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Clin Med 3 > Fluids, Electrolytes, and Imbalances - Exam 2 > Flashcards

Fluids, Electrolytes, and Imbalances - Exam 2 Flashcards

1
Q

Na is the major what?

A

major cation in extracellular fluid (ECF)

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2
Q

what does Na regulate?

A

regulates transmission of impulses in nerve and muscle fibers

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3
Q

Na is the main factor in determining what?

A

main factor in determining volume of extracellular space

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4
Q

who is a risk with hyponatremia?

A

elderly

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5
Q

what does Na help maintain?

A

helps maintain acid-base balance

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6
Q

what is dysnatremias?

A

disruptions of Na concentration

has more to do with hydration (fluid status) than circulating sodium

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7
Q

what is the most common type of hyponatremia?

A

hypo-osmolality with hypervolemia

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8
Q

hyponaturemia and impaired water excretion?

A

pt is fluid overloaded, so Na is diluted -> have impaired water excretion

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9
Q

causes of impaired water excretion and hyponatremia

A

HF, cirrhosis, renal failure, aggressive IV fluid admin (give too much fluid)

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10
Q

how does hyperglycemia cause hyponatremia

A

high serum sugar causes the cells to release water diluting sodium while not overloading the body with water

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11
Q

how does hypertonic mannitol admin cause hyponatremia?

A

water movement out of brain cells

-given for cerebral edema to try to decrease ICP -> try to move water out of brain cells, but also moves water out of other cellist the body, so can dilute Na in the entire body

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12
Q

how does SIADH occur? what does SIADH cause?

A
  • hyponatremia as a result of excess water
  • result of increase in circulating ADH
  • caused by hypersecretion or ectopic source (secreting too much ADH)
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13
Q

chronic alcoholics and hyponatremia

A

beer potomania syndrome - binge drinkers

-get chronic suppression of ADH with alcoholics

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14
Q

hyponatremia caused by water into occurs in who?

A

marathon athletes (need to check their Na first b/c don’t want to dilute them too much), drugs (ecstasy)

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15
Q

what is acute hyponatremia? chronic hyponatremia?

A

acute: < 48 hrs
chronic: >48 hrs or duration, unclear how long they’ve had it

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16
Q

the more acute the hyponatremia, the great there what?

A

the greater the complications

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17
Q

what are the most important determinants of onset of symptoms for hyponatremia?

A

the degree of hyponatremia and rapidity that it develops

-the more acute it is, the more severe it is

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18
Q

what are the first presentations of hyponatremia and at what levels of Na do you get them?

A

nausea and malaise

-Na falls below 125-130

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19
Q

hyponatremia sx’s at levels below 115-120

A

HA, lethargy, obtunded, seizures, coma, resp arrest, pulmonary edema

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20
Q

goals of tx for hyponatremia

A
  • prevent further decline in serum Na concentration (#1)
  • decr ICPin pts at risk for developing brain herniation
  • relieve sx of hyponatremia
  • avoid excessive overcorrection in pts at risk for osmotic demyelination syndrome
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21
Q

what is the first thing to do when treating hyponatremia?

A

prevent further decline in serum sodium concentation

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22
Q

what people are at risk for developing brain herniation from hyponatremia/are at risk of hyponatremia?

A
  • competitive exercise, ecstasy, psychosis
  • women and children post-op
  • recent brain injury, surgery, neoplasm
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23
Q

what happens if you overcorrect Na too quickly?

A

get neurologic sx’s -> osmotic demyelination syndrome

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24
Q

how do you treat hyponatremia?

