Fluids & Electrolytes Flashcards
1
Q
serum osmolality equation
A
2 x Na + BUN/2.8 + glucose/18
2
Q
normal serum osmolality
A
265-285
3
Q
formula to correct metabolic acidosis
A
weight x 0.3 x base deficit
4
Q
acidemia pH
A
<7.36
5
Q
alkalemia pH
A
> 7.44
6
Q
bicarb in metabolic alkalosis
A
> 25
7
Q
bicarb in metabolic acidosis
A
<25
8
Q
CO2 in respiratory alkalosis
A
<40
9
Q
CO2 in respiratory acidosis
A
> 40
10
Q
primary cause of respiratory acidosis
A
hypoventilation (elevated CO2) ex: CNS disease
11
Q
primary cause of respiratory alkalosis
A
hyperventilation (low CO2) ex: pneumonia
12
Q
leading cause of metabolic acidosis
A
diarrhea
13
Q
common causes of metabolic alkalosis
A
vomiting, prolonged NG suction, pyloric stenosis and CF
14
Q
lab findings of pyloric stenosis
A
hypochloremic hypokalemia metabolic alkalosis
15
Q
pH in pyloric stenosis
A
high
16
Q
serum chloride in pyloric stenosis
A
low
17
Q
serum potassium in pyloric stenosis
A
low
18
Q
serum sodium in pyloric stenosis
A
low
19
Q
bilirubin in pyloric stenosis
A
high
20
Q
anion gap calculation
A
sodium - (chloride + bicarb)
21
Q
normal anion gap
A
8 to 12 (chloride is elevated)
22
Q
causes of acidosis with normal anion gap
A
diarrhea, RTA
23
Q
type 1 RTA aka
A
distal RTA
24
Q
job of proximal tubule
A
retains bicarb
25
job of distal tubule
secrete H+
26
type 1 RTA issue
not secreting H+ into urine resulting in hyperchloremic, hypokalemic metabolic acidosis
27
type 1 RTA urine pH
>5.5
28
type 2 RTA issue
losing excess bicarb in urine (not taking it back up)
29
type 2 RTA urine pH
<5.5 (distal is still functioning and secreting H+)
30
type 2 RTA mimicker
acetazolamide (carbonic anhydrase inhibitor)
31
type 4 RTA issue
resistance to aldosterone or aldosterone deficiency causing hyperkalemia
32
chloride in elevated anion gap
normal
33
elevated anion gap associations
```
Methanol
Uremia
DKA
Paraldehyde
Ingestion/Iron/Isoniazid
Lactic acid
Ethanol/Ethylene glycol
Salicylates
```
34
daily sodium requirement
3 meq/kg/day (preemies need 6-9)
35
hypernatremia definition
>145
36
improper mixing of formula (not enough water) can cause
hypernatremia
37
diarrhea effect on sodium
can cause hypernatremia (lose more water than Na)
38
fetus % body weight water
90%
39
adolescent/adult % body weight water
60%
40
high serum osmolality with inappropriately dilute urine
DI
41
nephrogenic DI pattern
x-linked, males only
42
hyponatremia definition
<130
43
urine sodium in hyponatremia 2/2 GI losses
low urine sodium (kidneys hold onto it)
44
ADH with high serum osmolality
retains fluid
45
ADH is stored where
posterior pituitary
46
things that can trigger SIADH
cerebral injury, pulmonary or endocrine disorders, vincristine, cyclophosphamide, carbamazepine
47
SIADH presentation
hyponatremia
48
SIADH underlying problems
hyponatremia 2/2 fluid retention
49
urine sodium in hyponatremia 2/2 SIADH
high (>25)
50
SIADH serum osmolality
low (over hydrated)
51
SIADH treatment
fluid restriction (furosemide and hypertonic saline if not enough)
52
med that blocks effect of ADH on kidney
demeclocycline (derivative of doxy so only >8 yrs) and lithium (too many side effects)
53
when to use hypertonic saline in SIADH
Na<120
54
FeNa calculation
(Urine Na x Plasma Cr / Plasma Na x Urine Cr) x 100
55
urien sodium in dilutional hyponatremia
increased
56
hyponatremic dehydration causes damage where
pontine (seizures)
57
total body sodium in dilution hyponatremia
normal
58
urine sodium concentration in nephrotic syndrome
low
59
cerebral salt wasting treatment
