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CDM 2 Exam 2 > Lecture 10 - Fluids & Electrolytes > Flashcards

Lecture 10 - Fluids & Electrolytes Flashcards

1
Q

how to calculate mEq

A

( Mass (mg) X valence) / (molecular weight)

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2
Q

mOsm/L of NaCl?

A

308 mOsm/L

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3
Q

Normal plasma osmolality?

A

~ 270-295 mOsm/L

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4
Q

Isotonic Solutions

A

270-300 mOsm/L

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5
Q

Hypotonic solutions

A

< 270 mOsm/L

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6
Q

Hypertonic solutions

A

> 300 mOsm/L

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7
Q

Why should significantly hypotonic fluids ( < 154 mOsm/L) not be admin directly to patients?

A

can cause cellular swelling and cell death

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8
Q

What makes solutions Iso, Hypo, Hypertonic?

A 
Hypertonic = due to Electrolyte balances
Hypotonic = due to have fraction of electrolyte of normal solution
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9
Q

Total Body Water Calculation

A

~ 50% for women (of total body weight)
~ 60% for men (of total body weight)

also ~73% of Lean body mass

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10
Q

Osmolar Gap Calculation

A

Measured Na+ mEq/L + {[(measured glucose - 100)/100] X 1.6}

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11
Q

Osmolar Gap seen when pts have which symptoms?

A 
Severe Hyperglycemia
Hyperlipidemia
Azotemia/uremia
Mannitol infusion
Toxic alcohols
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12
Q

Causes of Osmolar Gap

A

high glucose or low sodium

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13
Q

Neonate fluid replacement calc (< 10kg)

A

100ml/Kg

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14
Q

Pediatric fluid replacement calc ( 10-20kg)

A

1000ml + 50ml/each kg between 10-20kg

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15
Q

Adolescent/Adult fluid replacement calc (> 20kg)

A

1500ml + 20ml/each kg > 20kg

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16
Q

Mild Dehydration Therapy

A

Replace over 8-24hrs
Provide additional 6-8oz per episode of diarrhea

ORT = Oral rehydration therapy
too much glucose can cause osmotic diarrhea
Optimal mix of fluid, electrolytes, carbs

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17
Q

Examples of Oral Rehydration solutions

A 
WHO/UNICEF ORT
Ceralyte 50,70,90 (# = amount of sodium)
Infalyte
Naturalyte
Pedialyte Liquid and Freezer pops
Rehydrate
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18
Q

Moderate/Severe Dehydration Therapy

A

Req hospitalization and IV rehydration

Txm must include water deficit + maintenance fluid needs + ongoing abnormal/excessive losses

** Fluids will distribute into body fluid compartments based on osmolarity of the solution and the effective free water content**

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19
Q

Common causes of volume overload

A

HF
Liver cirrhosis
Nephrotic Syndrome

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20
Q

Acidemia

A

pH < 7.35 = higher amounts of bicarb, or lower lvls of C02

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21
Q

Alkalosis

A

pH > 7.45

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22
Q

Pulmonary & Metabolic Regulatory Mechanism

A 
respiratory = if issue is in lungs
Metabolic = if issue is in kidneys
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23
Q

General Na reference range?

