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AP II Test 1 > Fluids and Electrolytes Part 2 > Flashcards

Fluids and Electrolytes Part 2 Flashcards

1
Q

Neurological symptoms of hyponatremia: (10)

A
  • N&V
  • visual disturbances
  • depressed consciousness
  • agitation
  • confusion
  • coma
  • seizures
  • muscle cramps
  • weakness
  • myoclonus
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1
Q

If Na < 123 mEq/L, then ____ ___ may result.

If Na < 100, then ___ ____ may result.

A

cerebral edema

cardiac symptoms

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2
Q

_____ _____ can cause pulmonary edema, HTN, and heart failure.

A

Hypervolemic hyponatremia

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3
Q

For _____, decrease MAC!

A

hyponatremia

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4
Q

Treatment for hyponatremia: (3)

A
  • water restriction
  • loop diuretic in case of water overload
  • hypertonic saline in the case of severe hyponatremia with neuro symptoms
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5
Q

Correct Na deficits very SLOWLY!!!!

Optimal rate of correction is ___-__mmol/L/hr until Na= 125 mEq/L, then proceed slower.

Replace half of the deficit in the first 8 hrs, and the rest over 1-3 days. Monitor sodium levels every 1-2 hrs.

A

0.6-1

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6
Q

Dose of Na (mEq) for hyponatremia:

A

(kg x (140-[Na]) ) x 0.6

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7
Q

Correct Na slowly because may cause ____ ___ ___

A

central pontine myelinolysis

Symptoms include: acute para- or quadraparesis, dysphagia, dysarthria, diplopia, loss of consciousness, and other neurological symptoms associated with brainstem damage.

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8
Q

An increase in ECF [Na] (above 145 mEq/L) which may be accompanied by the presence of low, normal, or high total-body Na content is called _____.

Major cause is:

A

hypernatremia

lack of fluid replacement

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9
Q

Signs of hypernatremia: (3)

A
  • Intense thirst (unless malfunctioning thirst mechanism)
  • Lethargy, mental status changes coma and convulsions.
  • Shock, peripheral edema, myoclonus, ascites, muscle tremor, hyperactive reflexes, pleural effusion, expanded intravascular fluid volume
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10
Q

Treatment of hypernatremia:

A
  • diuretics
  • hypotonic crystalloids restore normal osmolality and volume
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11
Q

Hypernatremia______the MAC of our anesthetics

A

increases

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12
Q

Potassium is the most abundant intracellular fluid cation. which maintains membrane potential. True or false?

A

true

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13
Q

What keeps K in check? (4)

A
  • kidneys
  • insulin (big factor)
  • hormones
  • HCO3
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14
Q

Increase in pH results in _____ in K and vice-versa.

A

decrease

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15
Q

______ HCO3 decreases K. Hyperventilation produces the same effect.

A

Increased

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16
Q

Beta2 adrenergic agonists ______ K indirectly due to ___ changes.

A

decrease

pH

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17
Q

Hypokalemia is present when K < ___ mEq/L

A

3.5

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18
Q

Causes of hypokalemia include: (4)

A
  • inadequate intake
  • excess renal loss
  • GI losses
  • ECF to ICF shift–such as beta agonist, vitamin b12, insulin
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19
Q

Inadequate intake of K resulting in hypokalemia results from: (4)

A
  • anorexia
  • starvation
  • alcoholism
  • hyperaldosteronism
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20
Q

Hypokalemia from excess renal loss results from: (6)

A
  • diuresis
  • chronic metabolic alkalosis
  • PCN
  • Nafcillin
  • renal tubular acidosis
  • hypomagnesium
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21
Q

Vomiting and diarrhea can result in hyperkalemia. True or false?

A

false

hypokalemia

22
Q

ECF to ICF shifts can be caused by: (6)

A
  • Beta 2 agonist
  • acute alkalosis
  • insulin
  • vitamin B12 therapy
  • lithium overdose
  • hyperventilation
23
Q

In the range of 2-2.5 mEq/L, hypokalemia can cause: (5)

A
  • muscle weakness
  • arrythmias
  • ST depression
  • T wave depression
  • appearance of a U wave

The changes do not correlate with the severity of Potassium depletion. Dysrrhythmias include a-fib and PVC’s.

24
Q

Another cause of _____is stress induced by surgery. The increased catecholamine activity causes hypokalemia due to ____ action.

A

hypokalemia

beta2

25
Q

If potassium is below _____, treat with IV___.

