Fluids, Electrolytes, Nutrition Flashcards
drugs that push potassium into the cells
insulin
beta agonists
epinephrine
causes of hypokalemia
alkalosis, pushes positive ions out of the way
carb loading
stress, epinephrine drump (dobutamine, albuterol)
hypothermia
drugs that increase potassium excretion
mineralocorticosteroids
loop diuretics
thiazide diuretics
dig and potassium correlation
low pot increases dig levels as less is bound up
why should you not put potassium in d5 only?
the dextrose will trigger an insulin dump and the insulin will push the K into the cells
how long after IV KCl should you wait to get a new level?
2 hours
succinylcholine affect on potassium
increases potassium level and can cause EKG changes
drugs that decrease K excretion from kidneys
ACEI, ARB
K sparing diuretics
trimethoprim
what level is K an emergency?
> 6.5meq/L
could be <2.5meq/L as well
continuous monitoring
do not use calcium to correct hyperK if on what medication?
digoxin, will release a lot of digoxin and can cause instant overdose and even death
what drug should be given if symptomatic hyperkalemia?
calcium via push
how to treat hyperkalemia
insulin regular 10units+D50 amp
if acidotic - bicarb amp q30min
albuterol - unreliable
binders/exchangers
sodium polystyrene sulfate
exchanges Na for K
15g up to 4 times a day
liquid has sorbitol that has cases of intestinal necrosis (worst case if close to surgery)
patiromer
exchanges Ca for K
8.4g PO daily, max dose 25.2g po daily
delayed onset, can be used for daily maintenance
not for crisis
Sodium zirconium cyclosilicate
exchanges Hydrogen and Na for K
10g PO TID x 48 hrs, then daily for maintenance
K Riders have how much potassium and sodium?
K - 22 meq/250ml
Na - 20meq/250ml
hypocalcemia replacement dose if symptomatic
CaCl 1g
Ca-gluconate 2-3g
when to do bolus vs continuous feedings
bolus = terminates in stomach
continuous - inserts into duodenum or jejunum
average water intake needed with enteral feedings
30ml/kg/day of free water flushes
Max Dextrose per peripheral line
<10% dextrose
lipid max rate of infusion
0.1g/kg/hr w/1.2 micron filter
kCal from macros
Protein - 4 kcal/g
lipids - 10 kcal/g
dextrose - 3.4 kcal/g
things not to mix in a TPN bag
lipids and dextrose - destabilizes lipids
calcium and phosphorous back to back
if a patient is in alkalosis, give electrolytes as which salts
chloride (extra -)
if a patient is in acidosis, give electrolytes as which salts
acetate - converts to bicarb for alkalosis
conversion of fluid to volume expansion…
NS/LR
D5W
Albumin 5%
Albumin 25%
Hetastart
NS/LR 1L = 250ml
D5W 1L = 100 ml
Albumin 5% 1L = 1L
Albumin 25% 1L = 5L
Hetastarch 1L = 1L
Crystalloids
NS, D5W, LR, Plasmolyte
have little crystals
Colloids
Hetastarch
Albumin
PRBCs
hazards of using albumin 25%
if a patient is dehydrated, it will pull fluid from inside the cells and dehydrate them
great for pulling fluid from ascites or pleural effusions
daily fluid intake pediatric calculation
100ml/kg x 10 kg
50ml/kg x 20 kg
20ml/kg x weight
daily fluid intake for adults
20 - 40 ml/kg/day for adults
pressure threshold to give hypertonic saline
> 20mmHg sustained, best to give small boluses and evaluate
calculation for hypertonic saline dosing for hyponatremia
want to increase 8-12meq/day
1-2ml/kg/hr usually
assess every 1 to 2 hours
normal adult kcal requirements
25 - 35kcal/kg
typical dietary macros needed
20-35% protein
30% fats
35% carbs
