Fluids, Electrolytes, Blood Replacement Flashcards
Role of ADH/vasopressin
Increases volume status via DT/CD H20 reabsorb
SIADH
When ingestion of water does not adequately stress ADH resulting in hyponatremia
Two major players in sodium regulation
aldosterone: inc Na absorption
ANP: dec Na absorption
Signs to assess patient’s fluid status
CXR urine output edema Turgor Lung crackles
Tx for acute hyponatremia
No sx: 50 mL 3% saline bolus
Sx: 100 mL 3% saline bolus
Tx for chronic hyponatremia
No sx: reverse cause
Mild sx: 30 mL 3% saline and desmopressin/lasix
Severe: 100 mL 3% saline bolus
Na goal correction in hyponatremia
8-10 mEq/L in first 24 hours
too rapid of a correction in hyponatremia?
Osmotic demyelination syndrome
more likely in <105, alcoholics, malnutrition
Tx for SIADH
Fluid restriction
IV hypertonic soln
Diuretics
Vasopressin receptor antagonists
Tx for hypernatremia
D5W (more for acute presentation)
Too rapid of a correction in hypernatremia?
Cerebral edema, seizures
Free water deficit calculation
0.6M/0.5W * weight (kg) * ((actual/140) -1)
Acute hypernatremia: correct 1/2 in first 24 hours
EKG findings in hypokalemia
prolonged QT
U waves
Flat or inverted T waves
Transcellular shift causes of hypokalemia
Alkalosis
Hyperventilation
Insulin
Beta agonists
Hypokalemia tx
KCl 10 mEq/hr IV
Every 10 mEq will increase K by 0.1
(Need central line for >20 mEq/hr)
Hyperkalemia EKG findings
Wide QRS
Peaked T waves
sine waves
Tx for hyperkalemia
Give calcium to stabilize cell membrane
Push K into cells: insulin/glucose, bicarb, beta agonist
Remove K: loop diuretic or dialysis
Maintenance calculation IVF adults
D5 1/2 NS 100/50/20 rule 100 ml/kg for first 10 kg 50 ml/kg for next 10 kg 20 ml/kg for every kg after that Divide by 24 hours
Quick calc for IVF maintenance
35 cc/kg/day for IBW
RBCs contents
centrifuged whole blood, platelets removed
Indicated to increase O2 capacity to tissues
1 unit inc Hgb by 1 g/dL and Hct by 3%
FFP
Contains proteins and clotting factors
Indicated in elevated INR, DIC, liver dz/warfarin
Cryoprecipitate
Fibrinogen, factor 8, vWF
Indicated: hemophilia A, DIC
Type and screen
determines ABO and Rh type and screens for most common antibodies
Type and cross
Recipient serum tested against intended donor RBC prior to transfusion
TRALI
Transfusion Related Acute Lung Injury
Dyspnea, fever, hypotension
CXR: white out
Supportive care
TACO
Transfusion Associated Circulatory Overload
Acute congestive HF, no fever, elevated BNP
Tx: lasix
4 Ts of HIT likelihood
Thrombocytopenia
Timing of platelet fall
Thrombosis or other sequelae
Other causes of thrombocytopenia
