Fluids & Electrolytes Flashcards
What determines osmotic pressures?
Proteins
Amount of total body weight composed of water
2/3
More in men
Infants have more
.9% NaCl composed of…
Na 154
Cl 154
LR composed of….
Na 130 K 4 Cl 109 Ca 2.7 Bicarbonate 28
Volume replacement…
4cc/kg/hr for first 10kg
2cc/kg/hr for 2nd 10kg
1cc/kg/hr for each kg after
Best indicator: urine output
Hyperkalemia treatment
Calcium gluconate… Cardiac membrane stabilizer
10U insulin
1Amp 50% dextrose
Sodium bicarbonate(K enters cell in exchange forH)
Kayexalate
Dialysis
To correct hypokalemia this also needs to be replaced
Mg
EKG changes in Hyperkalemia
Peaked T waves
Hypernatremia symptoms
Restless, irritable, ataxia, seizures
Correct with D5 water SLOW- avoid brain swelling
Hyponatremia symptoms
Headache, N/V, seizures
Correct no more than 1mEq/hr— avoid central pontine myelinosis
Side effect with too fast correction of Hyponatremia
Central pontine myelinosis
Do not correct more than 1mEq/ hour
Pseudohyponatremia cause….
Due to hyperglycemia
For each 100 glucose over normal add 2 to Na value
Hypercalcemia- most common malignant cause
Breast cancer
No LR
No thiazide diuretics
Tx: NS @200-300/hr, LASIK
Mal dz: mithramycin, calcitonin, dialysis
Signs of hypocalcemia
Hyperreflexive Chvosteks sign Perioral numbness and tingling Trousseau sign Prolonged QT interval
Protein adjustment for calcium
For every 1g decrease in protein add 0.8 to Ca
Anion gap calculation
Na- (HCO3 + Cl)
Normal < 10-15