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Renal II Quizam 1 > Lecture 5: Fluid and Electrolyte Imbalance - Na, K > Flashcards

Lecture 5: Fluid and Electrolyte Imbalance - Na, K Flashcards

1
Q

What are the 2 main causes of intracellular edema?

A
  1. Depression of metabolic systems of tissues
  2. Lack of adequate nutrition to the cells

*Cells lack the resources needed to drive the Na+-K+-ATPase pump, causing Na+ to accumulate in cells –> H2O rushes in

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2
Q

What 3 factors are working to prevent extracellular edema?

A
  1. Interstitium normally has low compliance
  2. Lymph flow can increase 10-50 fold
  3. Increased amts of protein-poor capillary fluid flow wash protein out from the interstitial space, thereby decreasing capillary filtration pressure
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3
Q

With ACE inhibition the GFR falls, but serum levels of what will rise?

A

Creatinine

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4
Q

Using the mnemonic SALT LOSS what are the sx’s of hyponatremia?

A
  • Stupor/coma
  • Anorexia, N/V
  • Lethargy
  • Tendon reflexes decreases
  • Limp muscles (weakness)
  • Orthostatic hypotension
  • Seizures/HA
  • Stomach cramping
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5
Q

What are some of the main causes of Euvolemic Hyponatremia?

A
  • SIADH
  • Drugs/Stress
  • Glucocorticoid deficiency
  • Hypothyroidism
  • Primary polydipsia
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6
Q

What are 2 major causes of increased effective circulating volume which can cause hypervolemic hyponatremia?

A

1) Acute renal failure
2) Advanced chronic renal failure

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7
Q

What are some of the major causes of decreased effective circulating volume which can cause hypervolemic hyponatremia?

A
  • CHF
  • Liver disease
  • Sepsis
  • Nephrotic syndrome
  • Pregnancy
  • Anaphylaxis
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8
Q

What is the correct way to tx a patient with hyponatremia that is only a level 1 (no or minimal symptoms)?

A
  • Fluid restriction
  • Consider vaptan under select circumstances (i.e., can’t tolerate fluid restriction, need to correct [Na+] for surgery, etc..)
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9
Q

What is the correct way to tx a patient with hyponatremia that is a level 2 (moderate sx’s)?

A
  • Vaptan or hypertonic NaCl
  • Followed by fluid restriction
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10
Q

What is the correct way to tx a patient with hyponatremia that is a level 3 (severe sx’s)?

A

Hypertonic NaCl, followed fluid restriction or vaptan

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11
Q

Why does hyponatremia need to be corrected slowly?

A

Overly rapid correction —> osmotic demyelination syndrome

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12
Q

What is the rate that can be used to correct hyponatremia in someone who is acute symptomatic?

A
  • 2.5 mEq/L/h to get to safe zone
  • Should NOT increase more than 20 mEq/L/day
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13
Q

What is the rate that can be used to correct hyponatremia in someone that has chronic (>48 hrs) hyponatremia?

A
  • Should be ~0.5 mEq/L/h until 120 mEq Na+/L
  • Total increase should not exceed 8-12 mEq/L/day and no more than 18 mEq/L in first 48 hrs
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14
Q

What is one of the major tumors that can cause SIADH?

A

Oat-cell carcinoma of the lung

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15
Q

What are 3 situations in which hypernatremia is commonly seen?

Often a known indicator of?

A
  1. Not uncommon in those living alone who fall at home
  2. Known indicator of neglect in nursing homes
  3. People in the desert without enough water
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16
Q

What are 5 causes of Hyprvolemic Hypernatremia?

A
  1. Administration of hypertonic saline or hypertonic sodium bicarbonate
  2. Hypertonic dialysis
  3. Hypertonic feedings
  4. Primary hyperaldosteronism
  5. Cushing syndrome
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17
Q

What are 3 causes of Euvolemic Hypernatremia?

A
  1. Diabetes insipidus (central or nephrogenic)
  2. Hypodipsia = diminished thirst
  3. Insensible dermal and skin losses (only if hypodipsic)
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18
Q

What are 2 causes of Hypovolemic Hypernatremia?

A
  1. Lack of access to water
  2. “Broken” thirst mechanisms
19
Q

Using the mnemonic TRIP, what are the symptoms of Hypernatremia?

A
  • Twitching, tremors, hyperreflexia
  • Restlessness, irritable, confusion, etc. (due to brain cell shrinkage)
  • Intense thirst, dry mouth, decreased urine output
  • Pulmonary and peripheral edema
20
Q

What to use for treatment of hypovolemic hypernatremia?

A

Isotonic saline

21
Q

In hypervolemic/euvolemic hypernatremia what is used as treatment?

A

HYPOtonic IV solutions (i.e., D5W, half-normal saline, quarter-normal saline)

22
Q

What is the rate of infusion for correcting hypernatremia?