A

2.6

KCl

26
Q

KCl must be diluted in NS (____ mL) and should not be infused faster than ____mEq/hr in a peripheral IV, and ___mEq/hr through a CVL. Monitor the EKG continuously

A

250

10

20

27
Q

Hyperkalemia indicated when > ___mEq/L

A

5.3

28
Q

Causes of hyperkalemia: (4)

A
  • pseudohyperkalemia
  • altered interal K balance
  • drugs
  • altered external K balance
29
Q

What causes pseudohyperkalemia? (2)

A

sample lysis

technical issues

30
Q

KNOW:

What causes internal K balance changes? (4)

A
  • acidosis
  • insulin deficiency
  • MH (malignant hyperthermia)
  • cell necrosis
31
Q

What can succinylcholine, digitalis, non-selective B-blockers,** _______**, and spironolactone cause?

A

ACE-inhibitors

cause hyperkalemia

32
Q

Decreased excretion from renal disease, transfusions, and hypoaldosterone can cause altered internal/external K balance resulting in this.

A

external

hyperkalemia

33
Q

Signs and symptoms of hyperkalemia:

6-7 mEq/L –>

10-12 mEq/L –>

A

muscle weakness

peaked T waves and long PR interval

wide QRS, ventricular fibrillation and asystole

34
Q

Treatment for hyperkalemia is determined by presence of ECG changes. Stabilize heart with IV _____.

Redistribute potassium into cells by IV glucose and insulin, (amp D50 + ____ units Insulin- lowers levels within 10 min and lasts 4-6 hours.

A

calcium

10

35
Q

What are other treatments for hyperkalemia? (8)

A
  • bicarb
  • hyperventilation
  • dialysis
  • diuretics
  • B agonists
  • aldosterone
  • agonists
  • kayexelate
36
Q

What is responsible for endocrine and exocrine secretions, cell growth, transport and secretion of fluids and electrolytes, and muscle contractions?

A

calcium

37
Q

Calcium is controlled by: (2)

A

PTH

calcitonin

38
Q

Calcium is a coagulation factor. True or false?

Calcitonin tones down calcium. True or false?

Blood products _______ Ca values.

A

true

true

decreases

39
Q

Calcium exists in the body in 3 forms:

A
  • bound to protein (40%)
  • ionized, physiologically active (50%)
  • nonionized chelated with anions: phosphate, sulfate, citrate (10%)
40
Q

Ionized calcium does not vary with the albumin level, and therefore it is useful to measure the ionized calcium level when the serum albumin is not within normal ranges, or when a calcium disorder is suspected despite a normal total calcium level. True or false?

A

true

41
Q

Calcium levels must be adjusted for low albumin.

If Albumin is low, then the adjusted calcium value is lower than the measured serum calcium value. True or false?

A

false

higher than

42
Q

PTH causes increased calcium reabsorption in the kidney and decreased excretion. It also causes bone resorption, therefore increasing calcium. True or false?

A

true

43
Q

Hypocalcemia

calcium < ____mg/dL (or 2.2-2.6 mmol) or

ionized calcium levels < _____mmol/L.

A
  1. 5
  2. 1-1.4
44
Q

What are the causes of hypocalcemia? (4)

A
  • low PTH
  • ineffective PTH
  • low albumin
  • iatragenic in OR
45
Q

What causes low PTH?

A

hypoparathyroidism

46
Q

What may cause ineffective PTH?

A

lack of vit. D

47
Q

What may cause low albumin resulting in low Ca? (2)

A

critical illness

liver disease

48
Q

What may cause iatragenically low Ca in the OR? (3)

A

acute hyperventilation

infusion of blood products

parathyroid/thyroidectomy

50
Q

Decrease in Ca is observed when blood is transfused because:

A

citrate binds to calcium

51
Q

These symptoms describe what?

The prognosis is overall poor. While some patients die, most survive and of the survivors, approximately one-third recover; one-third are disabled but are able to live independently; one-third are severely disabled.[11] Permanent disabilities range from minor tremors and ataxia to signs of severe brain damage, such as spastic quadriparesis and locked-in syndrome. Some improvements may be seen over the course of the first several months after the condition stabilizes.

A

central pontine myelinolysis from giving Na too fast

52
Q

Acute severe ___________ causes an osmotic shift of water from the cells, leading to shrinkage of the brain and tearing of meningeal vessels and IC hemorrhage.

A

hypernatremia (as with Na replacement for hypoNa)

53
Q

What are EKG changes for hyperkalemia?

A

peaked t waves

AP II Test 1 (12 decks)

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