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Cardio-Renal I FINAL > Hughes - Fluid and Electrolytes Part 1 > Flashcards

Hughes - Fluid and Electrolytes Part 1 Flashcards

1
Q

body water composition decreases as ____ increases

A

adipose tissue

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2
Q

2/3 of water is ______
(intracellular or extracellular)

A

intracellular

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3
Q

the 1/3 of water that is extracellular – breakdown where it’s located

A

70% is intertitial and 30% is intravascular

so very small portion is actually in the vessels

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4
Q

3 major INTRAcellular ions

A

potassium
magnesium
phosphate

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5
Q

3 major EXTRAcellular ions

A

sodium
chloride
bicarbonate

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6
Q

water moves from ___ ti ___ osmolality
recap what osmolality is

A

low to high

particles/kg of water

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7
Q

all body fluids are maintained between ___-___mOsm/kg

A

280-295

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8
Q

the kidney is able to regulate osmolality through the activity of….

A

ADH

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9
Q

TRUE OR FALSE

decreased plasma tonicity causes an increase in ADH

A

FALSE - decrease

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10
Q

increased plasma tonicity causes a ___ in ADH

explain what happens

A

increase

more low-solute water will be retained in the body, and thus the urine will be more concentrated

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11
Q

kidney regulates volume through the movement of ____

A

aldosterone

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12
Q

what is the main extracellular osmol

A

sodium

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13
Q

what does entresto do to natriuretic peptide levels

A

increases them by preventing their breakdown

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14
Q

true or false

if a patient is literally visually blown up with fluid, they cannot be hypovolemic

A

FALSE - they can be – can still be hypovolemic intravascularly

whole body vs intravascular are different things

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15
Q

pt gets DVT in leg and it is swelling

are they hypervolemic?

A

NO

can be hypovolemic bc the fludi that’s supposed to be in the vessels is going to a compartment where it’s not supposed to be

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16
Q

the symptoms that occur from hypovolemia occur bc of what 2 things

A

-the underlying cause (ie - vomiting)

-decreased perfusion (fatigue, thirst, etc)

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17
Q

another name for hypervolemia

A

edema

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18
Q

3 things that can cause hypervolemia (edema)

A

increased renal sodium retention

hypoalbuminemia

increased capillary pressure (due to sepsis, trauma, etc)

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19
Q

orthopnea meaning

A

shortness of breath when lying down but improves when you sit up

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20
Q

name 3 cases of “hypervolemia” and what the symptoms would be

A

pulmonary edema - SOB, orthopnea

peripheral edema- swollen legs

ascites - (peritoneal cavity filled w fluid) - abdominal distention, dullness, SOB

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21
Q

symptoms of HYPERVOLEMIA are due to what 2 things

A

-the underlying cause (anuria from renal disease)

-where the fluid is

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22
Q

the more ______ the electrolyte abnormality, the more severe the signs and symptoms will be

A

ACUTE - ie - if sodium changes drastically in 1 day vs slowly over a long time

(also, the further out of range)

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23
Q

hyponatremia technically means….

explain how this can be complicated

A

low ratio of
total body sodium: total body water

if someone drinks more than 16 L a day (the most a kidney can excrete), the sodium can get diluted and appear low, even tho the level is normal

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24
Q

the clinical presentation for hyponatremia is mainly ____ effects

how?

A

NEUROLOGIC

because fluid shifts through the BBB – cerebral edema

if sodium gets very low (110-115) — can cause seizure and coma!!!!!!

