Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Genitourinary > Renal Considerations of Fluids and Electrolytes > Flashcards

Renal Considerations of Fluids and Electrolytes Flashcards

1
Q

What is Hypokalemia

A

a serum potassium concentration of less than 3.5 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

At what point is hypokalemia considered severe

A

a mEq/L of less than 2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What typically causes deficits in potassium

A

poor dietary intake

excessive loss of body fluid (typically these losses are from the GI or renal systems)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Often renal loss or potassium occurs from

A

diuretic treatment

or renal tubular / interstitial disease hyperaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clinical features of Hypokalemia

A

mild- can be asymptomatic

Cardiovascular manifestations are the most important- hypotension, palpation and or ventricular arrhythmias, Cardiac arrest

Neuromuscular manifestations include: Generalized malaise, Skeletal muscle weakness / cramps, Smooth muscle problems with constipation and ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Muscle cell breakdown known as ___________ is possible with decreased intracellular potassium levels

A

Rhabdomyolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

when critically low potassium (severe less than 2.5) you might see

A

Flaccid paralysis

Hypercapnia

severe rhabdomyolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnostic Findings of Hypokalemia

A

Serum potassium levels less than 3.5

EKG findings- flattened or inverted T waves, Prominent U waves, ST depression, Premature Ventricular Contractions.

Urine potassium less than 20 mEq/L suggests GI losses, while greater than 40 suggests Diuretic use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to treat emergency situation of hypokalemia

A

IV potassium chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to manage non-emergent situations of hypokalemia

A

oral Potassium therapy usually Potassium Chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Important factor in treating hypokalemia

A

Ensuring to treat the underlying cause of the hypokalemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What level of total body potassium constitutes Hyperkalemia

A

greater than 5.0 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hyperkalemia is most commonly associated with

A
  • Renal Failure
  • ACEi therapy (38% of hospital admissions)
  • Potassium-sparing diuretic use (spironolactone)
  • Hyporenimeic hypoaldosteronism
  • Cellular death
  • Metabolic Acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical Features of Hyperkalemia

A

mild can be asymptomatic
- Severe- arrhythmias and death
- S/S are that are relatively common:
Numbness / tingling in extremities, muscle weakness, flaccid paralysis, Depressed or absent Deep Tendon Reflexes, Palpations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diagnostic findings of Hyperkalemia

A

serum pot. > 5.0 mEq/L

  • if secondary to renal dysfunction; BUN and Creatinine will be elevated
  • ABG’s may reveal metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

EKG findings of Hyperkalemia

A

include: Peaked T waves , Prolonged PR segment, Loss of P wave, Prolonged ORS complex, ST-segment elevation, Ectopic beats and escape rhythms, Progressive widening of QRS complex, Sine wave, Ventricular fibrillation, Asystole, Axis deviations, Bundle branch blocks, Fascicular blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of Hyperkalemia

A

aggressiveness depends on pot. level and evidence of cardiac toxicity

Life-threatening hyperkalemia should be treated immediately and look for cause.

Severe- Give IV Calcium Gluconate to stabilize cardiac membranes

Administer nebulized Albuterol (beta agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of Hyperkalemia

A

if severe… also add IV sodium Bicarbonate to lower potassium level. This draws Hydroen out of the cells

IV Glucose (dextrose 50 ) with IV insulin are also utilized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Other treatment options for hyperkalemia

A

Diuretics that are not potassium sparing

Kayexalate - acts on GI to excrete Potassium

Dialysis - tx option if no other treatment works or if there are other contraindications to other treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

True or False- Sodium concentration is not actually demonstrating sodium serum levels

A

True- it is important to understand that it is actually reflecting disturbance in water homeostasis

Think of it as ore a representation of the total body amount of sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Medical term for low sodium levels

A

Hyponatremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What sodium serum conc. defines hyponatremia

A

less than 135 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

S/S might not occur in hyponatremia until what mEq/L level

A

125

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Many elderly pt’s are in a chronic form of mild hyponatremia (131-134 ish) especially when on BP meds. This is ok as long as it is stable and documented as such

A

True Statement

25
Q

What is the most common electrolyte disturbance seen in the hospital and is typically due to the fluids introduced Intravenously

A

Hyponatremia

26
Q

Pathophysiology for hyponatremia

A

too much water on board.

27
Q

DDx of hyponatremia should include:

A 
Hypertonic fluid shift
SIADH
Acute renal failure
Chronic Kidney Disease
Cerebral salt wasting 
Diuretic therapy
28
Q

S/S of hyponatremia

A
  • Nausea with or without emesis
  • malaise and or HA
  • Decreased level of consciousness
  • seizures
  • coma
29
Q

Diagnostic findings of hyponatremia

A

serum sodium concentration less than 135 mEq/L

Now find a cause.. to do this utilize serum osmolality
check urine osmolality
check urine sodium conc.

