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Common Problems In acute Care > Nutritional support and Fluid& electrolyte imbalance > Flashcards

Nutritional support and Fluid& electrolyte imbalance Flashcards

1
Q

Nutrition labs

A

albumin levels of < 3.35 indicate protein malnutrition: edema can be expected if albumin level is < 2.7

hgb < 12 for women and < 13 for men can indicate lack of iron or protein resulting in inadequate oxygen profusion

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2
Q

earliest indication of malnutrition

A

prealbumin

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3
Q

when do you transfuse?

A

8 and 24

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4
Q

when a person gets 2 units how does it affect hgb and htc

A

1:3 is the ration of hgb to htc

1 unit of pRBC: hgb goe sup 1 then hematocrit goes up 3

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5
Q

IF cannot use the GI tract

diverticulitis, perf diverticula etc

A

Parenteral Nutrition

support greater than 2 weeks or using dextrose solution > 10% then need central vein

otherwise can use peripheral

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6
Q

IF can use GI tract and need support greater than 6 weeks (brain injury, closed head injury)

A

Enterostomal tube (PEG tube)

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7
Q

If cannot use GI tract and need support less than 6 weeks then use:

A

nasoenteric tube (ND- duotube)

risk for aspiration: duodenal tube
not risk for aspiration: NG tube

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8
Q

Complications of enteral nutrtional support

enteral is the solution

A 
Aspiration
diarrhea
emesis
gi bleeding
mechanical obstruction of tube
hypernatremia**
dehydration**
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9
Q

complications of parenteral nutritional support

parenteral is mode of delivery

A 
pneumothorax
hemothorax
arterial laceration
air emboli
catheter thrombosis
catheter sepsis
hyperglycemia**
HHNK**
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10
Q

evaluation of hyponatremia

A
  • urine Na (10-20)
  • serum osmolality (usually 2x Na)
  • clinical status
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11
Q

what does measuring urine Na help distinguish?

A

renal from non-renal causes.

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12
Q

what does a urine Na > 20 suggest?

A

renal salt waisting (problem with the kidneys)

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13
Q

what does a urine Na < 10 suggest?

A

renal retention of Na to compensate for extrarenal fluid loss (problem other than the kidneys)

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14
Q

Isotonic hyponatremia

A
  • occurs with extreme hyperlipidemia or hyperproteinemia
  • body water is normal and the patients are asymptomatic
  • tx: cut down fat (no fluid restriction***)

pseudeohyponatremia: serum osmo 284-292

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15
Q

what does isotonic mean

A
  • of equal tension
  • having the same tonicity as another solution
  • a solution that causes no change in cell volume (don’t swell or shrink)
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16
Q

hypotonic

A

a fluid in which cells would swell

  • having a lesser osmotic pressure than a reference solution
  • low tonicity
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17
Q

hypotonic Hyponatremia

A

-serum osmo < 280: state of body water excess diluting all body fluids; clinical signs rise from water excess

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18
Q

what do you need to do in a patient with hypotonic hyponatremia?

A

need to assess if the patients is hypovolemic or hypervolemic
-if hypovolemic, assess whether hyponatremia is due to extrarenal salt losses or renal salt wasting

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19
Q

how does someone end up hypovolemic with urine Na < 10

A
  • dehydration
  • diarrhea
  • vomiting (NG tube suctioning-prolonged)
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20
Q

what are causes of hypovolmia with urine Na > 20

A
  • low volume and kidneys cannot conserve Na
  • diuretics**
  • ace inhibitors
  • mineralcorticoid deficiency (adrenal insuficiency)
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21
Q

What are causes of hypervolemic, hypotonic hyponatremia

A

-edematous states
chf
liver dz
advanced renal failure

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22
Q

what do you do with Hypervolemic, hypotonic (serum osmo < 280) hyponatremia

A

restrict water

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23
Q

Hypertonic solution examples

A 
D10
saline 3%-5% NS or NaCl
D5
D5 0.9%
D5 0.45%
5% dextrose in lactated Ringer's
24
Q

Isotonic solutions

A

D5W
0.9%NS
D5 1/4 NS
Lactated Ringer’s

25
Q

Hypotonic solutions

A
  1. 45% NS

0. 33% NS

26
Q

how do hypertonic solutions work

A
27
Q

How do isotonic solutions work

A

used to replace fluid losses, usually extracellular lossses and to expand the intravascular volume. Most isotonic solutions do not provide calories or free water
0.9% NS and lactated ringers

28
Q

how do hypotonic solutions work

A

administered to expand intracellular space

  • commonly used to infused to dilute extracellular fluid and rehydrate cells of pts who have hypertonic fluid imbalances and to tx gastric fluid loss and dehydration from excessive diuresis.
  • provides free water, Na, Cl
    0. 45% NS or 1/2 NS
29
Q

when are hypertonic solutions used?

