolic acidosis include
4
Causes of high anion gap metabolic acidosis include
Lactic acidosis
Ketoacidosis from diabetes, alcoholism, or starvation
Toxins such as ethylene glycol, methanol, and salicylates
Acute or chronic renal failure
Hyponatremia is Caused from what?
actual decrease in extracellular sodium or an increase in extracellular fluid volume.
Causes of hyponatremia include (12), hints includes failure of 3 organ systems Excess \_\_\_\_ secretion Something that happens with burns Use of this drug
Use of diuretics, vomiting , third spacing such as with burns, excessive sweating, lack of dietary sodium, intracellular sodium shifts. Also heart failure, hepatic failure, excess ADH secretion, nephrotic syndrome, renal failure, Mannitol use (osmitrol)
Hypernatremiacauses ;
Name (7)
Hypernatremiacauses ; urinary losses, hyperventilation, water deprivation, diarrhea, excessive perspiration, primary aldosteronism, cushing syndrome
Hypernatremia S/S result from
hyperosmolarity and cellular dehydration, which include
Thirst and dehydration
Anorexia, nausea, and vomiting as early signs and symptoms
Hypernatremia
Neurologic signs and symptoms, such as (6) when the serum sodium level exceeds __ mEq/L
____ ____ as a result of dehydrated brain tissue or engorged vasculature
agitation, irritability, lethargy, coma, muscle twitching, and hyperreflexia when the serum sodium level exceeds 160 mEq/L
Intracranial hemorrhage as a result of dehydrated brain tissue or engorged vasculature
Hypernatremia Treatments include
Replace fluids first when ___ is the cause of hypernatremia
If the patient cannot ingest oral fluids, initially administer ____ __% in ____ or ____ saline intravenously
Gradually reduce the serum sodium level to prevent water from shifting too rapidly back into the cells, why?
Replace fluids first when hypovolemia is the cause of hypernatremia
initially administer dextrose 5% in water or hypotonic saline intravenously
Rapid overcorrection of hypernatremia can lead to cerebral edema and seizures
Chloride imbalances
Hypochloremia is a serum chloride level below __ mEq/L
Occurs with hypo____ and hyper____ (due to ____ excretion)
Causes S/S that are basically the same as ____
Chloride imbalances
96 mEq/L
Occurs with hyponatremia and hyperkalemia (due to KCl excretion)
Causes S/S that are basically the same as hyponatremia
Chloride imbalances Treatments include
Replacement of chloride and sodium electrolytes with monitoring
Hyperchloremia is a serum chloride level that exceeds ___ mEq/L
106 mEq/L
Hyperchloremia Results from the same factors that cause ____, except for ___ ____ingestion and ____ ____ which cause hyperchloremia but do not affect the serum sodium level
Produces the same SS of hyper____, plus deep, ____ ____
hypernatremia, except for ammonium chloride ingestion and salicylate intoxication, which cause hyperchloremia but do not affect the serum sodium level
Produces the same SS of hypernatremia, plus deep, labored breathing
Chloride imbalances
Treatments include
The same as for hypernatremia and includes restoring normal fluid volume and osmolality
How does Alkalosis affect the serum potassium level?
Alkalosis decreases the serum potassium level by driving potassium into the cells in exchange for hydrogen ions.
Acidosis and hyperosmolarity cause potassium to (enter/leave) the cells
leave
Certain hormones such as ____ and ____ and medications such as ____ drive K into the cells
aldosterone and insulin
beta-agonists
Hypokalemia is a serum potassium level of less than what?
3.5 mEq/L
Gastrointestinal Causes of hypokalemia include
5
vomiting, diarrhea, intestinal obstruction, fistulas, gastrointestinal suctioning
Renal causes of hypokalemia include
7
renal insufficiency, renal losses, nephritis, dialysis, DKA, diuretic or steroid therapy, cushing’s syndrome
S/S of hypokalemia include muscle weakness and cramps, usually where?
How might this attribute to respiratory issues?
usually in the legs and proximal muscles, respiratory muscle weakness may lead to respiratory failure
paralysis, hyporeflexia, paralytic ileus, paresthesia, latent tetany, are all S/S of this electrolyte imbalance
Hypokalemia
Hypokalemia can cause these EKG changes. Do these changes indicate clinical severity?
Cardiac dysrhythmias might demonstrate ST depression, U waves, and bradycardia
Changes such as flattened or inverted T waves and U waves, do not correlate with clinical severity
When should hypokalemia be treated?
When below 3.5
Treatment for hypokalemia should be treated with IV potassium through a large bore peripheral site or a central line at no more than __ to __ mEq/hr to prevent ____ and ____ ____
10 to 20
hyperkalemia
cardiac arrest
what 2 things should you always use when giving IV potassium?
