Fluids, Electrolytes, Nutrition

Question 1

drugs that push potassium into the cells

Answer 1

insulin
beta agonists
epinephrine

Question 2

causes of hypokalemia

Answer 2

alkalosis, pushes positive ions out of the way
carb loading
stress, epinephrine drump (dobutamine, albuterol)
hypothermia

Question 3

drugs that increase potassium excretion

Answer 3

mineralocorticosteroids
loop diuretics
thiazide diuretics

Question 4

dig and potassium correlation

Answer 4

low pot increases dig levels as less is bound up

Question 5

why should you not put potassium in d5 only?

Answer 5

the dextrose will trigger an insulin dump and the insulin will push the K into the cells

Question 6

how long after IV KCl should you wait to get a new level?

Answer 6

2 hours

Question 7

succinylcholine affect on potassium

Answer 7

increases potassium level and can cause EKG changes

Question 8

drugs that decrease K excretion from kidneys

Answer 8

ACEI, ARB
K sparing diuretics
trimethoprim

Question 9

what level is K an emergency?

Answer 9

> 6.5meq/L
could be <2.5meq/L as well
continuous monitoring

Question 10

do not use calcium to correct hyperK if on what medication?

Answer 10

digoxin, will release a lot of digoxin and can cause instant overdose and even death

Question 11

what drug should be given if symptomatic hyperkalemia?

Answer 11

calcium via push

Question 12

how to treat hyperkalemia

Answer 12

insulin regular 10units+D50 amp
if acidotic - bicarb amp q30min
albuterol - unreliable
binders/exchangers

Question 13

sodium polystyrene sulfate

Answer 13

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)

Question 14

patiromer

Answer 14

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

Question 15

Sodium zirconium cyclosilicate

Answer 15

exchanges Hydrogen and Na for K
10g PO TID x 48 hrs, then daily for maintenance

Question 16

K Riders have how much potassium and sodium?

Answer 16

K - 22 meq/250ml
Na - 20meq/250ml

Question 17

hypocalcemia replacement dose if symptomatic

Answer 17

CaCl 1g
Ca-gluconate 2-3g

Question 18

when to do bolus vs continuous feedings

Answer 18

bolus = terminates in stomach
continuous - inserts into duodenum or jejunum

Question 19

average water intake needed with enteral feedings

Answer 19

30ml/kg/day of free water flushes

Question 20

Max Dextrose per peripheral line

Answer 20

<10% dextrose

Question 21

lipid max rate of infusion

Answer 21

0.1g/kg/hr w/1.2 micron filter

Question 22

kCal from macros

Answer 22

Protein - 4 kcal/g
lipids - 10 kcal/g
dextrose - 3.4 kcal/g

Question 23

things not to mix in a TPN bag

Answer 23

lipids and dextrose - destabilizes lipids

calcium and phosphorous back to back

Question 24

if a patient is in alkalosis, give electrolytes as which salts

Answer 24

chloride (extra -)

Question 25

if a patient is in acidosis, give electrolytes as which salts

Answer 25

acetate - converts to bicarb for alkalosis

Question 26

conversion of fluid to volume expansion…
NS/LR
D5W
Albumin 5%
Albumin 25%
Hetastart

Answer 26

NS/LR 1L = 250ml
D5W 1L = 100 ml
Albumin 5% 1L = 1L
Albumin 25% 1L = 5L
Hetastarch 1L = 1L

Question 27

Crystalloids

Answer 27

NS, D5W, LR, Plasmolyte
have little crystals

Question 28

Colloids

Answer 28

Hetastarch
Albumin
PRBCs

Question 29

hazards of using albumin 25%

Answer 29

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

Question 30

daily fluid intake pediatric calculation

Answer 30

100ml/kg x 10 kg
50ml/kg x 20 kg
20ml/kg x weight

Question 31

daily fluid intake for adults

Answer 31

20 - 40 ml/kg/day for adults

Question 32

threshold for hypertonic saline due to intracranial pressure

Answer 32

> 20mmHg sustained, best to give small boluses and evaluate

Question 33

calculation for hypertonic saline dosing for hyponatremia

Answer 33

want to increase 8-12meq/day

1-2ml/kg/hr usually

assess every 1 to 2 hours

Question 34

normal adult kcal requirements

Answer 34

25 - 35kcal/kg

Question 35

typical dietary macros needed

Answer 35

20-35% protein
30% fats
35% carbs