A

bolus 3% saline

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25
what is the most common cause of hypernatremia? causes?
volume depletion/hypovolemia (fluid volume is low, so salt goes high) -fever, sweating, vomiting, diarrhea, primary hypodipsia (ex: condition where you don't drink)
26
what diabetes causes hypernatremia?
diabetes insipidus
27
how does diabetes insidious cause hypernatremia?
-passage of large volume of dilute urine cause hypovolemic hypernatremia thru 2 mechanisms
28
2 mechanisms that diabetes insipidus causes hypernatremia?
1. decreased secretion of ADH from posterior pituitary | 2. increased renal resistance to ADH - can't concentrate urine (passing lots of dilute urine)
29
most common cause of diabetes insipidus causing hypernatremia?
damage after trauma or surgery to the region of the pituitary and hypothalamus
30
primary hyperaldosteronism causing hypernatremia
- problem with the adrenal (usually a benign tumor) | - have excess production of aldosterone -> increased Na and water and decreased K
31
increased what and decreased what in primary hyperaldosteronism?
increased sodium and water and decreased K
32
altered thirst mechanism causing hypernatremia - common in who?
psych pts and elderly institutionalized pts
33
signs and sx's of hypernatremia
AMS, ataxia, seizures, hyperreflexia, spasticity/twitching, irritability, lethargy
34
management of hypernatremia?
D5W IV
35
caution in what when treating hypernatremia?
hyperglycemia
36
treatment of diabetes insipidus?
desmopressen - ADH analog
37
K+ is the most abundant what?
cation
38
what is K+ vital to?
cell metabolism and neurologic and cardiac electrical transmission
39
what are the main regulators of K+?
kidneys
40
98% of K+ is ___?
intracellular, chiefly in muscle
41
K+ is secreted and reabsorbed where?
within the nephrons of the kidneys
42
most common causes of hypokalemia?
diuretic therapy, diarrhea, vomiting
43
what meds cause large shifts of K+ from extracellular to intracellular?
diuretics (esp Loops and Thiazides) insulin beta-adrenergic agonists (albuterol, terbutaline)
44
hypo___ can cause hypoK?
hypomagnesemia (b/c K and Mg are very intimately related)
45
hyperaldosteronism does what to K?
increases K excretion from kidneys
46
sx's of hypokalemia?
muscle weakness/cramping respiratory muscle weakness palpitations ileus, constipation, fatigue
47
get mostly what type of sx's when hypokalemic?
muscle sx's b/c most K is stored in the muscles (and also in muscles of the gut)
48
what is seen on an EKG if pt is hypokalemic?
flat T waves, ST segment depression, U waves
49
what can mild hypokalemia be treated with?
oral KCl
50
what does severe and symptomatic hypokalemia need to be treated with?
IV replacement w/K and continuous telemetry
51
if hypokalemic and also hypomagnesemia, what do you replete first?
must replete Mg first before K + replacement (b/c both are related)
52
Mg+ plays a big role in regulation of what?
the Na+K+ATPase pump
53
if see K+ above 7 or 8, what do you want to do?
redraw -sometimes when draw blood cells, they smack against tube and break open and release K (hemolysis), so K will be falsely elevated -> redraw to confirm actually hyperkalemia
54
hyperkalemia can be due to what?
impaired urinary K+ excretion common complication in renal disease/insufficiency medications (ACEIs, ARBs, Aldosterone antagonists - spironolactone)
55
hyperkalemia is a common complication in what?
renal disease/insufficiency
56
meds that cause hyperkalemia?
ACEIs - Lisinopril ARBs - Losartan Aldosterone antagonist - spironolactone
57
what are the sx's of hyperkalemia?
muscle weakness/paralysis, paresthesias, arrhythmias
58
what is seen on an EKG when hyperkalemic?
tall or peaked T waves, widened/bizarre QRS, flat P wave | TWiFP
59
what is the first thing given when treating hyperkalemia? why?
IV calcium-gluconate or chloride -CARDIOPROTECTIVE - DOESN'T DECREASE K+
60
what meds actually treat hyperkalemia?
IV hypertonic glucose with regular insulin (moves excess K+ into the cells) IV loop or thiazide diuretics (rapid removal of K+ from body)
61
treat what causes for hyperkalemia?
treat reversible causes - hypovolemia
62
PO treatment of hyperkalemia?
have to give resins that bind K+ and excreted in stool -Kayexalate-sodium polysterene (not used much)
63
what else, besides meds, treats hyperkalemia?
hemodialysis
64
where is Ca primary stored?
bones and teeth
65
what processes require Ca+?
- blood coagulation - nerve excitability - development of action potentials for muscle contraction (skeletal, cardiac, smooth)
