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Fluids & Lytes > Fluids & Lytes > Flashcards

Fluids & Lytes Flashcards

1
Q

serum osmolality calculation

A

2Na + (BUN/2.8) + (glucose/18)

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2
Q

normal serum osmolality

A

265-285

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3
Q

formula to correct metabolic acidosis

A

mEq bicarb = wt x 0.3 x base deficit

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4
Q

causes of metabolic alkalosis

A

Vomiting! – losing acid

  • pyloric stenosis
  • NG suction
  • CF
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5
Q

electrolytes in pyloric stenosis

A

hypochloremic
hypokalemic
metabolic alkalosis

  • think losing HCl in emesis (therefore low Cl, and alkalosis)
  • hypokalemic from contraction- absorb Na and secrete K in kidneys
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6
Q

causes of normal anion gap acidosis

USED CARP

A
  • decreased bicarb
  • kidney dysfxn
  • diarrhea ** most common
  • increase Cl
USED CARP
U- ureterostomy
S- small bowel fistula
E- extra chloride
D- diarrhea
C- carbonic anhydrase inhibitor (acetazolamide)
A- adrenal insufficiency
R- RTA
P- pancreatic fistula
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7
Q

type 1 RTA (7)

A
  • distal collecting tubule
  • unable to rid of H
  • metabolic acidosis without gap
  • urine pH inc >5.5
  • hyperchloremic
  • hypokalemic
  • mimicked by spironolactone
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8
Q

type 2 RTA (6)

A
  • proximal tubule
  • unable to reabsorb HCO3
  • metabolic acidosis
  • distal tubule still able to secrete H –> acidify urine
  • urine pH <5.5
  • mimicked by acetazolamide
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9
Q

type 3 RTA

A

combination of 1 & 2

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10
Q

type 4 RTA

A
  • aldo resistance
  • unable to resorb Na or secrete K
  • hyperkalemia results
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11
Q

elevated anion gap causes

A 
MUDPILES
M- methanol
U- uremia
D- DKA
P- paraldehyde
I- ingestion/isoniazid/iron
L- lactic acid
E- ethanol/ethylene glycol
S- salicylates
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12
Q

daily requirement for Na

A

3 mEq/kg/day

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13
Q

central diabetes insipidus

A

lack of ADH

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14
Q

peripheral diabetes insipidus

A

resistance of ADH

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15
Q

labs in DI

A

high serum osmolality

inappropriately dilute urine

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16
Q

nephrogenic DI (3)

A
  • x linked (males only)
  • kidney doesn’t respond to ADH
  • unable to respond to exogenous vasopressin
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17
Q

how to determine the type of hyponatremia

A

calculate FeNa

= (Una+Pcr)/(Ucr+Pna)

18
Q

causes of SIADH (9)

A
  • head trauma/infection/brain tumor –> pituitary injury –> SIADH
  • pulm d/o
  • endo d/o
  • chemo (vincristine, cyclophosphamide)
  • AED (carbamazepine)
  • post op
  • guillian barre
19
Q

SIADH

  • serum NA?
  • serum K?
  • BP?
  • UOP?
  • urine Na
  • BUN/Cr?
A 
low
nl
high
low
high
nl
20
Q

treatment for SIADH

A

fluid restriction

21
Q

what is the next step when fluid restriction does not work in SIADH? (3)

A
  • furosemide (NOT thiazide as it may decrease Na more)
  • hypertonic saline (give if Na less than 120)
  • demeclocycline
22
Q

when to use demeclocycline for treatment of SIADH

A

when fluid restriction fails

blocks the affect of ADH on kidney
can only us in children>8 (like doxycycline)

23
Q

what does chronic diuretic therapy do to Na

A

hyponatremia

24
Q

medications that cause hyponatremia (4)

A

1- vincristine (SIADH)
2- cyclophosphamide (diminished H20 excretion)
3- chloropropramide (stimulates vasopressin)
4- thiazides (blocks renal Na and Cl resorption)

25
Q

with dilutional hyponatremia what is the total body sodium

A

normal
dilutional hyponatremia in serum d/t water intoxication
urine Na increased

26
Q

affect of hyponatremic dehydration on brain

A

pontine damage

27
Q

urine sodium in dilutional hyponatremia

A

high

28
Q

urine sodium in 3rd spacing

A

low

29
Q

daily requirement for K

A

2 meq/kg/d

30
Q

sx of hypokalemia (6)

A 
muscle pain
weakness
paralysis
constipation
ileus
polyuria
31
Q

EKG changes in hypokalemia (3)

A

T wave flattening –> U wave
ST depression
PVC

32
Q

potassium replacement in hypokalemia

A

KCl 0.5-1 meg/L per kg over an h (max 40)

33
Q

hypocalcemia EKG changes

A

QT prolongation

34
Q

hypomagnesium EKGchanges

A

prolonged PR and QT intervals

35
Q

hypoglycemia EKG changes

A

none

36
Q

hyponatremia EKG changes

A

none

37
Q

hypernatremia EKG changes

A

peaked T wave

with worsening sx have widened QRS and absence of P waves

38
Q

treatment of hyperkalemia (6)

A
  • calcium chloride IV
  • insulin (+glucose)
  • bicarb
  • albuterol
  • furosemide
  • kayexelate (oral polystyrene resin)
39
Q

sodium concentration in oral rehydration fluid

A

75 mEq/L

40
Q

rate of oral rehydration fluid with moderate-severe dehydration

A

50 cc/kg over 1-4 hrs

10 kg baby = 500 cc (or 16 oz) = 4 oz/h

41
Q

labs in CF

A

hypochloremic
hyponatremic
metabolic alkalosis
with dehydration

Lose NaCl in sweat
then have contraction alkalosis

42
Q

skin findings in hypernatremia

A

doughy skin

Fluids & Lytes (1 decks)

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