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Clinical Medicine 3 > Lytes > Flashcards

Lytes Flashcards

1
Q

Concentration of solutes/lyes per L solution/water is called what?

A

Osmolality

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2
Q

Normal Osmolality range?

A

285-295

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3
Q

Elevated Osmolality means what for volume and lyte concentration?

A

Volume depletion and increase of lyte concentration

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4
Q

Decreased Osmolality means what for volume and lyte concentration?

A

Volume overload and dilution of lytes

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5
Q

Which hormone regulated H2O?

A

ADH

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6
Q

EtOH intake does what to ADH?

A

Decreases ADH and increases urination

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7
Q

If blood volume decreases what happens to ADH? Where regulated?

A

Increased ADH levels to pretent peeing, regulated at kidneys

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8
Q

Third Spacing is a large volume moving from where to where?

A

From intravasular space to interstitial space

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9
Q

Which IV soluton does not cross cell membrane because it’s too big? Where does it stay?

A

Colloids. Stays intravascular.

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10
Q

How do Colloids expand intravascular volume?

A

By increasting oncotic pressure and bring fluid from extravascular space

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11
Q

Which IV solution crosses into the cells? What does it use to do this?

A

Crystalloids, via small molecules.

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12
Q

What do Crystalloids do to intravascular and interstitial fuid volumes?

A

Increases both

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13
Q

What are the three types of Crystalloids?

A

Isotonic, Hypotonic, Hypertonic

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14
Q

Isotonic solute concentrate compared to blood? Does what to cells?

A

Same concentrate as blood. Cells stays the same.

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15
Q

Hypertonic solute concentrate compared to blood? Does what to cells?

A

Higher solute concentration as blood. Pulls solution/water from cell and shrinks.

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16
Q

Hypotonic solute concentrate compared to blood? Does what to cells?

A

Lower solute concentrate than blood. Moves into cell and swells cell by bringing water into it.

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17
Q

NaCl 0.9%, Lactated Ringers, and Ringer’s Solution are type tonicity?

A

Isotonic

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18
Q

When is Normal Saline given?

A

Mild hyponatremia, metabolic acidosis, low extracellular volume.

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19
Q

Which isotonic solution most closely mimics blood and plasma concentration?

A

Lactated Ringers

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20
Q

Who gets Lactated Ringers?

A

PT who needs lyte replacement

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21
Q

Can give Lactated Ringers with Lactic Acidosis?

A

NO! The bicarb is converted into lactic acid!

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22
Q

What pH can’t give Lactated Ringers?

A

Above 7.5

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23
Q

Lactated Ringers and liver dz?

A

Don’t give LR! Can’t metabolize lactate!

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24
Q

What does Ringer’s Solution not have which LR does?

A

No lactate!

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25
Q

Ringer’s Solution safe in lactic acidosis?

A

Yes

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26
Q

Dextrose 5% isotonic or hypotonic?

A

Starts isotonic but becomes hypotonic when metabolized

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27
Q

What does D5W do to blood products?

A

Hemolyzes them. Don’t give together.

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28
Q

Hypotonic solutions given to treat dehydration located where?

A

Intracellular dehydration

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29
Q

Tx for Hyperosmolar Hyperglycemia and DKA?

A

Dextrose

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30
Q

Hypertonic solutions do what do volume?

A

Volume expander

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31
Q

Hypertonic solutions safe?

A

Major complications! Don’t even store them in the same cabinet as other isotonic or hypotonics!

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32
Q

Which electrolyte is the main factor in determining extracellular space?

A

Sodium

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33
Q

Which electrolyte is involved with nerve impulse transmission and muscle fibers?

A

Sodium

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34
Q

When do Sx of hyponatremia occur?

A

<125 or 110 if it comes on slowly

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35
Q

What is Hypo-Osmolality with Hypervolemia?

A

Too much water and diluted sodium

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36
Q

What can elevated serum sugar cause cells to do?

A

Cells release water into intravascular space which dilutes Na+ and overloads body with water

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37
Q

What is elevated in SIADH?

A

ADH

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38
Q

What does too much ADH cause?