66
what factors influence serum Ca+ concentration?
PTH, vitamin D, calcium ion, phosphate
67
what is crucial for osteoclastic activity in bone? and ability of the intestines to store Ca?
Ca, phosphorous, and Vitamin d
68
what is the most common form of Ca found in the body and that is also usually measured?
ionized Calcium
69
most common causes of hypocalcemia?
- parathyroid disease - thyroid disease - thyroid or parathyroid-ectomy - CKD - vitamin d deficiency
70
Ca+ is bound to what in the serum? means what?
albumin -means need to check Ca and also albumin
71
what is albumin and what is it produced what?
it's a protein produced by the liver
72
what is the function of albumin/
the distribution of body fluids carrier protein in the blood for steroids, fatty acids, and thyroid hormone
73
hypoalbuminemia can cause?
pseudohypocalcemia
74
to determine true Ca levels, what is required?
correction for albumin
75
sx's of hypocalcemia?
- parasthesias - hyperreflexia - TETANY - MUSCLE SPASM - muscle cramps - seizures
76
classic physical findings of hypocalcemia?
Chvostek sign - facial spasm following the percussion of the facial nerve Trousseau's sign - spasm of the hand elicited by inflation of a BP cuff
77
what does an EKG look like when hypocalcemia?
prolonged QT interval
78
treatment of severe symptomatic hypocalcemia?
IV supplements - calcium gluconate
79
if have low Mg and also low Ca, what must you correct first?
must correct a Mg deficit first
80
tx for asymptomatic or mild hypocalcemia?
- PO Ca+ replacement with asymptomatic hypocalcemia | - PO calcium carbonate, calcium citrate, calcium carbonate
81
what are the most common causes of hypercalcemia?
hyperparathyroidism and bone malignancy (multiple myeloma)
82
signs and sx's of hypercalcemia?
MOANS, GROANS, STONES, AND PSYCHIATRIC UNDERTONES -bone pain, muscle weakness, confusion, lethargy, constipation, nephrolithiasis
83
common sx's seen in multiple myeloma and bone mets from cancers?
MOANS, GROANS, STONES, AND PSYCHIATRIC UNDERTONES
84
hypercalcemia tx
- volume expansion with isotonic saline - salmon calcitonin with a bisphosphenate - zoledronic acid (bisphosphenate)
85
how does calcitonin work to decrease Ca levels?
it decreases bone reabsorption and increases renal excretion of Ca
86
Mg+ is responsible for what?
- ATP processing - macronutrient and energy metabolism - neuromuscular transmission - can block Ca+ and K+ channels
87
what is the principle reservoir of Mg+?
bone
88
Mg+ levels regulated by what?
intestinal absorption and renal excretion | if these are off, then Mg+ is off
89
hypomagnesemia is commonly seen in what?
chronic ETOH abuse (from poor dietary intake)
90
causes of hypomagnesemia?
-***chronic ETOH abuse - reduced intestinal absorption - increased renal excretion - excessive GI loss (vomiting, diarrhea) - starvation - refeeding syndromes (after starvation and after gastric bypass)
91
what are the signs and sx's of hypomagnesemia?
- lethargy, confusion, tremors, convulsion - hyperreflexia, parathesias - cardiac arrhythmias
92
what does an EKG look like with hypomagnesemia?
widening of QRS, conduction prolongation and ST segment depression
93
what is tx for mild asymptomatic hypomagnesemia?
oral replacement with Mg salts - Mag-Ox (magnesium oxide) - Slow-Mag (magnesium chloride) - Mag-Tab (magnesium lactate)
94
precaution with what when treating hypomagnesemia with oral Mg salts?
may develop osmotic diarrhea
95
what is tx for severe or symptomatic deficiency of hypomagnesemia?
IV replacement Mg sulfate - careful monitoring for rebound hypermagnesemia and arrhythmias - caution when giving Mg+ to renal pts
96
caution when giving Mg+ to what pts?
renal pts
97
careful monitoring for what when treating severe or symptomatic deficiency of hypomagnesemia?
careful monitoring for rebound hypermagnesemia and arrhythmias
98
hypermagnesemia seen in?
seen in: - renal failure pts - supratherapeutic replacement - antacid abuse (milk of magnesium)
99
sx's of hypermagnesemia?
- decreased deep tendon reflexes - bradycardia - hypotension - flaccid paralysis - cardiac arrest - N, HA - hypocalcemia
100
what does an EKG look like with hypermagnesemia?
- tall T's - widened QRS - irregular conduction - escape beats
101
tx of hypermagnesemia?
- dietary restriction - elimination of magnesium containing meds - saline + loop diuretics (too pee it out and dilute it) -hemodialysis

Clin Med 3 (21 decks)

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