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Therapeutics > L 1-4: Fluids and Electrolytes > Flashcards

L 1-4: Fluids and Electrolytes Flashcards

1
Q

IBW equations

A

Male: 50kg + (2.3 * over 60inch)
Female: 50kg + (2.3* over 60inch)

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2
Q

NBW equation

A

IBW + 0.25(wt-IBW)

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3
Q

Three main organ systems involved in fluid balance

A

Skin
Lungs
Kidneys

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4
Q

When to use NBW, and ABW

A

> 130% of BW = use NBW
if pt is less than IBW, use ABW

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5
Q

Fluid intake

A

Should = fluid losses

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6
Q

Sensible vs insensible fluid loss

A

Sensible: 1-1.5 L/day
Insensible 1L/day

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7
Q

NG output vs Diarrhea output

A

NG: loss of acid - alkalosis
Diarrhea: Loss of base - acidosis

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8
Q

Isotonic range

A

275-290 mOsm/L

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9
Q

Hypotonic and Hypertonic range

A

Hypo: <275 mOsmol/L
Hyper: >920 mOsmol/L

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10
Q

Total osmolarity equation

A

Total osmolarity = osmolarity of IV solution + Osmolarity of added electrolytes

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11
Q

0.9% NS osmolarity

A

154 mOsmol/L

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12
Q

Calculating MIVF

A

Clinical estimate:
30-40ml/kg/day

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13
Q

Crystalloids

A

Isotonic, Hypotonic, or hypertonic
-Flexible
NS
1/2 NS
D5W
LR
Balanced salt solutions

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14
Q

Colloids

A

Hypertonic
Albumin (5 or 25%)
Hetastarch
Tetrastarch
Blood
Plasmanate

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15
Q

NS place in therapy

A

Fluid replacement, NOT maintenance

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16
Q

1/2 NS place in therapy

A

Maintenance - lots of flexibility

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17
Q

LR place in therapy

A

Resuscitation - burns, trauma, etc

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18
Q

D5W place in therapy

A

Free water replacement
NOT maintenance by itself

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19
Q

Colloid solution place in therapy

A

Hypertonic -plasma expanders
-Get fluid out of cell into plasma

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20
Q

Albumin adverse effects

A

Hypervolemia - Too much water in body
Azotemia - too much waste in body

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21
Q

Albumin

A

Supportive/symptomatic treatment

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22
Q

Synthetic colloids problems

A

Black Box Warning: Severe sepsis

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23
Q

RBCs

A

Packed RBCs used when low hemoglobin (<7-8 g/dL)

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24
Q

Most common MIVF

A

D5W + 1/2 NS + 20 mEq KCl/L

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25
Q

Dehydration warning urine output

A

<0.5 mL/kg/hr

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26
Q

Hyponatremia

A

Most common electrolyte disturbance in hospitalized patients
-Brain injury, seizure, death
Demyelation

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27
Q

Pseudohyponatremia

A

Extreme elevations of lipids and proteins increase the total plasma volume
-Seen with hypertriglyceridemia or hyperproteinemia
-We would not treat this (overcorrecting)

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28
Q

Hypertonic hyponatremia

A

High levels of osmolality

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29
Q

Hypotonic hyponatremia

A

Most complicated
Most common - >90% of all hyponatremia
Need to assess ECF volume:
-Hypovolemic
-Isovolemic
-Hypervolemic

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30
Q

Osmolality

A

Number of particles per liter of water (mOsm/L)

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31
Q

Hypovolemic Hypotonic Hyponatremia

A

Decrease in BOTH total body H2O and Na+
-Renal (urine Na+ > 20 mEq/L)
-Non renal (Urine Na+ <20 mEq/L(

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32
Q

Isovolemic Hypotonic Hyponatremia

A

TBW increase
Normal/slightly increased total body sodium

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33
Q

Most common cause of Isovolemic Hypotonic Hyponatremia

A

SIADH

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34
Q

SIADH

A

Syndrome of Inappropriate Anti Diuretic Hormone release
water intake exceeds capacity of the kidneys to excrete water*
-Urine Osm generally > 100 mOsm/kg
-Urine Na+ generally > 20-30mEq/L

35
Q

SIADH primarily caused by

A

DRUGS
Antineoplastics
-Cyclophosphamide
-Vinicristine, viblastine
Antipsychotics
Bromocriptine
Carbamazepine
Chlorpropramide
Desmopressin
Meperidine, morphine
Nicotine
NSAIDs (ibuprofen)
Oxytocin
SSRis
-Fluoxetine
-Sertraline
TCAs
-Amitriptyline
Imipramine
Tolbutamide

36
Q

Treatment of SIADH

A

Remove underlying cause (e.g. medications) if possible
First line - Free water restriction

37
Q

HYPERvolemic Hypotonic Hyponatremia

A

Total body sodium increased but TBW increased MORE

EDEMA
-Cirrhosis
-Heart failure
-Kidney failure
-Nephrotic syndromes

38
Q

Goal of treatment for hypovolemic

A

Restore volume deficit
DO NOT GIVE MORE THAN 8-12 mEq/L/day
Hypertonic NaCl (3%) if symptomatic (500 mEq)
Isotonic NaCl if asymptomatic

