NCC content Flashcards
how is total body water related to fat content?
inversely
how does total body water change with increasing gestational age?
it decreases
- around 24 weeks = 90%
- around term = 80%
does intracellular fluid and extracellular fluid decrease or increase with increasing gestational age?
- extracellular decreases
- intracellular increases
where is adh stored and why is it released?
- stored in posterior pituitary
- released when plasma osmolarity increases
how does adh work?
- acts directly on distal tubules and cortical/medullary collecting ducts
- increases permeability to free water
why is the premature infant’s response to adh blunted?
probably d/t end-organ insensitivity
what happens in SIADH?
-excess ADH secretion
clinical findings with SIADH
-weight gain, hyponatremia, decreased urine output, increased urine osmolality, decreased plasma osmolality
SIADH treatment
free water restriction
NaCl replacement
lasix therapy
what happens in DI?
-ADH deficiency
etiology of DI
- insensitivity of renal tubule to ADH
- congenital defects
clinical findings with DI
- increased Na
- hypotonic urine
- serum hypertonicity
- increased Ca
- decreased K
DI treatment
- hydrate
- electrolyte replacement
- diuretic therapy (thiazides)
How should fluids be managed for HIE babies?
- only replace IWL; too much fluid can cause worsening cerebral edema; kidney function may be compromised
- fluid restrict 60 ml/kg/day
normal sodium requirements
initial phase: 0-1 mEq/kg/day
pre diuretic phase: 2-3 mEq/kg/day
post diuretic phase (maintenance): 3-5 mEq/kg/day
values for hyponatremia
treatment for hyponatremia for symptomatic babies
-3% hypertonic saline: 1-3 ml/kg over 15 minutes, followed by 1-2 ml/kg/hr until Na > 120
treatment for asymptomatic hyponatremia
treat underlying cause and replace deficit
lab value for hypernatremia
serum Na >150
-over 160 = permanent CNS damage
what typically cause hypernatremia?
insensible water loss
how quickly should we try to decrease sodium levels?
- slower than when we increase sodium levels
- target correction over 12-48 hrs period
- should decrease no more than 0.5 mEq/kg/hr
normal requirements for K
- initial phase: none
- prediuretic phase: 1-2 mEq/kg/day
- postdiuretic phase: 2-3 mEq/kg/day
lab value for hypokalemia
serum K
correction for hypokalemia
- 0.5 mEq/kg/dose over 30-60 min only for true-life threatening arrhythmias
- if symptomatic but no life threatening, correct over 12-24 hours
lab values for hyperkalemia
> 6 for central serum draw
what can potentiate hyperkalemia?
- acidosis
- low Ca
EKG changes with hyperkalemia
- peaked T waves
- v tach, v fib, asystole
CBIG2
- 10% calcium gluconate: 100 mg/kg/dose over 10-15 min
- NaBicarb: 1-2 mEq/kg/dose over 10-30 min
- Insulin/glucose: d10w 2-3 ml/kg IV push, 0.05-0.1 U/kg bolus, then continuous infusion
- Albuterol (beta 2 adrenergic): 0.1-0.5 mg/kg/dose
how does calcium treat hyperkalemia?
stabilizes the myocardium; lowers threshold potential and protects again arrhythmias
how does bicarb treat hyperkalemia?
shifts K back into cell
what can be given to actually decrease K levels in the body
- furosemide: only effective if renal function is normal
- kayexelate: exchanges K for Na or Ca
- dialysis/exchange transfusion
how to treat hyperkalemia without EKG changes
- remove all K from fluids
- keep Ca and Mg levels normal
- correct acidosis
- ensure adequate fluid intake
- consider lasix
Cl loves Na
if Na levels are low, Cl levels are usually low as well and vice versa
where does Cl live?
extracellular anion
lab value for hypochloremia
lab value for hyperchloremia
> 110
what is serum CO2?
measure of blood bicarbonate level
