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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
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?
renal
26
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?
hypovolemic hypotonic hyponatremia
27
what is the management for acute (<48 hrs) hypovolemia hypotonic hyponatremia? (4)
bolus NaCl check labs q 1-2 hrs restrict free water +/- desmopressin
28
what can occur if hypovolemia hypotonic hyponatremia is overcorrected?
osmotic demyelination syndrome (ODS)
29
what is the management for chronic (>48 hrs) hypovolemia hypotonic hyponatremia? (3)
restrict free water +/- loop diuretics, oral urea, or vaptan
30
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
hypervolemic hypotonic hyponatremia
31
a patient presents with CNS symptoms and is retaining fluid. Dx? Treatment?
hypervolemic hypotonic hyponatremia restrict free water +/- loop diuretics or dialysis
32
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
euvolemic hypotonic hyponatremia
33
what does dilute urine with osmolarity < 100 indicate in euvolemic hypotonic hyponatremia?
no/low ADH released
34
what does concentrated urine with osmolarity > 100 indicate in euvolemic hypotonic hyponatremia?
ADH is present (SIADH)
35
Treatment for euvolemic hypotonic hyponatremia? (4)
restrict free water high salt and protein diet demeclocycline vasopressor (vaptan) in severe cases
36
what is the primary defense against hypernatremia?
thirst mechanism
37
patient presents with orthostatic hypotension, oliguria, lethargy, irritability, and weakness. Dx?
hypernatremia
38
occurs due to initial loss of water and sodium at the same time, then water is lost more than sodium, leading to hypernatremia
hypovolemic hypernatremia
39
what causes non-renal hypovolemic hypernatremia?
elderly / nursing home with less access to water
40
what causes renal hypovolemic hypernatremia?
osmotic diuresis (mannitol)
41
what is the etiology of hypovolemic hypernatremia if Una is normal?
non-renal
42
what is the etiology of hypovolemic hypernatremia if Una is elevated?
renal
43
treatment for hypovolemic hypernatremia?
normal saline +/- free water
44
occurs due to retaining more sodium than water
hypervolemic hypernatremia
45
treatment for hypervolemic hypernatremia? (2)
diuretics free water
46
occurs due to loss of free water only, can be caused by central/nephrogenic diabetes insipidus, fever, hypodipsia, sickle cell, or hyperventilation.
euvolemic hypernatremia
47
treatment for euvolemic hypernatremia?
free water
48
when correcting chronic hypernatremia, what should we limit the correction to?
12 in 24 hours
49
what is the most common cause of hyperkalemia?
renal disease
50
patient presents with lethargy, weakness, palpitations, SOB, and hyperventilation. Dx?
hyperkalemia
51
what diagnostic and results indicate hyperkalemia?
EKG peaked T waves
52
what is the management for acute hyperkalemia that is < 6.4 without EKG changes? (3)
treat cause stop meds assess diet
53
what is the management for acute hyperkalemia that is > 6.4 or with EKG changes? (5)
IV calcium gluconate (heart) insulin/glucose or salbuterol (K back into cells) loop diuretics sodium bicarb for acidosis hemodialysis for renal
54
what is the treatment for life-threatening K when dialysis is not available? what is the risk without treatment?
sodium polystyrene (kayexalate) colonic necrosis
55
what is the treatment for chronic hyperkalemia? (6)
diuretics fludrocortisone (aldosterone) patiromer / sodium zirconium bicarb (acidosis) ACEI / ARB (heart) sodium polystyrene
56
potassium is the major ________ electrolyte
intracellular
57
intracellularly, K balance is maintained by the _______ ____
Na/K pump
58
extracellularly, K balance is maintained with _______ ____ ____
dietary K intake
59
what is the most common cause of hypokalemia in developing countries?
diarrhea
60
patient presents with constipation, weakness, muscle cramps, tetany, depression/fatigue, arrythmias, hallucinations, and delirium. Dx?
hypokalemia
61
what diagnostic and results indicate hypokalemia?
EKG T wave flattening
62
treatment for mild-moderate hypokalemia? (3)
oral potassium recheck in 1-2 weeks +/- K sparing diuretic
63
treatment for severe hypokalemia (<2.5)? (3)
IV potassium in 100mL normal saline cardiac monitoring +/- K sparing diuretic
64
what should we do if a patient is not responding to treatment for hypokalemia?
check magnesium deficiency

Renal-Genitourinary (7 decks)

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