39
Q

Goal of treatment for isovolemic

A

Furosemide and 3% NaCl if symptomatic
0.9% if Asymptomatic and water restriction

40
Q

Goal of treatment for Hypervolemic

A

Furosemide and judicious 3% NaCl in symptomatic
Furosemide in asymptomatic patients

41
Q

Acute symptomatic hyponatremia

A

BRAIN SWELLS
cerebral edema
Irreversible and sometimes fatal
Altered mental status and seizures

42
Q

Treatment of Acute Symptomatic Hyponatremia

A

Increase serum sodium by 1-2 mEq/L/hr until symptoms resolve
-Goal 120 mEq/L
-Complete correction is NOT necessary - if correction is too rapid can cause demyelation

43
Q

What is the max sodium increase to treat Acute Symptomatic Hyponatremia in the first day?

A

8-12 mEq/L in the first 24 hrs

44
Q

Demyelination risk factors

A

Serum Sodium <105 mEq/L
Hypokalemia
Alcohol use disorder
Malnutrition
Advanced liver disease

45
Q

Rule of 8

A

Treat with hypertonic saline (3%) - replace half of sodium deficit in 8 hrs; then remaining deficit within 8-16 hrs

46
Q

Acute symptomatic hyponatremia monitoring

A

Serial exam of heart, lungs, and neurologic status several times over the first 12 hours
-Serum Sodium conc. q2-4 hrs until asymp
-then q 6-8hrs until WNL

47
Q

Hypernatremia

A

Always associated with Hypertonicity
-Impaired thirst response or pts without access to water
-Infants
-Elderly
-Persons with a disability

Loss of hypotonic fluids OR ingestion of sodium or hypertonic fluids

Must assess volume status (ECF)

48
Q

HyPOvolemic HyPERnatremia

A

Restore hemodynamic status first
-0.9 NACl

Once intravascular volume restored:

Calculate free water deficit

49
Q

Replacing free water deficit

A

Provide free water
-D5W continuous infusion
-Enteral free water via feeding tube

Match I/O if possible

DO NOT CORRECT TOO QUICKLY

Goal is 0.5 mEq/l/hr decrease in Naserum

50
Q

Isovolemic Hypernatremia (Diabetes Insipidus)

A

Etiology: brain injury/trauma, nephrogenic (drug induced)

TX:
-Desmopressin: Acute administer SubQ/IV 0.25-.5 mL BID
Chronic - Intranasally 0.05-0.2mL BID

Vasopressin: Acute continuous infusion titrated hourly to goal UOP

51
Q

Potassium (K) levels

A

Normal Level: 3.5-5 mEq/L

52
Q

HYPERvolemic HYPERnatremia

A

Hypernatremia from hypertonic fluids is uncommon
-Hypertonic saline resuscitation

TX:
-Stop hypertonic fluids/cause
-Rapidly excreted
-Diuretic if needed
Match I/O

Too much fluid - kick it out

53
Q

Potassium use

A

Primary intracellular cation
Responsible for cell metabolism
Glycogen and protein synthesis
Determines the resting potential across cell membranes in cardiac and non-cardiac tissue
Hypo and hyper associated with fatal arrythmias

54
Q

Factors affecting potassium

A

Na/K ATPase pump
-Insulin
-Glucagon
-Catecholamines
-Aldosterone

Kidneys

Arterial pH/acid-base returns

55
Q

Hypokalemia - causes

A

Diuretic loss
B-agonist medications
NG drainage
Metabolic alkalosis
Diarrhea
Magnesium depletion
-Co-factor for Na/K ATPase

56
Q

Which will kill a patient quicker hyper or hypokalemia

A

Hyperkalemia - do not want to overcorrect when treating: goal: normalize

57
Q

Hyopkalemia treatment

A

3-3.4
Treatment debatable
PO K+ for patients with cardiac conditions

<3 mEq - ALWAYS treat
-PO route preferred
IV for symptomatic patients or pts who cannot take PO
Should attempt to correct Mg2+ deficit

58
Q

IV K+

A

Do not give potassium push via IV - can kill someone

Arrhythmia or cardiac arrest if given too quickly

59
Q

Infusion rate of IV K+ without cardiac monitoring

A

10 mEq/hr

60
Q

Hyperkalemia

A

> 5.5 mEq/L
Cardiac arrythmias

61
Q

Goals of therapy for hyperkalemia

A

C a big K drop
FIRST: Manage cardiac arrest
THEN:
1. Antagonize the membrane actions
2. Decrease the extracellular K+ concentrations
3. Remove K+ from body

62
Q

C a Big K drop

A
  1. Antagonize the membranes (Calcium)
  2. A BIG
    Decrease EC K+ concentrations
    (Albuterol, Bicarb, Insulin and Glucose - push K+ back into cell where it belongs)
  3. K DROP
    -Remove K from the body
    -Kayexalate/Lokelma
    -Diuretics (furosemide)
    -Renal unit of dialysis Of Patient
    (3rd step not always necessarry)
63
Q

Acute tx of hyperkalemia: need to know

A

Give calcium chloride whenever possible (one gram over 1-2 minutes)

DO NOT GIVE INSULIN WITHOUT DEXTROSE could have seizures

–Study chart in notes!!