Always use an infusion pump
Cardiac monitor
Use ____ potassium in less acute situations
oral
Check serum ____ level because it can also be depleted in a patient with persistent hypokalemia
magnesium
Hyperkalemia; try to name 13 causes
don’t worry, they’re broken down in other cards in this stack
1 increased oral or intravenous intake of potassium 2 inability to excrete sufficient potassium, 3 acute renal disease, 4 crush injuries, 5 tumor lysis syndrome, 6 chronic renal failure, 7 ACE inhibitors (the prils) and 8 potassium sparing diuretics, 9 use of potassium containing salt substitutes, 10 adrenal insufficiencies, 11 acidosis, 12 anoxia, 13 hyponatremia
this electrolyte imbalance can also lead to hyperkalemia
hyponatremia
name 2 types of pharmaceuticals (and the suffix) and one consumable that can lead to hyperkalemia
ace inhibitors (-prils)
potassium sparing diuretics
use of salt substitutes that contain potassium
this type of injury can lead to hyperkalemia
crush injuries (can also be caused by tumor lysis syndrome; you destroy cells, they release K)
these two respiratory conditions can lead to hyperkalemia
acidosis
anoxia
Name 5 somatic conditions that can contribute to hyperkalemia
inability to excrete sufficient potassium, acute renal disease, tumor lysis syndrome, chronic renal failure, adrenal insufficiencies
with hyperkalemia, Paresthesia and muscle weakness may lead to ____ ____
flaccid paralysis
Various electrocardiogram changes correlate with the severity of the hyperkalemia, unlike this electrolyte imbalance
hypokalemia
Peaked T waves occur when the serum potassium level reaches what range?
5.0 to 6.6 mEq/L
with Hyperkalemia, Possible electrocardiogram changes include what?
peaked T waves, widened QRS, and prolonged PR interval
Dysrhythmias related to hyperkalemia include (8)
sinus bradycardia, sinus arrest, first degree heart block, nodal rhythm, idioventricular rhythm, ventricular tachycardia, Vfib, and asystole
In an emergent situation, what is the role of administration of calcium chloride or calcium gluconate in the treatment of hyperkalemia?
to antagonize cardiac toxicity by increasing the threshold potential and reestablishing cardiac excitability; however, it has no effect on serum potassium levels
In an emergent situation, what are the steps taken and drugs involved with the temporary treatment of hyperkalemia?
In an emergent situation, Administer calcium chloride or calcium gluconate to antagonize cardiac toxicity by increasing the threshold potential and reestablishing cardiac excitability; however, it has no effect on serum potassium levels
Administer IV glucose (50ml D50W) with regular insulin (10 units), and sodium bicarbonate (50 to 150 mEq) to drive potassium into the cells in exchange for sodium and rapidly reduce the serum potassium level. Always give the glucose first and keep in mind that this only temporarily reduces the sodium potassium level.
In an emergent situation, list the drugs and doses involved with the temporary treatment of hyperkalemia?
calcium chloride or calcium gluconate
IV glucose (50ml D50W)
insulin (10 units)
sodium bicarbonate (50 to 150 mEq)
another way to treat hyperkalemia is to give a beta2-antagonist, such as ____ (____), to drive potassium back into the cells.
albuterol (Ventolin)
treating hyperkalemia by Promoting potassium excretion in urine can be done by giving what?
by giving a loop or osmotic diuretic
In a non emergent situation, hyperkalemia can be treated this way by giving this drug to poop it out
Kayexalate and poop it out in a non emergent situation
what is the last resort when all other treatments fail in the treatment of hyperkalemia?
If all of these efforts fail with significant hyperkalemia, prepare for renal dialysis
Calcium abnormalities are usually associated with these two other electrolyte abnormalities
phosphorus and magnesium abnormalities
Causes of Hypocalcemia include;
don’t worry if you can’t get them all, they’ll be broken down in other cards
1 acute pancreatitis 2 rhabdo 3 hypoparathyroidism 4 hypovitaminosis D 5 malabsorption syndrome 6 malnutrition 7 chronic nephrotic syndrome 8 chronic nephritis 9 Cushing syndrome 10 tumor lysis syndrome 11 overdose of calcium channel blockers 12 multiple blood transfusions (usually more than 10 units) when citrate in banked blood binds with calcium, making it inactive
Causes of Hypocalcemia include overdose of this pharmaceutical
overdose of calcium channel blockers,
How does multiple blood transfusions contribute to hypocalcemia?
(usually more than 10 units) when citrate in banked blood binds with calcium, making it inactive
what are the two conditions involving the breakdown of cells that can contribute to hypocalcemia?
rhabdo
tumor lysis syndrome
Hypocalcemia can be secondary to these somatic conditions (5)
acute pancreatitis hypoparathyroidism malabsorption syndrome chronic nephrotic syndrome chronic nephritis
S/S of hypocalcemia include (6)
1 cardiac dysrhythmias, 2 constipation and lack of appetite, 3 tetany (when excitability affects the skeletal muscles), 4 seizures, 5 positive Trousseau’s sign 6 Positive Chvostek's sign
How do you check for positive Trousseau’s sign?
induced by inflating BP cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes, producing carpal spasm
What is Positive Chvostek’s sign?
what does it indicate?