A

Not enough peeing and volume overload! Hypo-osmolality Hypervolemia.

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39
Q

Tx for hyponatremia with fluid overload if ASx or only mild Sx?

A

Fluid restriction

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40
Q

Tx for hyponatremia with fluid overload if severe Sx?

A

Fluid restriction + SLOW Na+ replacement to 135 checked q4h, +/- diuresis

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41
Q

Replacing Sodium too fast can cause what?

A

Central Pontine Myelinolysis

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42
Q

What is the most common cause of Hypernatremia

A

Volume depletion/hypovolemia

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43
Q

What does Diabetis Insipidus do to urination passage and sodium levels?

A

Pass large volume of dilute urine resulting in hypovolemic hypernatremia

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44
Q

Which hormone is lacking in DI?

A

ADH

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45
Q

If brain is fine what else can cause passage of large volume of dilute urine?

A

Increased renal resistance to ADH

46
Q

Primary Hyperaldosteronism usually caused by what?

A

Benign tumor

47
Q

Primary Hyperaldosteronism does what to Na+, H2O, and K+?

A

Retains Na+ and H2O, excretes K+

48
Q

Too aggressive administration of 0.9% NaCl can cause what?

A

Hypovolemic Hypernatremia

49
Q

Which electrolyte is the main factor in determining extracellular space?

A

Sodium

50
Q

Which electrolyte is involved with nerve impulse transmission and muscle fibers?

A

Sodium

51
Q

When do Sx of hyponatremia occur?

A

<125 or 110 if it comes on slowly

52
Q

What is Hypo-Osmolality with Hypervolemia?

A

Too much water and diluted sodium

53
Q

What can elevated serum sugar cause cells to do?

A

Cells release water into intravascular space which dilutes Na+ and overloads body with water

54
Q

What is elevated in SIADH?

A

ADH

55
Q

What does too much ADH cause?

A

Not enough peeing and volume overload! Hypo-osmolality Hypervolemia.

56
Q

Tx for hyponatremia with fluid overload if ASx or only mild Sx?

A

Fluid restriction

57
Q

Tx for hyponatremia with fluid overload if severe Sx?

A

Fluid restriction + SLOW Na+ replacement to 135 checked q4h, +/- diuresis

58
Q

Replacing Sodium too fast can cause what?

A

Central Pontine Myelinolysis

59
Q

What is the most common cause of Hypernatremia

A

Volume depletion/hypovolemia

60
Q

What does Diabetis Insipidus do to urination passage and sodium levels?

A

Pass large volume of dilute urine resulting in hypovolemic hypernatremia

61
Q

If brain is fine what else can cause passage of large volume of dilute urine?

A

Increased renal resistance to ADH

62
Q

Primary Hyperaldosteronism usually caused by what?

A

Benign tumor

63
Q

Primary Hyperaldosteronism does what to Na+, H2O, and K+?

A

Retains Na+ and H2O, excretes K+

64
Q

Too aggressive administration of 0.9% NaCl can cause what?

A

Hypovolemic Hypernatremia

65
Q

How quick to correct Hypernatremia?

A

No more than 1mEq/L/hr or else cerebral edema, cerebral herniation, or seizure

66
Q

Tx for Hypernatremic-Hypovolemia?

A

IV Isotonic 0.9% NaCl and reduced salt intake

67
Q

Tx for Hypernatremic-Euvolemia?

A

IV hypotonic D5W

68
Q

Tx for Hypernatremic-Hypervolemia?

A

D5W, diuretics

69
Q

Which electrolyte is the main factor in determining extracellular space?

A

Sodium

70
Q

Which electrolyte is involved with nerve impulse transmission and muscle fibers?

A

Sodium

71
Q

When do Sx of hyponatremia occur?

A

<125 or 110 if it comes on slowly

72
Q

What is Hypo-Osmolality with Hypervolemia?

A

Too much water and diluted sodium

73
Q

What can elevated serum sugar cause cells to do?

A

Cells release water into intravascular space which dilutes Na+ and overloads body with water

74
Q

What is elevated in SIADH?

