IV Fluids and Electrolytes >:(

Question 1

Normal plasma osmolality

Answer 1

280 - 295 mOsm/kg

Question 2

Saline Equivalents

Answer 2

Crystalloids

NS, Lactated ringers

Question 3

Water equivilants

Answer 3

D5W

Question 4

Dehydration

Answer 4

Depletion of INTRACELLULAR fluid.

Best replaced with IV NS

Question 5

Hypovolemia

Answer 5

Depletion of INTRAVASCULAR volume.

Replaced with blood products etc.

Question 6

Hyponatremia

Answer 6

Sodium < 135 meq/L
Results form a water load
<120 is direct life threat

Question 7

Hyponatramia etiologies

Answer 7

Inability to suppress ADH
True volume depletion
SIADH
Low dietary intake
Renal failure

Question 8

Hypovolemic Hyponatremia

Answer 8

GI or renal losses

Just replace volume orally or IV

Question 9

Hypervolemic Hyponatremia

Answer 9

CHF, cirrhosis, renal failure
Fluid, sodium restriction
Utilize loop diuretics

Question 10

SIADH

Answer 10

Too much ADH
Hypervolemic hypotonic hyponatermia
Drug or dz induced

Question 11

SIADH Hyponatremia Tx

Answer 11

3% hypertonic saline
Furosemide
Fluid restriction

Question 12

Hypernatremia Etiologies

Answer 12

Unreplaced water loss
Water loss into cells (seizures)
Sodium overload

Question 13

Hypernatremia Manifestations

Answer 13

Rapid decrease in brain volume can result in cerebral hemorrhage.
Demyelinating lesions
Can also be chronic, brain adapts.

Question 14

Acute hypotonic hyponatremia =

Answer 14

Cerebral edema

Neuronal cell expansion

Question 15

Hypernatremia lab values

Answer 15

> 145 meq/L

Question 16

Hypernatremia Tx

Answer 16

D5W (hypotonic) and .45% NS

Question 17

Diabetes Insupidous (DI)

Answer 17

Not enough ADH production (central), or ADH resistant (nephrogenic)

Question 18

Tx for central DI

Answer 18

Desmporessin (ADH like activity)

Restrict fluid intake

Question 19

Nephrogenic DI Tx

Answer 19

Thiazide diuretic 
Sodium restriction (2 mg/day)

Question 20

Unreplaced water loss hypernatremia tx

Answer 20

Fluid replacement.

simply stunning.

Question 21

Rapid correction of fluids can lead to?

Answer 21

Cerebral edema

Question 22

What % of calcium is bound to albumin?

Answer 22

46%

Must obtain corrected Ca with albumin

Question 23

Hypercalcemia

Answer 23

Serum levels >10.5
Cancer and hyperPTH primary causes
Thiazide diuretics

Question 24

Hypercalcemia S/S

Answer 24

EKG changes, N/V anorexia, constipation, PolyUD, Neuropsych sx

Question 25

Hypercalcemic crisis

Answer 25

``` Acute renal failure, coma, arrhythmias, death. Tx: Saline and loop diuretics Biphosphonates Osteoclast inhibtors (calcitonin) Dialysis ```

Question 26

Hypocalcemia

Answer 26

< 8.5 mg/dL HypoPTH, vitamin D deficiency, loop diuretics Associated with refractory severe hypocalcemia

Question 27

Hypocalcemia S/S

Answer 27

tetany, paresthesias around mouth. | QT prolongation, decreased contractility

Question 28

Tx of Acute symptomatic Hypo-Ca

Answer 28

IV calcium salts | 100 - 300 mg elemental over 5-10 minutes

Question 29

Chronic hypocalcemia Tx

Answer 29

Oral calcium supplementation | 1-3 grams elemental Ca/day

Question 30

Normal serum phosphorus level

Answer 30

2.0 - 4.5

Question 31

Hyperphosphotemia

Answer 31

Decreased excretion due to low GFR Chemo and rhabdo Tx: GI binders, IV calcium salts, dialysis

Question 32

Hypophosphatemia

Answer 32

Proximal muscle weakness and osteomalacia | IV or oral phosphorous

Question 33

Hypomagnesemia

Answer 33

Occurs is 12% of hospitalized pt's Cramps, tetany, seizure Hypocalcemia Widened QRS, Afib, V-arrhythmias

Question 34

Drugs that cause hypomagnesemia

Answer 34

diuretics, aminoglycosides, alcohol, cisplatin, cyclosporine

Question 35

When to treat hypomagnesemia

Answer 35

if Less than 1.0 IV MgSO4 if severe Oral if mild-moderate

Question 36

Hypermagnesemia

Answer 36

Occurs when >2 mEq/L IV calcium to treat Dialysis Forced diuretics

Question 37

Hypokalemia

Answer 37

Low potassium | <3.5 mEq/L

Question 38

Hypokalemia etiologies

Answer 38

``` Beta 2 agonists Loop diuretics ACE inhibitors Thiazides, Insulin Metabolic acidosis, vomiting, diarrhea ```

Question 39

S/S of Hypokalemia

Answer 39

U wave changes (peaked) | Arrhythmias

Question 40

Hypokalemia Tx

Answer 40

IV or oral potassium

Question 41

Hyperkalemia

Answer 41

Increased K | >5,5 mEq/L

Question 42

Hyperkalemia Etiologies

Answer 42

Increased K intake (duh) Decreased excretion Aldosterone resistance

Question 43

Hypokalemia S/S

Answer 43

Ascending muscle weakness Wont affect resp. muscles. Peaked T waves, shortened QRS

Question 44

Hyperkalemia Tx

Answer 44

Abnorma EKG: IV calcium gluconate Consider bicarb if acidotic Loop diuretics?