Hyponatremia And IVF Flashcards
Which kids are at a higher rush of hyponatremia and why?
Those conditions associated with an increased risk of non-physiological ADH secretion
- Neurological infections - meningitis, encephalitis
- Respiratory infections - pneumonia
- Certain medications - morphine
- Head trauma
- Peri- and post-operative
- nausea
- Pain and stress
In what situations is it appropriate to use hypotonic IVF?
Never
What are the symptoms of hyponatremia
N&V Lethargy & decreased LOC Irritability Headache Apnea Seizures Coma
What monitoring should children on IVF have?
Before starting: electrolytes
Accurate ins and outs
Regular blood work - at least daily if children are at high risk of impaired renal excretion
In which situation would you use NaCl 0.45% versus 0.9%
- 9%:
- no baseline electrolytes available
- low normal sodium 135-137
- generally preferred - 45%
- higher sodium 145-154
Why is ringers lactate not a great maintenance option?
Lack of glucose
Presence of lactate
Why do kids need glucose in IVF?
Because they have limited glycogen stores
What conditions are excluded from this statement?
Those with significant difficulty regulating electrolytes and fly us: cardiac conditions, renal conditions, burns
Children less than 1 month - difficulty excreting sodium
How much sodium is in 0.9% NaCl?
154 mmol/L
Which kids are at risk of hypernatremia and fluid retention with isotonic fluids?
Those with: renal concentrating defects Severe dehydration Impaired ability to excrete Na Prolonged fluid restriction
What is a biochemical risk of lots of isotonic fluid especially if given fast?
Hyperchloremic metabolic acidosis
But this has not been shown in the trials about IVF
How would you define acute hyponatremia?
What is the risk?
Decrease in Na
What are isotonic fluids?
Why are kids at a higher risk of cerebral oedema with isotonic fluids?
0.9% NaCl
Hypo is less than this
Bc of SIADH