A

tx pts who have severe hyponatremia

30
Q

Hypertonic hyponatremia

A

(serum osmo > 290)

  • hyperglycemia: usually fron HHNK***
  • Osmolality is high and the Na is low
31
Q

Management of hyponatremia

A

tx based on cause

  • if hypovolemic give NS IV
  • if urine Na > 20, treat cause
  • if hypervolemic implement water restriction
  • if symptomatic give NS with a loop diuretic
  • if CNS symptoms consider 3% NS with loop diuretics
32
Q

Hypernatremia

A

usually d/t excess water loss; always indicates hyperosmolality (ie., deficit of water)

33
Q

Management of Hypernatremia

with hypovolemia

A

-severe hypermatremia with hypovolemia should be treated with NS followed by 1/2 NS

34
Q

Management of hypernatremia with euvolemia

A

free water (D5W-isotonic)

35
Q

Management of hypernatremia with hypervolemia

A
  • free water and loop diuretics

- may need dialysis

36
Q

Hypokalemia causes

A 
-diuretics***
GI loss
excess renal loss
alkalosis
laxative abuse
trauma (via epi)
insulin excess
hyperaldosteronism
Cushing's
renin-producing tumor
37
Q

S&S Hypokalmeia

A
  • muscular weakness, fatigue and -muscle cramps***
  • constipation or ileus due to smooth muscle involvement
  • if severe (< 2.5) flaccid paralysis, tetany, hyporeflexia and rhabdo
38
Q

Labs and diagnostics hypokalemia

A
  • decreased amplitude on ecg
  • broad T waves
  • prominent U waves
  • PVCs, V-tach, V-fib
39
Q

management of hypokalemia

A

oral replacement if > 2.5 and no ecg abnormalities

  • IV replacement at 10 if cannot take PO
  • if < 2.5 or severe S/S may give 40 meq/hr IV- check 3 hours and institute continuous ecg monitoring
40
Q

Hyperkalemia

A

-excess intake
-renal failure
-drugs (NSAIDS)
hypoaldosteronism
-shifts of intracellular K to extracellular space occur with acidosis. K increases 0.7 meq/L with each 0.1 drop in pH

41
Q

Hyperkalemia S/S

A
  • weakness, flaccid paralysis
  • abd distention
  • diarrhea
42
Q

Hyperkalemia mngt

A 
exchange resins (kayexelate)
- if> 6.5 or cardiac toxicity or muscle paralysis consider: insulin 10 u with 1 amp D50
43
Q

Calcium

A

a major cellular ion and impt as a mediator of neuromuscular and cardiac function.

normal total calcium of 2.2-2.6mmol/L (8.5-10.5 mg/dl)
normal ionized calcium of 1.1-1.4 mmol/L

44
Q

what is calcium maintained by?

A

Vitamin D, parathyroid hormone and calcitonin

45
Q

what increases and decreases ionized calcium

A

acidemia increases

alkalemia decreases

46
Q

what is the role of albumin in calcium levels?

A

-50% of calcium is bound to albumin, a normal caclium level in presence of low albumin suggests that the patient is hypercalcemic

47
Q

how to calculate corrected calcium?

A

corrected calcium = measured total Ca _ 0.8 or 4- serum albumin where 4 represents the average albumin level

48
Q

Causes of hypocalcemia

A 
hypothyroid
hypomagnesemia
pancreatitis
renal failure
severe trauma
multiple blood transfusions
49
Q

S/S of hypocalcemia

A 
increased DTRs
muscle/abd cramps
trousseau's sign
convulsions
chvostek's sign
prolonged QT
50
Q

Management of hypocalcemia

A
  • check blood pH (alkalosis)
  • if acute, IV calcium gluconate
    chronic: oral supplements, vit d, aluminum hydroxide
51
Q

hypercalcemia causes

A
  • hyperparathyroidism
  • hyperthyroid
  • vit d toxicity
  • prolonged immobilization**
  • thiazide diuretics**
52
Q

S/S hyperkalemia

A
  • fatigue
  • muscle weakness
  • depression
  • anorexia
  • N/V
  • constipation
  • severe hypercalcemia can cause coma and death
  • serum ca > 12 considered emergency
53
Q

Management of hypercalcemia

A
  • may need calcitonin if impaired cardiovascular or renal function
  • dialysis
  • if > 12 begin NS infusion with loop diuretics
54
Q

Hypocalcemia

A

S/S high

55
Q

Hypercalcemia

A

S/S low

Common Problems In acute Care (4 decks)

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