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test 2 > hypovolemia > Flashcards

hypovolemia Flashcards

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1
Q

Body Fluid Pathophysiology

A
  • ECF > sodium, chloride, bicarb
  • ICF > potassium and phosphate
  • Body fluid osmolality 280-295 mOsm/kg
  • Vasopressin is stimulated when osmolality is greater than 285 mOsm/kg or changes in blood volume or blood pressure,
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2
Q

Hypovolemia -renal causes

A

Mannitol • Diuretics • Tubulointerstitial injury • Hereditary defect • Some antibiotics • Diabetes Insipidus

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3
Q

low volume xtra renal

A
  • Extrarenal causes

* Fluid loss from GI, skin and respiratory system • Fluid accumulation within tissue compartments

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4
Q

Treatment – replete the fluid and find the cause

normo
hypernatremic
metabolicacidosis

A
  • Normo- or hyponatremia > NS
  • Hypernatremic > ½ NS
  • Metabolic acidosis > bicarb • Hemorrhage/anemia > red blood cell transfusion
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5
Q

Hyponatremia: Na < 135 mM

A
  • Physical exam: generalized swelling, neuro symptoms (dizziness to seizures)
  • Evaluation: labs and calculate water deficit and correct it over 48-72 hours
  • Treatment: slow infusion of NS to avoid osmotic demyelination syndrome, increased risk of ODS with alcoholism, malnutrition, hypokalemia or liver transplants
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6
Q
  • Euvolemic hyponatremia:
  • Hypervolemic hyponatremia
  • Acute symptomatic hyponatremia:
  • Chronic hyponatremia:
A
  • Euvolemic hyponatremia: treat underlying cause
  • Hypervolemic hyponatremia: treat underlying cause and add an ACE
  • Beer potomania: NS and eat a regular diet
  • Acute symptomatic hyponatremia: hypertonic solution slowly, mechanical ventilation if necessary
  • Chronic hyponatremia: fluid restrict
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7
Q

Hypovolemic and urine Na > 20

A

Hypovolemic and urine Na > 20 look for renal cause, urine Na < 20 look for extrarenal losses

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8
Q

Euvolemic and urine Na > 20

A

are they hypothyroid, medication causes or SIADH

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9
Q

Hypervolemic and urine Na >20,

A

acute or chronic renal failure, urine NA <20 nephrotic syndrome, cirrhosis, cardiac

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10
Q

Hypernatremia

Plasma Na 145 mM • High mortality 40-60% • Combined water and electrolyte deficit causes

A

• Causes • Diabetes insipidus • Trauma • Hydrocephalus • Inflammation • Renal and nonrenal routes • Insensible losses • Diarrhea most common GI cause • Osmotic diuresis most common renal water loss

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11
Q

hyper NA ECF volume increased

A

hypertonic NaCl or NaHCO3

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12
Q

Hyper NA - is ECF volume decreased

A

Is ECF volume decreased > evaluate urine osmole excretion rate

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13
Q

• Is ECF volume decreased > evaluate urine osmole excretion rate

A
  • > 750 mOsm/d treat with diuretic
  • < 750 mOsm/d treat with desmopressin
  • Central DI: urine osmo increases • Nephrogenic DI: urine osmo unchanged
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14
Q

Hypernatremia – Evaluation and Management

A
  • Physical exam: neuro symptoms, confusion to coma leading to cerebral edema and seizures
  • Diagnostics: history, ROS for thirst, polyuria, source of water loss • Labs: serum and urine osmo
  • Give DDAVP to differentiate between central and nephrogenic DI
  • Treatment
  • Find underlying cause • Admin free water by mouth or NG tube • Replace slowly 10 mM/d
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15
Q

Hypokalemia

A
  • K < 3.5 mM • Impacts cardiac rhythm, BP, and CV morbidity
  • Causes
  • Decreased intake • Redistribution into cells such as metabolic alkalosis or hypothermia
  • Non-renal loss: GI, sweat, hyperaldosteronism, bicarbonaturea, diarrhea
  • Renal loss: medications
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16
Q