replaced fluids and electrolytes
60
measured sodium with edema
measures low but total body sodium is elevated (more water but it contains sodium)
61
measured sodium with nephrotic syndrome
measures low but is normal (space is taken up by plasma proteins)
62
daily potassium requirement
2 meq/kg/day
63
hypokalemia
<3.5
64
history of diarrhea coming in with muscle pain, weakness, constipation, ileus and polyuria
hypokalemia
65
diuretic that causes hypokalemia
furosemide
66
EKG changes with hypokalemia
flat T waves, ST depression and PVCs (U wave after T if extreme)
67
explanation for weakness during vomiting and diarrhea
hypokalemia
68
emergent treatment of hypokalemia
KCl 0.5-1.0 meq/L over one hour (max 40 meq) - must monitor EKG during replacement
69
treatment of hypokalemia if acidotic
potassium acetate
70
treatment of mild hypokalemia
oral rehydration
71
muscle weakness and prolonged QT interval
hypocalcemia
72
diarrhea, weakness and prolonged PR or QT interval
hypomagnesemia
73
hyperkalemia
>5.0
74
initial EKG findings with hyperkalemia
peaked T waves
75
EKG findings with severe (>10) hyperkalemia
absence of P waves and widened QRS complexes (associated with PEA)
76
mild hyperkalemia treatments
```
glucose and insulin
sodium bicarb
albuterol
IV lasix
oral polystyrene resin
```
77
severe (>10) hyperkalemia treatment
IV calcium chloride or dialysis
78
treatment of electromagnetic dissociation (wide QRS w/ muffled heart sounds and non-palpable pulses)
IV calcium chloride (hyperkalemia)
79
potassium levels in alkalosis
low (H+ moving out of cells and K+ into cells)
80
potassium levels in acidosis
high (too much H+ in EC fluid so starts moving into cells and K+ exchanges)
81
5% dehydration
tachycardia with decreased tears and decreased UOP
82
5% dehydration means they are short
50 mL/kg
83
5% dehydration rehydration
oral - 50/kg + maintenance with half over first 8 hours and half over the next 16
84
10% dehydration
tachycardia with sunken eyes and fontanelle, poor skin turgor
85
10% dehydration means they are short
100 mL/kg
86
10% dehydration rehydration
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
15% dehydration
shock and delayed capillary refill
88
15% dehydration means they are short
150 mL/kg
89
15% dehydration rehydration
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
oral rehydration solution must contain
75 met/L sodium and glucose
91
isotonic dehydration
sodium 135-145
92
dehydrated baby fed tea or water
hyponatremic dehydration
93
type of dehydration with biggest impact on circulation
hyponatremic dehydration bc fluid moving from ECF to ICF
94
free water moves into CNS cells when serum Na
<125 (seizures)
95
hyponatremic dehydration sodium replacement
(desired sodium - measured sodium) x weight
| add this to mIVF
96
hypernatremic dehydration effect on brain
tearing of bridging blood vessels and intracranial hemorrhage from shrinking of brain cells (water leaving)
97
correcting hypernatremia too quickly could cause
cerebral edema (decrease by no more than 10-12 men/L/day)
98
correction of sodium in chronic hypernatremic dehydration
decreased sodium by 0.5 men/L/hour
99
hyponatremia and hypochloremia with elevated BUN and specific gravity
hyponatremic dehydration
100
hypernatremia, yperchloremia, elevated BUN and spec gram
hypernatremic dehydration
101
hyponatremia, severe hyperglycemia
pseudohyponatremia
102
hyponatremia, hypochloremia, low BUN, high spec grav
SIADH
103
hypernatremia, hyperchloremia, high BUN, low spec grav
DI
104
hyponatremia and normal Cl
lab error
