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BOARDS > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

serum osmolality equation

A

2 x Na + BUN/2.8 + glucose/18

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2
Q

normal serum osmolality

A

265-285

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3
Q

formula to correct metabolic acidosis

A

weight x 0.3 x base deficit

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4
Q

acidemia pH

A

<7.36

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5
Q

alkalemia pH

A

> 7.44

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6
Q

bicarb in metabolic alkalosis

A

> 25

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7
Q

bicarb in metabolic acidosis

A

<25

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8
Q

CO2 in respiratory alkalosis

A

<40

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9
Q

CO2 in respiratory acidosis

A

> 40

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10
Q

primary cause of respiratory acidosis

A

hypoventilation (elevated CO2) ex: CNS disease

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11
Q

primary cause of respiratory alkalosis

A

hyperventilation (low CO2) ex: pneumonia

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12
Q

leading cause of metabolic acidosis

A

diarrhea

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13
Q

common causes of metabolic alkalosis

A

vomiting, prolonged NG suction, pyloric stenosis and CF

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14
Q

lab findings of pyloric stenosis

A

hypochloremic hypokalemia metabolic alkalosis

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15
Q

pH in pyloric stenosis

A

high

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16
Q

serum chloride in pyloric stenosis

A

low

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17
Q

serum potassium in pyloric stenosis

A

low

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18
Q

serum sodium in pyloric stenosis

A

low

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19
Q

bilirubin in pyloric stenosis

A

high

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20
Q

anion gap calculation

A

sodium - (chloride + bicarb)

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21
Q

normal anion gap

A

8 to 12 (chloride is elevated)

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22
Q

causes of acidosis with normal anion gap

A

diarrhea, RTA

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23
Q

type 1 RTA aka

A

distal RTA

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24
Q

job of proximal tubule

A

retains bicarb

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25
Q

job of distal tubule

A

secrete H+

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26
Q

type 1 RTA issue

A

not secreting H+ into urine resulting in hyperchloremic, hypokalemic metabolic acidosis

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27
Q

type 1 RTA urine pH

A

> 5.5

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28
Q

type 2 RTA issue

A

losing excess bicarb in urine (not taking it back up)

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29
Q

type 2 RTA urine pH

A

<5.5 (distal is still functioning and secreting H+)

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30
Q

type 2 RTA mimicker

A

acetazolamide (carbonic anhydrase inhibitor)

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31
Q

type 4 RTA issue

A

resistance to aldosterone or aldosterone deficiency causing hyperkalemia

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32
Q

chloride in elevated anion gap

A

normal

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33
Q

elevated anion gap associations

A 
Methanol
Uremia
DKA
Paraldehyde
Ingestion/Iron/Isoniazid
Lactic acid
Ethanol/Ethylene glycol
Salicylates
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34
Q

daily sodium requirement

A

3 meq/kg/day (preemies need 6-9)

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35
Q

hypernatremia definition

A

> 145

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36
Q

improper mixing of formula (not enough water) can cause

A

hypernatremia

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37
Q

diarrhea effect on sodium

A

can cause hypernatremia (lose more water than Na)

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38
Q

fetus % body weight water

A

90%

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39
Q

adolescent/adult % body weight water

A

60%

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40
Q

high serum osmolality with inappropriately dilute urine

A

DI

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41
Q

nephrogenic DI pattern

A

x-linked, males only

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42
Q

hyponatremia definition

A

<130

43
Q

urine sodium in hyponatremia 2/2 GI losses

A

low urine sodium (kidneys hold onto it)

44
Q

ADH with high serum osmolality

A

retains fluid

45
Q

ADH is stored where

A

posterior pituitary

46
Q

things that can trigger SIADH

A

cerebral injury, pulmonary or endocrine disorders, vincristine, cyclophosphamide, carbamazepine

47
Q

SIADH presentation

A

hyponatremia

48
Q

SIADH underlying problems

A

hyponatremia 2/2 fluid retention

49
Q

urine sodium in hyponatremia 2/2 SIADH

A

high (>25)

50
Q

SIADH serum osmolality

A

low (over hydrated)

51
Q

SIADH treatment

A

fluid restriction (furosemide and hypertonic saline if not enough)

52
Q

med that blocks effect of ADH on kidney

A

demeclocycline (derivative of doxy so only >8 yrs) and lithium (too many side effects)

53
Q

when to use hypertonic saline in SIADH

A

Na<120

54
Q

FeNa calculation

A

(Urine Na x Plasma Cr / Plasma Na x Urine Cr) x 100

55
Q

urien sodium in dilutional hyponatremia

A

increased

56
Q

hyponatremic dehydration causes damage where

A

pontine (seizures)