64
Q

Chronic tx of Hyperkalemia med

A

Patiromer (Valtassa)

MOA: Binds K+ in the GI tract and decreases absorption

65
Q

Magnesium normal levels

A

1.5-2.5 mg/dL

66
Q

Magnesium role in body

A

Important role in neuromuscular function

-Cofactor for ATP and Alkaline phosphatase

Related to Ca2+ and K+ metabolism

Regulated by intake and kidney excretion

67
Q

Hypomagnesemia

A

<1.5 mg/dL
-Usually associated with disorders of the GI tract or kidneys
-Diarrhea
-Decreased intestinal absorption
-Severe malnutrition

Drugs
-Diuretics (thiazide or loop)

68
Q

Goals of therapy for hypomagnesemia

A

-Resolution of symptoms
-Identify correct underlying causes
-Restoration of the NL MG2+ concentration
-Correction of concomitant electrolytes
Don’t forget to treat associated electrolyte disturbances

69
Q

Tx of hypomagnesemia

A

PO
-Asymp with MG > 1
-Milk of mag (5-10 mL PO QID)
Mag-OX 800 mg PO daily or 400 mg PO TID w/meals

IV
-Symptomatic pts (or cannot tolerate PO)

Mg 1-2 mg/dL - 0.5 mEq/kg
Mg <1mg/dL 1 mEq/kg

70
Q

Calcium Range in body

A

8.5-10.5 mg/dL

71
Q

Calcium role in body

A

-Necessary for bone formation and neuromuscular function

-Serum concentrations are controlled mainly by the PTH, vitamin D, and calcitonin

-Organs involved in calcium metabolism: Bone, kidneys, and the intestine

72
Q

Hypocalcemia

A

More frequently seen in hospitalized pts

Etiologies:
Mg deficiency
Large volumes of blood products
Hypoalbuminemia (must correct calcium)

73
Q

Calcium correection

A

Measured calcium + (4-measured albumin) * 0.8)

74
Q

Hypocalcemia Clinical presentation

A

Neuromuscular
-Muscle cramps, tetany

CNS
-Depression, anxiety, memory loss, confusion, hallucination, seizures

Dermatologic
-Hair loss, eczema

Cardiac
-QTC prolongation, arrythmias

75
Q

Acute treatment hypocalcemia

A

100-300 mg elemental Ca IV over 5-10 min

1 gram CaCl = 3 grams Ca gluconate (270 mg elemental Ca)

Cl can be admin IV push during code
-Gluconate is preferred for PIV admin
(+) lower % of elemental Ca
(-) less predictable increase in Ca2+ concentration
(+) Less risk for extravasation (necrosis)

Usual admin rate - 1gm/hr

Correct hypomagnesemia

76
Q

Chronic treatment hypocalcemia

A

PO Calcium
1-3 g/day of elemental Ca2+

-Vitamin D supplementation
-Calcitriol 0.25 mg PO daily or every other day

77
Q

Phosphorous range in body

A

2.5-4.5 mg/dL

78
Q

Phosphorous role

A

Critical for structure and function
-respiratory and cardiac muscle function
-Enzymatic rxns that control carbohydrate, fat, and protein metabolism
-Source of high energy bonds of ATP
-Modulates the oxygen carrying capacity of hemoglobin
-Regulated by intake, vitamin D, PTH and renal function
Makes ATP

79
Q

Hypophosphatemia

A

Mild to moderate
1-2 mg/dL

Severe:
<1 mg/dL

Etiologies:
-Decreased intake
-Impaired absorption
-Intracellular shifts

80
Q

4, 3, 2 rule

A

Keep K+ above - 4
Keep P above 3
Keep Mag above 2

81
Q

Treatment of Hypophosphatemia - mild to moderate

A

Oral PO4
Phos-Nak -> 30-60 mMol/day in 2-3 doses (cannot handle all at once)

Fleets Phospho-soda (4.1 mMol/mL) 5 mL diluted 2-3 times/day

82
Q

Treatment of Hypophosphatemia - severe

A

IV PO4
Use KPhos when K+ < 4mEq/L
Use NaPhos when K+ > 4mEq/L

83
Q

Phos replacement

A

1 mMol NaPhos = 1.33 mEq Na+ & 1.33 mEq Phos

1mMol KPhos = 1.47 mEq K+ & 1.47 mEq Phos

Admin:
Give PO doses as divided doses
Infuse IV doses no faster than 7 mMol/hr
Never push KPHOS - only given as piggyback

Therapeutics (61 decks)

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