30
Q

what is the purpose of serum osmolality in the diagnosis of hyponatremia

A

helps to differentiate between isotonic, hypertonic, and hypotonic hyponatremia

If between 280-295 (isotonic)
if greater than 295 (hypertonic)
if less than 280 (hypotonic)

31
Q

Urine osmolality utilized for hyponatremia

A

if greater than 100 mOsm/kg then suggests that the kidneys are lakcing ability to dilute urine (not diuresing)

32
Q

How is urine sodium concentration utilized in hyponatremia examination

A

depending on the cause, urine sodium will either be increased or decreased

if decreased- think CHF or Cirrhosis

if increased- consider renal failure and diuretics

33
Q

Management of Hyponatremia

A

complex- depends on volume status, as well as severity and cause of hyponatremia

if hypervolemic hyponat. such as CHF or Cirrhosis then - the underlying cause should be the focus of treatment, fluid restrictions salt restriction loop diuretics

34
Q

If SIADH is cause of hyponatremia (one of the most common) what is the management

A

First line treatment- free water restriction

second line treatment- PO sodium tablets

35
Q

what should be used for pts that are hyponatremic and hypovolemic

A

extracellular volume should be replaced with isotonic fluid (0.9% NaCl)

36
Q

for severe symptomatic hyponatremia (neurologic symptoms) first line treatment should be prompt IV of?

A

Hypertonic Saline (3% NaCl)

This can be dangerous and needs to be done in ICU…

37
Q

Repercussions of correcting hyponatremia too quickly

more than 4-8 mmol/L per day

A

can cause Osmotic Demyelination Syndrome

historically called Central Pontine Myelinolysis

38
Q

Key to successful treatment of hyponatremia

A

treating the underlying cause

39
Q

Pt should be sent to ICU for treatment of Hyponatremia if sodium conc. is less than what

A

125 mEq/L

40
Q

Hypernatremia is a common problem of

A

Sodium conc. exceeding 145 mEq/L

41
Q

what is the general causes of hypernatremia

A

impaired thirst and/or restricted access to water.

42
Q

common causes of hypernatremia

A

diarrhea, diuretic therapy, hyperglycemia, or DI

43
Q

pathophysiology of hypernatremia

A

extracellular fluid is hyperosmolar

tis leads to neuronal cell shrinkage as water content is pulled out of cytoplasim

This leads to temporary or permanent brain injury

44
Q

Mortality rates of ____ - ____ are seen in ICU pt’s with serum sodium over 150 mmol/L

A

30-48%

45
Q

Risk factors for hypernatremia

A
  • Advanced age
  • mental or physical impairment
  • Uncontrolled diabetes
  • Diuretic therapy
  • Hospitalization
  • Nursing home resident with inadequate nursing care
46
Q

Clinical features of hypernatremia

A
  • Decreased level of consciousness
  • Restlessness/Irritability
  • Convulsions/Coma
  • Dry mouth and dry mucous membranes
  • lack of tears and decreased saliva production
  • Tachycardia / hypotension
  • Oliguria or anuria
  • Hyperventilation
47
Q

Diagnostic findings of hypernatremia

A

serum greater than 145 mEq/L

serum osmolality greater than 290 mOsm/kg

urine sodium concentration may be elevated or decreased dependent on the cause

low urine sodium suggests DI

48
Q

Management of Hypernatremia

A

treat the underlying condition

49
Q

True or False- Hyovolemia should be treated last (with normal saline in a pt suffering from hypernatremia

A

False- this should be treated first

50
Q

when replacing volume in pts with hypernatremia it is very important to remember and consider

A

Rapid water replacement can cause cerebral edema

51
Q

what is Hypervolemia

A

state of decreased blood plasma volume

52
Q

possible etiologies of Hypovolemia

A

loss of blood
loss of plasma
loss of body sodium and intravascular fluid

53
Q

Clinical features of hypovolemia

A 
extreme thirst
nausea
tachycardia
hypotensive
cyanosis / delayed CR
Dizziness
54
Q

Hypovolemic shock treatment

A

Emergency oxygen to increase efficiency of remaining blood supply

Administration of IV fluids (volume)

inotrope therapy- dopamine, noradrenaline

Fresh froxen plasma or whole blood

55
Q

Define hypervolemia

A

too much fluid in the blood

increase in total sodium content which leads to increase in extracellular water.

56
Q

Etiologies of Hypervolemia

A

inability to regulate sodium
(CHF, renal failure, Liver faiure etc)

Exogenous sodium - IV solutions, medications such as mannitol

Fluid mobilization after Burn injury

57
Q

Clinical features of Hypervolemia

A 
Wt gain
edema of LE and possibly UE
Ascites
Pulmonary Edema 
Nocturnal dyspnea 
JVD
58
Q

Diagnostic Findings of Hypervolemia

A

O2 sats low
CXR showing pulm. cong.
CBC levels -falsely low
CMP- sodium BUN, potassium low , urine osmolality low

59
Q

Treatment of Hypervolemia

A

Treat the underlying cause

  • Sodium / H20 restrictions
  • Diuretics- loop recommended
  • NTG and morphine to vasodilate and reduce pulm cong.
  • Hydralazine/Captopril- reduce afterload
  • O2 suplementation
  • Hemodialysis

Genitourinary (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions