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Renal-Genitourinary > Na-K Electrolyte Disorders > Flashcards

Na-K Electrolyte Disorders Flashcards

1
Q

how to calculate total body water?

A

60% x person’s weight in kgs. (70kg)

0.6 x 70 = 42 liters = 42,000 ml

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2
Q

the spontaneous movement of fluid/water through a semi-permeable membrane from a low solute concentration into a high solute concentration to equalize the concentrations.

A

osmosis

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3
Q

movement of molecules of a substance through a semi-permeable membrane barrier from an area of higher concentration to an area of lower concentration

A

diffusion

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4
Q

the measure of dissolved solutes in a solution based on weight and mass (It measures the concentration of solute particles in a solutio)

A

osmolality

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5
Q

the measure of dissolved solutes in a solution per volume (considers the total volume of the solution)

A

osmolarity

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6
Q

measure of the osmotic pressure gradient (osmolality) of two solutions separated by a semipermeable membrane
(the ability of an extracellular solution to make water move into or out of a cell by osmosis)

A

tonicity

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7
Q

ICF and ECF with the same concentration

A

isotonic

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8
Q

ECF is less concentrated than cells

A

hypotonic

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9
Q

ECF is more concentrated than cells

A

hypertonic

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10
Q

what is the most common electrolyte abnormality in hospitalized patients?

A

hyponatremia

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11
Q

what usually causes hyponatremia?

A

water imbalance

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12
Q

what are the acute signs and symptoms of hyponatremia? (3)

A

altered mental status
seizures
coma/death

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13
Q

what are the chronic signs and symptoms of hyponatremia?

A

usually asymptomatic bc brain protects itself

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14
Q

what is the hyponatremia algorithm of assessment? (4)

A

sodium level
serum osmolality
if hypotonic, evaluate fluid status
check urine osmolality

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15
Q

what does a urine osmolality less than 20 indicate? (2)

A

dilute
non-renal

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16
Q

what does a urine osmolality over 20 indicate? (2)

A

concentrated
renal

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17
Q

known as pseudohyponatremia or false hyponatremia due to extra “stuff” affecting the instrument’s reading of sodium levels, like proteins and cholesterol

A

isotonic hyponatremia

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18
Q

what is the treatment for isotonic hyponatremia?

A

treat underlying problem

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19
Q

occurs when extra molecules results in an increase in tonicity, drawing water from the cells into the plasma and this increased fluid in the plasma dilutes the sodium level

A

hypertonic hyponatremia

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20
Q

what is the most common cause of hypertonic hyponatremia?

A

DKA

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21
Q

what is the treatment for hypertonic hyponatremia?

A

get rid of extra components

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22
Q

what are the 3 types of hypotonic hyponatremia?

A

hypovolemic
euvolemic
hypervolemic

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23
Q

occurs when an initial loss of water and salt is replaced by retaining water only, which lowers the Na levels

A

hypovolemic hypotonic hyponatremia

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24
Q

a patient presents with severe vomiting, diarrhea, hemorrhage, and dehydration. The urine osmolality is normal. what is the etiology?

A

non-renal

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25
Q

a patient presents with aldosterone deficiency, diuretics, ACEI/ARBs, nephropathies, and cerebral sodium-wasting syndrome. The urine osmolality is very high. what is the etiology?

A

renal

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26
Q

a patient presents with dehydration, orthostatic hypotension, decreased skin turgor, dry mucous membranes, headache, lethargy, N/V, and muscle cramps. They also have AMS and seizures. Dx?

A

hypovolemic hypotonic hyponatremia

27
Q

what is the management for acute (<48 hrs) hypovolemia hypotonic hyponatremia? (4)

A

bolus NaCl
check labs q 1-2 hrs
restrict free water
+/- desmopressin

28
Q

what can occur if hypovolemia hypotonic hyponatremia is overcorrected?

A

osmotic demyelination syndrome (ODS)

29
Q

what is the management for chronic (>48 hrs) hypovolemia hypotonic hyponatremia? (3)

A

restrict free water
+/- loop diuretics, oral urea, or vaptan

30
Q

occurs due to a large increase in third spacing and lesser increase in total body Na and the low plasma volume activates ADH and RAAS which retains water = hyponatremia

A

hypervolemic hypotonic hyponatremia

31
Q

a patient presents with CNS symptoms and is retaining fluid. Dx? Treatment?

A

hypervolemic hypotonic hyponatremia

restrict free water
+/- loop diuretics or dialysis

32
Q

occurs due to kidneys excreting more urine and the volume loss activates ADH which retains water = no fluid shifting or edema so plasma Na concentration decreases

A

euvolemic hypotonic hyponatremia

33
Q

what does dilute urine with osmolarity < 100 indicate in euvolemic hypotonic hyponatremia?

A

no/low ADH released

34
Q

what does concentrated urine with osmolarity > 100 indicate in euvolemic hypotonic hyponatremia?

A

ADH is present (SIADH)

35
Q

Treatment for euvolemic hypotonic hyponatremia? (4)

A

restrict free water
high salt and protein diet
demeclocycline
vasopressor (vaptan) in severe cases

36
Q

what is the primary defense against hypernatremia?

A

thirst mechanism

37
Q

patient presents with orthostatic hypotension, oliguria, lethargy, irritability, and weakness. Dx?

A

hypernatremia

38
Q

occurs due to initial loss of water and sodium at the same time, then water is lost more than sodium, leading to hypernatremia

A

hypovolemic hypernatremia

39
Q

what causes non-renal hypovolemic hypernatremia?

A

elderly / nursing home with less access to water

40
Q

what causes renal hypovolemic hypernatremia?

A

osmotic diuresis (mannitol)

41
Q

what is the etiology of hypovolemic hypernatremia if Una is normal?

A

non-renal

42
Q

what is the etiology of hypovolemic hypernatremia if Una is elevated?

A

renal

43
Q

treatment for hypovolemic hypernatremia?

A

normal saline +/- free water

44
Q

occurs due to retaining more sodium than water

A

hypervolemic hypernatremia

45
Q

treatment for hypervolemic hypernatremia? (2)

A

diuretics
free water

46
Q

occurs due to loss of free water only, can be caused by central/nephrogenic diabetes insipidus, fever, hypodipsia, sickle cell, or hyperventilation.

A

euvolemic hypernatremia

47
Q

treatment for euvolemic hypernatremia?

A

free water

48
Q

when correcting chronic hypernatremia, what should we limit the correction to?

A

12 in 24 hours

49
Q

what is the most common cause of hyperkalemia?

A

renal disease

50
Q

patient presents with lethargy, weakness, palpitations, SOB, and hyperventilation. Dx?

A

hyperkalemia

51
Q

what diagnostic and results indicate hyperkalemia?

A

EKG

peaked T waves

52
Q

what is the management for acute hyperkalemia that is < 6.4 without EKG changes? (3)

A

treat cause
stop meds
assess diet

53
Q

what is the management for acute hyperkalemia that is > 6.4 or with EKG changes? (5)

A

IV calcium gluconate (heart)
insulin/glucose or salbuterol (K back into cells)
loop diuretics
sodium bicarb for acidosis
hemodialysis for renal

54
Q

what is the treatment for life-threatening K when dialysis is not available? what is the risk without treatment?

A

sodium polystyrene (kayexalate)

colonic necrosis

55
Q

what is the treatment for chronic hyperkalemia? (6)

A

diuretics
fludrocortisone (aldosterone)
patiromer / sodium zirconium
bicarb (acidosis)
ACEI / ARB (heart)
sodium polystyrene

56
Q

potassium is the major ________ electrolyte

A

intracellular

57
Q

intracellularly, K balance is maintained by the _______ ____

A

Na/K pump

58
Q

extracellularly, K balance is maintained with _______ ____ ____

A

dietary K intake

59
Q

what is the most common cause of hypokalemia in developing countries?

A

diarrhea

60
Q

patient presents with constipation, weakness, muscle cramps, tetany, depression/fatigue, arrythmias, hallucinations, and delirium. Dx?

A

hypokalemia

61
Q

what diagnostic and results indicate hypokalemia?

A

EKG

T wave flattening

62
Q

treatment for mild-moderate hypokalemia? (3)

A

oral potassium
recheck in 1-2 weeks
+/- K sparing diuretic

63
Q

treatment for severe hypokalemia (<2.5)? (3)

A

IV potassium in 100mL normal saline
cardiac monitoring
+/- K sparing diuretic

64
Q

what should we do if a patient is not responding to treatment for hypokalemia?

A

check magnesium deficiency

Renal-Genitourinary (7 decks)

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