When is it especially important to check for it?
Positive Chvostek’s sign - abnormal spasm of the facial muscles elicited by light taps on the cheek to stimulate the facial nerve in patients who are hypocalcemic. It is a sign of tetany. Checking for this sign is especially important after thyroid or parathyroid surgery.
What are some other S/S of hypocalcemia?
1 Muscle twitching and cramping,
2 facial grimacing,
3 numbness and tingling of the fingers, toes, nose, lips, and earlobes,
4 hyperactive deep tendon reflexes,
5 abdominal pain,
6 prolonged QT intervals on an electrocardiogram tracing,
7 anxiety,
8 irritability, and even psychosis,
9 More severe effects include laryngospasm, bronchospasm, seizures, and cardiac failure
what are the more severe S/S of hypocalcemia?
More severe effects include laryngospasm, bronchospasm, seizures, and cardiac failure
Treatment of hypocalcemia includes ____ ____ __% in __% dextrose and infuse over __ to __ minutes. Do not give faster than __ to __mL/hr because rapid infusion can cause ____.
calcium gluconate 10% in 5% dextrose and infuse over 10 to 20 minutes. Do not give faster than 0.5 to 1mL/hr because rapid infusion can cause hypotension.
what is the chemical state of phosphorus in the body?
almost all phosphorus is combined with oxygen, forming phosphate
hypercalcemia is Frequently seen in patients with malignancies, may also be cause by these (6)
hyperparathyroidism, thiazide diuretics, hypervitaminosis D, hyperthyroidism, Addison’s disease, renal failure
S/S of hypercalcemia include (13)
broken down in other cards
S/S include headache, irritability, fatigue, malaise, difficulty concentrating, anorexia, nausea and vomiting, constipation, depressed deep tendon reflexes, shortened QT intervals, polyuria, polydipsia, Ileus
gastrointestinal S/S of hypercalcemia include (5)
anorexia, nausea and vomiting, constipation, ileus
A serum calcium level that exceeds __ mg/dl requires immediate attention
13.5
how is hypercalcemia treated?
Treat the underlying cause, increase excretion with loop diuretic Administer calcitonin (Miacalcin) or phosphate to inhibit bone reabsorption of calcium
what are the two electrolytes that have a seesaw effect with each other?
What regulates this?
Phosphorus and calcium
they are regulated by a hormone called parathyroid hormone
what are some causes of Hypophosphatemia?
4
Causes include; hyperparathyroidism, vitamin D deficiency, intestinal malabsorption, renal tubular acidosis
Hypophosphatemia; what are the S/S
Anorexia, muscle weakness, rhabdo, respiratory failure, hemolysis, altered mental status
How is Hypophosphatemia treated?
- Supplements with high phosphorus diet; fish, meat, nuts, lentils, legumes
- IV phosphate or potassium phosphate
- Frequently monitor the serum phosphate level to guide therapy
- Assess for sudden symptomatic hypocalcemia caused by increased calcium-phosphorus binding, which may be a complication of IV phosphate administration
what does a high phosphorus diet contain?
fish, meat, nuts, lentils, legumes
Causes of Hyperphosphatemia include
6
Causes include; hypoparathyroidism, chronic renal disease, Addison’s disease, leukemia, sarcoidosis, osteolytic metastatic bone tumor
Hyperphosphatemia is Characterized by vague symptoms such as (8)
headache, irritability, fatigue, malaise, difficulty concentrating, anorexia, nausea and vomiting, constipation
____ and magnesium excretion are interdependent
calcium
A sudden calcium load causes excretion of calcium and magnesium
Causes of magnesium imbalances Include
9
1 malabsorption syndrome, 2 ulcerative colitis, 3 ileal bypass, 4 cirrhosis, 5 alcoholism, 6 chronic renal disease, 7 diabetic ketoacidosis, 8 diuretic therapy, 9 malnutrition
Magnesium imbalances May also include patients who have received massive amounts of blood transfusions of ____ blood, those with acute ____, and those who have recently undergone what? cardiopulmonary bypass surgery.
citrated blood
acute pancreatitis
and those who have recently undergone cardiopulmonary bypass surgery.
S/S of hypomagnesemia include; nausea, vomiting, sedation, increased deep tendon reflexes, muscle weakness
1 nausea 2 vomiting 3 sedation 4 increased deep tendon reflexes 5 muscle weakness
With significant hypomagnesemia these 5 things can occur
hypotension, bradycardia, coma, respiratory paralysis, and cardiac arrest occur.
severe hypomagnesemia can be present without producing any symptoms. When symptoms do occur, they usually include... hints: Neuromuscular effects such as the ones with calcium EKG changes (4)
Neuromuscular effects such as weakness, muscle fasciculations, and positive
Trousseau’s and Chvostek’s signs,
EKG changes such as flattened T waves, prolonged QT intervals, torsades, and Vfib
Hypermagnesemia Might result from (3)
reduced excretion caused by advanced renal failure, adrenocortical insufficiency, magnesium overdose in a patient with renal compromise
