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Renal > IMP: Neph fluids and lytes > Flashcards

IMP: Neph fluids and lytes Flashcards

1
Q

total body water goes _______ as we age

A 
down:
infant 70%
adult 60%
elderly 50%
obese 45%
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2
Q

(2) pathological circumstances when tissue perfusion and ECF volume becomes uncoupled

A
  1. heart failure w/ edema (pickle lady)
  2. cirrhosis of liver with ascites
    In both conditions ECF is increased, but tissue perfusion is low
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3
Q

under normal circumstances, ECF volume is regulated by changes in ________ ___________/___________

A

sodium excretion/retention

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4
Q

If you think about serum Na+ levels, think _______

if you think about extracellular vol, think _____

A

water,

sodium

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5
Q

when addressing electrolyte imballance and dehydration

A

FIRST think CIRCULATING BLOOD VOLLUME–IV fluids (normal saline, LR) then address electrolytes if they haven’t normalized themselves

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6
Q

assess circulating blood volume via

A

VITAL SIGNS–P/E–peeing?

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7
Q

the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity)

A

ascites

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8
Q

too much water

A

hyponatremia

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9
Q

hyponatremia (2) – treated differently

A

acute (^ water intake–cell lyce) vs. persistent (ex. SIADH)

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10
Q

serum tonicity tested by

A

serum sodium

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11
Q

The _______ and ______ of water movement into cells determines the degree of cell swelling and cellular dysfunction, and therefore the SEVERITY OF SYMPTOMS

A

speed and severity

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12
Q

Tx of hyponatremia:
Mild asymptomatic:
Life threatening:

A

-FLUID RESTRICTION (take course of problem into account)
(Central Pontine Demyelination Syndrom)
-over 48-72 hrs raise Na+ w/ 3% IV solution (hypernormal saline)

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13
Q

Dangers to change Na+

A

quickly

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14
Q

_____ _____ _________ can produce a chemical that mimics ADH–> SIADH

A

Oat Cell Carcinoma

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15
Q

Limit of ability to cope w/ hyponatremia– “danger zone”

A

seizure + other CNS symptoms

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16
Q

key number for serum sodium – imp for differentiating SIADH from

A

20 (adequate)

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17
Q

serum sodium >20

A

SIADH

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18
Q

Hypernatremia think

A

not enough water–dehydration–> mental changes early (lethargy, irritability, seizure, coma)

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19
Q

Cx of hypernatremia (4)

A
  1. inability to access water
  2. DI
  3. diaphoresis, respiratory losses
  4. Hyperglycemia (osmotic diuresis)
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20
Q

hypernatremia –> hypertonicity of ECF –> ____ pulled out of ICF

A

water – thus mental changes

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21
Q

state of perspiring profusely

A

diaphoresis

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22
Q

water volume of volume depleted adult M/F

A

male: 50%
female: 40%

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23
Q

ascites

A

the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity)

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24
Q

Tx for hypernatremia

A

IV half normal saline–REPLACE THE WATER DEFICITE

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25
Q

don’t use “dehydration” use

A

low circulating blood volume

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26
Q

Don’t make ADH

A

DI

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27
Q

dehydration =

A

free water deficit-hypernatremia Tx w/ free water repleiton

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28
Q

volume depletion =

A

extracellular fluid or effective circulating blood volume depletion Tx w/ isotonic fluid replacement

29
Q

for dehydration correct volume deficits first then

A

correct water imbalances (slowly)

30
Q

hypovolemia def and cx (4)

A

any condition in which the ECF vol is reduced,

Cx: V/D, bleeding, 3rd spacing

31
Q

normovolemic aka

A

euvolemic

32
Q

hypovolemia cx

A

suboptimal circulating blood vol because of low PRELOAD

33
Q

edema and ascites are signs of

A

sodium excess and an expanded ECF vol

34
Q

SIADH pt’s will be ________ _________ but euvolemic

A

hypotonic hyponatremia

35
Q

Cx of hyperkalemia (4)

A
  1. renal failure (can’t get rid of dietary K+)
  2. Iatrogentic (K+ sparring drugs)
  3. extensive tissue destruction
  4. acidiosis
36
Q