Hypokalemia – Evaluation and Management

A
  • Physical exam: arrhythmias, polyuria, phosphaturia, bicarb retention
  • Diagnostics: basic labs, osmolality, urinary pH, thyroid function
  • Treatment: • Replace K orally, IV only if cannot take PO
  • Correct underlying cause
17
Q

Hyperkalemia

A
  • K > 5.5 mM
  • Causes:
  • Pseudohyperkalemia – occurs with improper venipuncture
  • Intra-extracellular shift as in acidosis, thermal trauma, succinylcholine admin
  • Inadequate excretion
18
Q

Hyperkalemia – Evaluation and Management

A

Physical exam: cardiac arrhythmias, Brugadas sign on EKG
• Diagnostics: • EKG • Basic labs
• Treatment:
• Treat cardiac effects immediately
• Reduce K level
• Remove K by sodium polystyrene sulfonate exchange, diuretics or HD

19
Q

Hypercalcemia

A
  • Ca > 10.1 mg/dl
  • Causes:
  • Excessive PTH production • Malignancy • Vitamin D overproduction • Hyperthyroidism • Immobilization • Excessive calcium intake • Medications
20
Q

Hypercalcemia – Evaluation and Management

A
  • Physical exam: • Mild elevation – asymptomatic • Vague neuropsychiatric symptoms • Lethargy, stupor, coma • GI distress • EKG changes
  • Diagnostics: • Basic labs • EKG • PTH level
  • Treatment • IV fluids (4-6 liters) • Hydrocortisone if vitamin D overproduction
21
Q

Hypocalcemia

A

Hypocalcemia
• Ca < 8.9 mg/dl
• Causes: • Hypoparathyroidism
• Parathyroid agenesis or destruction • Reduced parathyroid function
• Hyperparathyroidism
• Impaired Vit D production • Medications • Acute pancreatitis • Rhabdomyolysis • Cancer

22
Q

Hypocalcemia – Evaluation and Management

A
  • Physical Exam: paresthesias, Chvosteks sign, carpal spasm, seizures, bronchospasm, laryngospasm, prolonged QT
  • Diagnostics: basic labs, PTH level
  • Treatment – based on severity • Calcium gluconate for symptomatic and severe cases •
23
Q

Metabolic Alkalosis

A

Determine the cause
• Causes: • Bicarb load • GI loss • Renal causes • Diuretics • HTN • K deficiency • Excess mineral corticosteroids • High/low renin • Cushing’s syndrome • CA
• Treatment • NS or KCl or surgery

24
Q

Alcoholic Acidosis:

A

IV fluids (NS or 5% dextrose)

25
Q

Salicylate Induced Acidosis:

A

Gastric lavage, activated charcoal, IV bicarb, HD for severe cases

26
Q

Ethylene Glycol Induced Acidosis

A

saline, osmotic diuresis, HD, thiamine, pyridoxine supplement

27
Q

Methanol Induced Acidosis:

A

similar to ethylene glycol treatment

28
Q

Isopropanol alcohol toxicity:

A

watchful waiting and supportive treatment

29
Q

Lactic Acidosis

A

Bicarb therapy, treat underlying cause

30
Q

Calculate AG • High AG

A

ketoacidosis, lactic acidosis, renal failure and toxins • NG Acidosis : GI tract bicarb loss, renal tubular acidosis

31
Q

Respiratory Acidosis

A
  • Causes: • Pulmonary disease • Medications • Head trauma • Alcohol • Bronchospasm
  • Diagnostics • ABG, PFTs, basic labs, non-pulm work up
  • Treatment - oxygen
32
Q

Respiratory Alkalosis

A
  • Causes: • CNS stimulation such as pain, fever, tumor, trauma • Pneumonia • Aspiration • Anemia • Medications • PE • Sepsis • Heat exposure
  • Treatment- breathe into a brown bag, ventilator, beta-adrenergic blocker
33
Q

just

A

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test 2 (13 decks)

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