A

ADH

75
Q

What does too much ADH cause?

A

Not enough peeing and volume overload! Hypo-osmolality Hypervolemia.

76
Q

Tx for hyponatremia with fluid overload if ASx or only mild Sx?

A

Fluid restriction

77
Q

Tx for hyponatremia with fluid overload if severe Sx?

A

Fluid restriction + SLOW Na+ replacement to 135 checked q4h, +/- diuresis

78
Q

Replacing Sodium too fast can cause what?

A

Central Pontine Myelinolysis

79
Q

What is the most common cause of Hypernatremia

A

Volume depletion/hypovolemia

80
Q

What does Diabetis Insipidus do to urination passage and sodium levels?

A

Pass large volume of dilute urine resulting in hypovolemic hypernatremia

81
Q

Which hormone is lacking in DI?

A

ADH

82
Q

If brain is fine what else can cause passage of large volume of dilute urine?

A

Increased renal resistance to ADH

83
Q

Primary Hyperaldosteronism usually caused by what?

A

Benign tumor

84
Q

Primary Hyperaldosteronism does what to Na+, H2O, and K+?

A

Retains Na+ and H2O, excretes K+

85
Q

Too aggressive administration of 0.9% NaCl can cause what?

A

Hypovolemic Hypernatremia

89
Q

3 most common causes of dyskalemia?

A

Meds, renal dysfunction, dietary insufficiency

89
Q

Hypokalemia below what value?

A

<3.5

89
Q

What do meds due to K+ in extracellular space?

A

Shift them intracellularly (diuretics, insulin, Beta adrenergic agonists)

89
Q

EKG findings with hypokalemia? (Hint: 3)

A
  1. Flat T-waves
  2. S-T segment depression
  3. U-waves
89
Q

Tx for mild Hypokalemia? Severe?

A

Mild=PO KCl

Severe=IV, not more than 10mEq/hr

90
Q

What monitoring needed for IV potassium treatment?

A

Continuous telemetry

91
Q

If hypokalemic and also hypomagnesemic what to treat first?

A

First treat magnesium, then potassium

92
Q

Hyperkalemia when above what value?

A

> 5.0

93
Q

Hyperkalemia common with what disease?

A

Renal dz/insufficiency

94
Q

ACEi, ARB, and Spironolactone do what to K+?

A

Elevate it

95
Q

EKG findings on Hyperkalemia? (Hint: 3)

A
  1. Tall or peaked T-waves
  2. Wide/bizarre QRS
  3. Flat P-waves
96
Q

Tx of Hyperkalemia?

A

IV Calcium Gluconate or CaCl to protect heart!

IV Hypertonic glucose and insulin to push K+ into cells. PO Resins, Kayexelate, diuresis.

97
Q

Calcium important for what 3 functions?

A
  1. Blood coagulation
  2. nerve excitability
  3. action potentials for muscle contraction
98
Q

What form of calcium is the most physiologically significant?

A

Ionized calcoum

99
Q

Hypocalcemia at what value?

A

<8.5, Sx at <7.5

100
Q

What protein does calcium bind to?

A

Albumin

101
Q

Hypoalmbunemia can cause what?

A

Pseudohypocalcemia

102
Q

What is Chvostek Sign?

A

Facial spasm with percussion of facial nerve. Sign of Hypocalcemia.

103
Q

What is Trousseau Sign?

A

Spasm of hand with BP cuff inflated. Sign of Hypocalcemia.

104
Q

EKG finding in Hypocalcemia?

A

Prolonged QT interval

105
Q

Tx for ASx Hypocalcemia? Tx with Sx?

A

ASx=PO Calcium

Sx=IV calcium

106
Q

If Hypocalcemia and hypomagnesemic which to treat first?

A

Magnesium!

107
Q

Stones, bones, moans, and groans when?

A

Hypercalcemia

108
Q

Hypercalcemia at what range? Sx?

A

> 10.5, Sx >12

109
Q

Hypercalcemia tx?

A

Restrict Ca-containing food and meds. IV loop diuretics to extrete. Hemodialysis.

Clinical Medicine 3 (7 decks)

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