S and Sx of hyperkalemia

A

primarrily EKG changes

37
Q

tall peaked T waves –> wide QRS –> sine wave appearance –> asystole

A

Hyperkalemia

38
Q

hyperkalemia tx
emergent:
life-threatening:

A

insuline–> drives K+ and glucose into cells,

dialysis

39
Q

Hyperkalemia value

A

K+ > 5.0 mmol/L

40
Q

normal K+

A

3.3-5.0 mmole/L

41
Q

hypokalemia value

A

K+<3.3 mmole/L

42
Q

hyokalemia cx

A
  1. inadequate intake

2. K+ loss (diuretics, V, NG suc, Burn)

43
Q

EKG flatteing of T wave, more PROMINANT U WAVE

A

hypokalemia

44
Q

severe hypokalemia (K+<3.0 mmole/L) S and Sx (2)

A
  1. EKG effects

2. muscle weakness–respiratory muscles

45
Q

tumor popular for wheeping K+

A

colonic villous adenoma

46
Q

__________ often accompanies hypokalemia and must be corrected to successfully replenish K+

A

hypomagnesmia

47
Q

Prominent U wave think

A

hypokalemia

48
Q

normal Ca rang

A

8.5-10.5 mmole/L

49
Q

inoized Ca++ range

A

4.65-5.25 mg/dl

50
Q

____% of Ca is bound to plasma proteins

A

60%

51
Q

3 major facters influencing serum [Ca]

A
  1. PTH– (Ca reabsorp in kidney, gut & Bone resorption)
  2. Vit D
  3. Calcium ion itself and Phosphate
52
Q

hypocalcemia most often caused by

A

disorder of PTH or Vit D

53
Q

acid/base disturbance of serum [Ca]

A
  1. acidosis–>reduces albumin/Ca binding–> ^free Ca

2. alkalosis- ^ Ca binding w/ albumin–low free Ca

54
Q

Mg deficiency can cx

A

hypocalcemia

55
Q

S and Sx of hypocalcemia (4)

A
  1. tetany
  2. Trousseau’s sign–carpopedal spasm w/ cuff inflation
  3. Chostek’s sign–spasm of facial m. w/ tapping
  4. seizures
56
Q

Ca percentage bound/unbound

A

60% bound–inactive

40% ionized–active

57
Q

hypercalcemia (2) major cx

A
  1. hyperparathyroidism (parathyroid adenoma)

2. malignancy (much higher than ^–bone tumor liberates Ca)

58
Q

reccurent renal calculi think

A

hypercalcemia

59
Q

Tx moderate-severe hypercalcemia

A
  1. ^ saline hydration

2. calcitonin (hormone from thyroid that opposes PTH, ^ renal excretion)

60
Q

inhibit Ca release by interfering w/ bone reabsorption

A

Bisphosphonates

61
Q

Mg homeostatis is a balance of _____ ______ and ______ ____

A

dietary intake and renal loss

62
Q

T/F there is direct hormonal regulation of Mg levels

A

F

63
Q

*Sx of hypermagnesemia (3)

A
  1. Hyporeflexia
  2. Hypotension
  3. bradycardia
64
Q

hypomagnesemia associated w/ (3)

A
  1. alcoholism (poor nutrition–assume hypomagnesmeic)
  2. chronic diarrhea
  3. loop diurents
65
Q

renal _______ ______ occurs in the face of hypomagnesemia

A

K+ wasting (hypokalemia)

66
Q

severe hypomagnesemia classically results in

A

hypocalcemia

67
Q

Cx of hypermagnesemia (3)

A
  1. renal insufficiency
  2. iatrogenic
  3. excess dietary or supplimentation
68
Q

ways to assess success of IV therapy for volume status (6)

A
  1. P/E–vitls, turgor, axilla, perfussion
  2. urine output
  3. daily wgt. meausrements
  4. intake and outputs (I&O’s)
  5. central venous pressure
  6. Lab (specific gravity, Hct, Cr/BUN, serum/urine osmalality)

Renal (5 decks)

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