57
Q

total body sodium in dilution hyponatremia

A

normal

58
Q

urine sodium concentration in nephrotic syndrome

A

low

59
Q

cerebral salt wasting treatment

A

replaced fluids and electrolytes

60
Q

measured sodium with edema

A

measures low but total body sodium is elevated (more water but it contains sodium)

61
Q

measured sodium with nephrotic syndrome

A

measures low but is normal (space is taken up by plasma proteins)

62
Q

daily potassium requirement

A

2 meq/kg/day

63
Q

hypokalemia

A

<3.5

64
Q

history of diarrhea coming in with muscle pain, weakness, constipation, ileus and polyuria

A

hypokalemia

65
Q

diuretic that causes hypokalemia

A

furosemide

66
Q

EKG changes with hypokalemia

A

flat T waves, ST depression and PVCs (U wave after T if extreme)

67
Q

explanation for weakness during vomiting and diarrhea

A

hypokalemia

68
Q

emergent treatment of hypokalemia

A

KCl 0.5-1.0 meq/L over one hour (max 40 meq) - must monitor EKG during replacement

69
Q

treatment of hypokalemia if acidotic

A

potassium acetate

70
Q

treatment of mild hypokalemia

A

oral rehydration

71
Q

muscle weakness and prolonged QT interval

A

hypocalcemia

72
Q

diarrhea, weakness and prolonged PR or QT interval

A

hypomagnesemia

73
Q

hyperkalemia

A

> 5.0

74
Q

initial EKG findings with hyperkalemia

A

peaked T waves

75
Q

EKG findings with severe (>10) hyperkalemia

A

absence of P waves and widened QRS complexes (associated with PEA)

76
Q

mild hyperkalemia treatments

A 
glucose and insulin
sodium bicarb
albuterol
IV lasix
oral polystyrene resin
77
Q

severe (>10) hyperkalemia treatment

A

IV calcium chloride or dialysis

78
Q

treatment of electromagnetic dissociation (wide QRS w/ muffled heart sounds and non-palpable pulses)

A

IV calcium chloride (hyperkalemia)

79
Q

potassium levels in alkalosis

A

low (H+ moving out of cells and K+ into cells)

80
Q

potassium levels in acidosis

A

high (too much H+ in EC fluid so starts moving into cells and K+ exchanges)

81
Q

5% dehydration

A

tachycardia with decreased tears and decreased UOP

82
Q

5% dehydration means they are short

A

50 mL/kg

83
Q

5% dehydration rehydration

A

oral - 50/kg + maintenance with half over first 8 hours and half over the next 16

84
Q

10% dehydration

A

tachycardia with sunken eyes and fontanelle, poor skin turgor

85
Q

10% dehydration means they are short

A

100 mL/kg

86
Q

10% dehydration rehydration

A

maintenance + 100 cc/kg over 24 hours
OR
20cc/kg over one hour, then half of what’s left over 7 hours and other half over the next 16

87
Q

15% dehydration

A

shock and delayed capillary refill

88
Q

15% dehydration means they are short

A

150 mL/kg

89
Q

15% dehydration rehydration

A

maintenance + 150 cc/kg with

20cc/kg boluses until clinical improvement then half of thats left over 7 and the other half the next 16

90
Q

oral rehydration solution must contain

A

75 met/L sodium and glucose

91
Q

isotonic dehydration

A

sodium 135-145

92
Q

dehydrated baby fed tea or water

A

hyponatremic dehydration

93
Q

type of dehydration with biggest impact on circulation

A

hyponatremic dehydration bc fluid moving from ECF to ICF

94
Q

free water moves into CNS cells when serum Na

A

<125 (seizures)

95
Q

hyponatremic dehydration sodium replacement

A

(desired sodium - measured sodium) x weight

add this to mIVF

96
Q

hypernatremic dehydration effect on brain

A

tearing of bridging blood vessels and intracranial hemorrhage from shrinking of brain cells (water leaving)

97
Q

correcting hypernatremia too quickly could cause

A

cerebral edema (decrease by no more than 10-12 men/L/day)

98
Q

correction of sodium in chronic hypernatremic dehydration

A

decreased sodium by 0.5 men/L/hour

99
Q

hyponatremia and hypochloremia with elevated BUN and specific gravity

A

hyponatremic dehydration

100
Q

hypernatremia, yperchloremia, elevated BUN and spec gram

A

hypernatremic dehydration

101
Q

hyponatremia, severe hyperglycemia

A

pseudohyponatremia

102
Q

hyponatremia, hypochloremia, low BUN, high spec grav

A

SIADH

103
Q

hypernatremia, hyperchloremia, high BUN, low spec grav

A

DI

104
Q

hyponatremia and normal Cl

A

lab error

BOARDS (24 decks)

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