A

Correct over 48 hours at ≤ 0.5 mEq/L/hr (i.e., < 12 mEq/L/day)

23
Q

What are the effects of hyperkalemia vs. hypokalemia on the cardiac conduction system?

A
  • Hyperkalemia —> membranes hyperpolarized = less likely to fire = BRADYcardia
  • Hypokalemia –> tachycardia

*This the opposite effect of what is occurring in cells

24
Q

What will be seen on the ECG of someone with hyperkalemia?

A

Peaked T wave

25
Q

What are some of the hormones/drugs, acid-base states, and deficiencies that cause an increase in K+ movement into cells?

A
  • Insulin
  • β2-agonist (epi) and α-blockers
  • Aldosterone deficiency
  • Alkalosis
  • Hypoosmolarity
26
Q

What are some of the factors (i.e., hormones, drugs, deficiencies, states) that cause an increase in K+ leaving the cell?

A
  • α-agonist (NE, Epi)
  • Insulin deficiency
  • β2-blockers
  • Acidosis
  • Hyperosmolarity
  • Exercise
  • Cell lysis
27
Q

Rapid absorption of K+ in diet into the ECF could lead to fatal hyperkalemia if not for its rapid redistribution into the ICF, which is most importantly due to what?

A

Insulin

28
Q

What are the 5 major influences on segmental absorption of K+ in the nephron during times of normal/excess K+?

A
  1. Plasma [K+]
  2. Aldosterone
  3. ADH
  4. Acid-Base Balance
  5. Tubular fluid flow rate
29
Q

Hyperkalemia will cause an increase in the release of what hormone?

A

Aldosterone

30
Q

Using the mnemonic GRAPHIC IDEA what are the causes of Hypokalemia?

A
  • GI losses (vomitting, diarrhea) Insufficient intake
  • Renal tubular acidosis (type I and II) Diuretics
  • Aldosterone Elevated β-adrenergic activity
  • Paralysis (periodic) Alkalosis
  • Hypothermia
  • Insulin excess
  • Cushing’s Syndrome
31
Q

The most prominent signs/sx’s of hypokalemia will be in what system?

A

Neuromuscular

  • Skeletal m. weakness

- Smooth m. weakness –> GI hypomobility causing ileus and constipation

32
Q

What are three CV system signs/sx’s associated w/ hypokalemia?

A
  1. Ventricular arrhythmias
  2. HYPOtension
  3. Cardiac arrest
33
Q

Hypokalemia will lead to what renal manifestations?

A

Impaired concentrating ability causes polyuria and nocturia

34
Q

Effect of hypokalemia on blood glucose levels?

A

Hyperglycemia

35
Q

What are the 3 main goals for treatment of Hypokalemia?

A
  1. Prevent life-threatening conditions
  2. Replace K+ deficit —> K+ replacement is mainstay
  3. Diagnose/correct underlying cause –> i.e., K+ losing diuretics
36
Q

Preventing life-threatening conditions associated w/ hypokalemia is especially urgent if rapid K+ falls to what level?

A

< 2.5 mEq/L

37
Q

Using the mnemonic RED FETS what are the causes of Hyperkalemia?

A
  • Renal disease: ARF, CKD, type IV RTA
  • Excessive intake: food, K+ IV fluids, blood transfusion
  • Drugs: K+ sparing diuretics, K+ salts of penicillin
  • Factitious: prolonged use of tourniquet, hemolysis
  • Endocrine: Addison’s disease
  • Tissue release: rhabdomyolysis, burns, hemolysis, cytotoxic therapy
  • Shift out of cell: acidosis, β-antagonists, insulin deficiency, tissue damage
38
Q

Which system will have the predominant and most important signs/sx’s of Hyperkalemia, what are they?

A
  • Cardiac
  • Abnormal heart rhythm, bradycardia
  • Peaked T wave
39
Q

What are 3 neuromuscular signs/sx’s of hyperkalemia?

A
  1. Numbness
  2. Weakness
  3. Flaccid paralysis
40
Q

Emergency management of Hyperkalemia is divided into 3 categories, how are cardiac effects managed first?

A

Antagonize cardiac effects —> give IV calcium

41
Q

In the treatment of Hyperkalemia what can be given to redistribute K+ intol cells?

A
  • Give insulin + glucose (most reliable) or
  • β2-agonist such as albuterol
42
Q

In the management of hyperkalemia what can be given to facilitate K+ elimination?

A
  • K+ losing diuretic
  • Consider mineralocorticoid (pts w/ hypoaldosteronism)
  • Cation exchange resin
  • Dialysis
43
Q

After effectively managing an emergency situation of hyperkalemia, what should be done?

A

Monitor intake (≤ 60 mEq/day), paying attention to hidden sources such as Abx

Renal II Quizam 1 (7 decks)

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