A

135-146mEq/L

symptoms tend not develop until lvls are above/below by 10mEq/L

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24
Q

Hyponatremia

A

Na lvl < 135

Severe < 125

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25
Where do Osmotic diuretics work?
PCT
26
Where do Loop diuretics work?
Loop of Henle
27
Where do ADH & Vasopressin antagonists work?
Collecting duct
28
Where do Thiazide diuretics work?
DCT
29
Examples of Osmotic diuretics
Mannitol, urea, glycerol
30
How do osmotic diuretics wok?
create osmotic gradient and inc water excretion
31
What are osmotic diuretics used for clinically?
reduce increased intracranial pressure, intraocular pressure, and promote removal of toxins
32
Example of Carbonic Anhydrase Inhibitor
Acetazolamide, acts mainly in proximal tubule
33
IV to PO furosemide?
20mg IV = 40 MG PO
34
Diuretic with risk of hyponatremia?
Thiazide diuretics
35
Spironolactone and eplerenone are antagonists for what?
Aldosterone They're potassium sparring diuretics Generally weak activity
36
Conivaptan & Tolvaptan are....
Vasopressin Antagonists (ADH) increase serum osmolality & Na but don't alter Na excretion
37
Conivaptan receptor antagonist at....
V1a and V2
38
Tolvaptan receptor antagonist at...
Selective V2 preferred
39
Osmolarity of D5W only
252 = hypotonic
40
Osmolarity 0.9% NaCl
308 = isotonic
41
Osmolarity 0.45% NaCl
154 = hypotonic
42
Osmolarity D5W + 0.225% NaCl
329 = hypertonic
43
Osmolarity D5W + 0.45% NaCL
406 = hypertonic
44
Lactated Ringer
273 = Isotonic
45
Plasma-Lyte
294 = isotonic
46
causes of Hyponatremia
Loss of sodium, gain of water or both
47
Mild Hypoatremia
126-135 typically asymptomatic/non-specific HA, Disorientation, mild confusion, blurry vison, N/V
48
Moderate Hyponatremia
120-125 range from mild-profound confusion, no concern of seizures
49
Severe hyponatremia
< 120 may include stupor/coma, severe neurologic changes
50
Hypovolemic Hyponatremia
Excessive electrolyte-rich solute loss relative to TBW loss
51
Euvolemic Hyponatremia
slight decrease/normal total body Na and normal/slightly elevated TBW (no fluid overload) common due to SIADH
52
Hypervolemic Hyponatremia
excessive overload leads to dilution effect in the serum endurance athletes
53
Correction rates for Hyponatremia
as low was 1-2 mEq/L per hour Typical Max = 6 mEq/L in 6hrs, 12 mEq/L in 24hrs, 18 mEq/L in 48hrs avoid rapid over correction, you'd avoid sodium based products if you do over correct
54
Hypovolemic Hyponatremia treatment
Mild/moderate = normal saline + lactated ringer More severe = 3% hypertonic saline
55
concern with rapidly correcting patients sodium?
Osmotic Demylenation
56
Euvolemic or Hypervolemic Hyponatremia treatment
Mild/moderate = volume restriction Severe = bolus hypertonic saline prioritized over volume restriction 1st 12-24hrs
57
If fluid restriction falls in Euvolemic/Hypervolemic then what....
Try loop diuretics, IV 20-40 Furosemide q6/12hrs | Vasopressin receptor antagonist
58
Only free water available in hospital?
Dextrose
59
Hypernatremia treatment
minimize sodium taking in give them volume ("Free Water" = electrolyte free) = Dextrose infusion want it to be sodium free
60
Hypovolemia Hypernatremia treatment
Isotonic solution over 2-4 days at a low rate
61
Hypervolemia Hypernatremia treatment
Loop diuresis elim excess fluid and sodium
62
hypochloremia lvls
< 97 mEq/L
63
hypochloremia treatment
chloride containing solution
64
Hyperchloremia lvls
> 108 mEq/L
65
Hyperchloremia treatments
D/c or reduce causative agent little treatment options sodiumbicarb can be given as buffer
66
Potassium range
3.5-5 mEq/L
67
Hypokalemia lvls
< 3.4 mEq/L Give potassium, but less worrisome than Hyperkalemia
68
Hyperkalemia lvls
> 5 mEq/L can cause arrhythmia when > 6
69
Hyperkalemia treatment
1st give Calcium gluconate 1-2g IV push if they are symptomatic or have ECG changes (stabilizes cardiac cell membranes) Then reduce/remove the potassium
70
Acute Hyperkalemia Treatment
Reduce: Insulin, Sodium Bicarb, Albuterol To remove: Kayexalate ( sodium polystyrene sulfonate) Hemodialysis = last stop
71
Chronic Hyperkalemia Treatment
Patiromer (Veltassa) or sodium zirconium cyclosilicate (Lokelma)
72
Phosphorus range
2.7-4.5 mg/dL
73
Hypophosphatemia
< 2.6 mg/dL
74
Hyperphosphatemia
> 4.5 mg/dL commonly seen with CKD
75
Hypophosphatemia treatment
Mild (2-2.5) or moderate (1-1.9) = oral supplements if functional GI Severe (< 1) = IV
76
Hyperphosphatemia Treatment
Treat underlying conditions give drugs that bind to phosphate and remove it ** tied to calcium, so if have hypercalcemia then avoid calcium binder **
77
Calcium ranges
8.5 - 10.2 mg/dL
78
Hypocalcemia
< 8.5 mg/dL
79
Hypocalcemia treament
Acute: Calcium glucoante > Calcium chloride Chronic: 1-2g/elemental per day
80
Hypercalcemia
> 10.2 mg/dL 1st clinical thought = cancer
81
Hypercalcemia acute treatment
1st step = hydration Severe: 200-300 ml/hr of NS for 2-6L Bisphosphate & RANK therapy = store calcium back into bones
82
Hypercalcemia chronic treatment
Cincalcet Frequent Bisphosphonates Denosumab
83
Hypomagnesemia
< 1.5 or lower Treatment: replace...the more severe the higher the dose Oral = mild/moderate, IV = severe
84
Hypermagnesemia
can give Calcium chloride

CDM 2 Exam 2 (16 decks)

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