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25
as mentioned, hyponatremia can cause neurologic effects because water rushes through the BBB, causing cerebral edema the brain adapts to this fluid within only a couple days. therefore....
we have to correct the sodium EXTREMELY SLOWLY -- not too fast no faster than 4-8 mEq in 24 hours otherwise, can get CNS effects like behavioral changes, seizures, osmotic demyelination --- brain shrinks -- lot of damage -- potential irreversible
26
treatment for hypovolemic hypotonic hyponatremia
replacement with IV normal saline is ideal -- bc as the volume comes back, the kidneys will regain their function and be able to remove the sodium on their own for mild cases, even just oral replacement solutions can be used (NOT water or gatorade - use pedialyte!!! need glucose AND electrolytes)
27
goal correction rate for hypotonic hypovolemic hyponatremia
4-8mEq/L/hour
28
treatment for HYPERVOLEMIC hypotonic hyponatremia
DO NOT GIVE IV FLUIDS!!! reduce oral fluid intake, allow for some sodium (if bc of heart failure - not too high) in the diet, and use loop diuretics (can also use vaptans)
29
3 potential causes of hypervolemic hypotonic hyponatremia
heart failure nephrotic syndrome cirrhosis
30
euvolemic hypotonic hyponatremia likely due to what?
hypothyroidism, cortisol deficiency, SIADH (syndrome of inappropriate ADH secretion)
31
as mentioned, a main cause of euvolemic hyponatremia is SIADH what are the causes of this? explain what SIADH is
lot of causes -- cancer, pain, nausea, CNS disease, and a LOT of drugs can cause it too much ADH is produced and the body, the body will retain water which dilutes sodium - causes hyponatremia
32
treatment for euvolemic hyponatremia
correct cause (remove offending drug) RESTRICT fluid intake potential drugs --- -loop diuretic -conivaptan (vaprisol) -tolvaptan -sodium chloride tablets -hypertonic saline demeclocycline, lithium (not really used
33
true or false in cases of euvolemia hyponatremia, we want to give IV fluids
FALSE restrict fluids. -- may do the job on its own and might not need drugs
34
how does a loop diuretic work to treat euvolemic hyponatremia
gets rid of more fluid (without concentrating it)
35
route administration conivaptan what is brand name?
IV only --- only used in ICU brand is Vaprisol
36
differentiate between the MOA of conivaptan and tolvaptan
both inhibit vasopressin (ADH) at the V2 receptor and the V1A receptor HOWEVER tolvaptan is much more selective for the V2 receptor, and thus has less vasodilation effects
37
CrCl in which conivaptan and tolvaptan should not be used
conivaptan - no less than 30mL/min tolvaptan - no less than 10mL/min
38
conivaptan and tolivaptan are contraindicated when
in cases of anuria!! patient needs to be able to pee to get rid of the excess fluid that will be produced by blocking ADH also contraindicated with strong CYP inhibitors, and tolvaptan contraindicated in hypovolemia
39
how is tolvaptan administered big concern with is
PO DO NOT CORRECT TOO QUICKLY !! (more than 12MeQ in 24 hours) -- osmotic demyelination also very expensive
40
as mentioned, hypertonic saline (3%) can be used to treat euvolemic hyponatremia what is a concern and how should it be administerd
dont overcorrect!!!!! also, give via central line bc peripheral line irritating
41
true or false normal saline can be used to treat euvolemic hyponatremia
FALSE - need hypertonic
42
1 gram of sodium chloride tablets = ___ mEq
17
43
true or false demeclocycline and lithium are first line for euvolemic hyponatremia
FALSE 2nd line if anything - not really used
44
which class of diuretics is a common inducer of hyponatremia
thiazides NOT LOOPS!
45
true or false loop diuretics can induce hyponatremia
FALSE - thiazides can, but not loops
46
explain how thiazides can induce hyponatremia
they cause a decrease in water and sodium reabsorption this low volume of fluid in the body triggers the release of ADH -- which increases the reabsorption of WATER in the collecting tubules
47
4 things that can make a patient prone to thiazide-induced hyponatremia
elderly high doses dietary sodium restriction drinking too much water
48
"hypernatremia" technically means a high ratio of ___:___
body sodium:body water
49
true or false hypernatremia is much more rare than hyponatremia
TRUE hypernatremia really only occurs if the thirst center of the brain is damaged
50
true or false unlike with correcting hyponatremia, when correcting hypernatremia we want to correct as QUICKLY AS POSSIBLE
FALSE SLOWLY - still the risk of osmotic demyelination and permanent brain damage -- lethargy, weakness, twitching, irritability, etc
51
explain the treatment for hypernatremia
of course - correct the cause replace fluid deficit: -if the pt is hypotensive/hypovolemic/shock -- use NORMAL SALINE to correct the volume, then correct with sodium -can use D5W or 0.45% normal saline if the actual total body sodium is also low
52
98% of potassium is located where
in the INTRACELLULAR compartment (mainly muscle)
53
how are potassium levels normally maintained in the body
by the sodium/potassium ATPase pump this is controlled by the KIDNEYS -- they eliminate the ingested potassium and also maintain the potassium shift between the extra and intracellular compartments
54
true or false aldosterone decreases the elimination of potassium
FALSE - increases elimination
55
name some things that affect the intracellular shift of potassium
insulin B-agonists A-agonists pH exercise
56
name 3 general causes of hypokalemia
low intake (dietary) increased intracellular uptake excessive loss
57
name 2 drugs that increase the intracellular uptake of potassium would these drugs thus cause hyperkalemia or hypokalemia
beta agonists and insulin HYPOKALEMIA bc moving INTRACELLULARLY and by "hypokalemia" we mean the concentration in the blood
58
can loop diuretics cause hypokalemia? what about thiazides?
yes - both can
59
briefly explain what happens as potassium levels get lower and lower in the blood
at 1st - asymptomatic -- possible malaise and fever as it gets lower, the heart rate starts to be affected and you can get cramps in the muscles CPK and AST are elevated, and at LOWEST LEVELS - rhabdomyolysis occurs (less than 2 mEq/L)
60
CHRONIC effects of hypokalemia (name 2)
decreased insulin secretion (and thus increased blood glucose) increased renal ammonia formation (hepatic encephalopathy)
61
is hypokalemia diagnosed by symptoms?
no the symptoms the patient presents with can be from so many different things. therefore, it is diagnosed by a BMP
62
3 general treatments for hypokalemia
-correct the cause -replete the fluid and electrolytes -hold any medications that may be predisposing them to hypokalemia
63
when a patient has hypokalemia, they almost always have.......
hypomagnesium
64
potassium levels are 3-4mEq/L how much does it take to correct by 0.1mEq/mL?? what if potassium levels are LESS THAN 3
20mEq per 0.1Meq increase so to go from 3-3.5 it would take 100mEq it takes more like 20-40mEq per 0.1mEq increase in the blood
65
when correcting potassium, it's very important to....
monitor carefully!!! serum potassium doesnt always reflect the total body potassium
66
which route of administration is preferred for treating hypokalemia
oral is preferred over IV
67
patient counseling point when they're given oral potassium for hypokalemia
take with fluid and a glass of water bc can cause GI issues like NVD, bleeding and perforation
68
oral potassium should be avoided in who
patients with impaired gastric motility -- can sit there in the GI tract for too long and cause perforation therefore, should also avoid drugs that slow the GI tract like benadryl - causes bleed
69
true or false unlike for sodium correction, overcorrection is not a concern for potassium
FALSE - IT IS STILL VERY MUCH A CONCERN overcorrection can cause a life-threatening arrythmia
70
IV potassium rate of administration, and how this changes if the patient presents with a life threatening arrythmia
DO NOT OVERCORRECT generally it's 40mEq/L - no faster than 10mEq/hour if the pt has a critical arrythmia - can give 60mEq at 40mEq/hour
71
true or false giving IV potassium is not preferred. one of the reasons is that it can cause phlebitis
TRUE
72

Cardio-Renal I FINAL (12 decks)

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