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Nephrology > IV Fluids and Electrolytes >:( > Flashcards

IV Fluids and Electrolytes >:( Flashcards

1
Q

Normal plasma osmolality

A

280 - 295 mOsm/kg

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2
Q

Saline Equivalents

A

Crystalloids

NS, Lactated ringers

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3
Q

Water equivilants

A

D5W

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4
Q

Dehydration

A

Depletion of INTRACELLULAR fluid.

Best replaced with IV NS

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5
Q

Hypovolemia

A

Depletion of INTRAVASCULAR volume.

Replaced with blood products etc.

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6
Q

Hyponatremia

A

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

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7
Q

Hyponatramia etiologies

A 
Inability to suppress ADH
True volume depletion
SIADH
Low dietary intake
Renal failure
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8
Q

Hypovolemic Hyponatremia

A

GI or renal losses

Just replace volume orally or IV

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9
Q

Hypervolemic Hyponatremia

A

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

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10
Q

SIADH

A

Too much ADH
Hypervolemic hypotonic hyponatermia
Drug or dz induced

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11
Q

SIADH Hyponatremia Tx

A

3% hypertonic saline
Furosemide
Fluid restriction

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12
Q

Hypernatremia Etiologies

A

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

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13
Q

Hypernatremia Manifestations

A

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

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14
Q

Acute hypotonic hyponatremia =

A

Cerebral edema

Neuronal cell expansion

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15
Q

Hypernatremia lab values

A

> 145 meq/L

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16
Q

Hypernatremia Tx

A

D5W (hypotonic) and .45% NS

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17
Q

Diabetes Insupidous (DI)

A

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

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18
Q

Tx for central DI

A

Desmporessin (ADH like activity)

Restrict fluid intake

19
Q

Nephrogenic DI Tx

A 
Thiazide diuretic 
Sodium restriction (2 mg/day)
20
Q

Unreplaced water loss hypernatremia tx

A

Fluid replacement.

simply stunning.

21
Q

Rapid correction of fluids can lead to?

A

Cerebral edema

22
Q

What % of calcium is bound to albumin?

A

46%

Must obtain corrected Ca with albumin

23
Q

Hypercalcemia

A

Serum levels >10.5
Cancer and hyperPTH primary causes
Thiazide diuretics

24
Q

Hypercalcemia S/S

A

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

25
Q

Hypercalcemic crisis

A 
Acute renal failure, coma, arrhythmias, death.
Tx:
Saline and loop diuretics
Biphosphonates
Osteoclast inhibtors (calcitonin)
Dialysis
26
Q

Hypocalcemia

A

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

27
Q

Hypocalcemia S/S

A

tetany, paresthesias around mouth.

QT prolongation, decreased contractility

28
Q

Tx of Acute symptomatic Hypo-Ca

A

IV calcium salts

100 - 300 mg elemental over 5-10 minutes

29
Q

Chronic hypocalcemia Tx

A

Oral calcium supplementation

1-3 grams elemental Ca/day

30
Q

Normal serum phosphorus level

A

2.0 - 4.5

31
Q

Hyperphosphotemia

A

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

32
Q

Hypophosphatemia

A

Proximal muscle weakness and osteomalacia

IV or oral phosphorous

33
Q

Hypomagnesemia

A

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

34
Q

Drugs that cause hypomagnesemia

A

diuretics, aminoglycosides, alcohol, cisplatin, cyclosporine

35
Q

When to treat hypomagnesemia

A

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

36
Q

Hypermagnesemia

A

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

37
Q

Hypokalemia

A

Low potassium

<3.5 mEq/L

38
Q

Hypokalemia etiologies

A 
Beta 2 agonists
Loop diuretics
ACE inhibitors
Thiazides, Insulin
Metabolic acidosis, vomiting, diarrhea
39
Q

S/S of Hypokalemia

A

U wave changes (peaked)

Arrhythmias

40
Q

Hypokalemia Tx

A

IV or oral potassium

41
Q

Hyperkalemia

A

Increased K

>5,5 mEq/L

42
Q

Hyperkalemia Etiologies

A

Increased K intake (duh)
Decreased excretion
Aldosterone resistance

43
Q

Hypokalemia S/S

A

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

44
Q

Hyperkalemia Tx

A

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

Nephrology (14 decks)

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