Schoenwald - Electrolytes Flashcards by Alice Richards

electrolytes (4)

CO2

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main regulator of water and Na

kidney

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primary circulating (extracellular) cation

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fxn of Na

neuromuscular fxn

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serum levels of Na are a balance btw (2)

dietary intake

renal excretion

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major contributor to plasma osmolality

Na → indicator of free body water

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osmolality is useful in evaluating (2)

hyponatremia

ADH related illnesses

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osmolality decreases w. __

and increases w. __

overhydration

dehydration

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what hormone regulates body water and osmolality

adh

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adh is stimulated by (3)

increased osmolality

hypovolemia

thirst

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where does adh act

collecting tubule → increases permeability → increases water reabsorption → more concentrated urine

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serum osmolality is elevated in (5)

hypernatremia

hyperglycemia

ketosis

dehydration

diabetes insipidus

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serum osmolality is decreased in (2)

overhydration

SIADH

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common cause of SIADH

drugs

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SIADH leads to __ water absorption

and __ sodium levels

increased

decreased

lose Na in urine

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what syndrome is associated w. inadequate amt of adh

diabetes insipidus

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sx of diabetes insipidus

increased thirst

large volume of dilute urine

hypernatremia

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urine osmolality measures

dissolved particles in urine

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t/f: urine osmolality is more specific than specific gravity

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urine osmolality evaluates

ability of kidney to concentrate urine

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urine osmolality is increased in (2)

siadh

chf

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urine osmolality is decreased in (2)

diabetes insipidus

excess fluid intake

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2 types of hyponatremia

Na depletion

dilutional

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Na depletion hyponatremia is caused by

free water loss

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dilutional hyponatremia is caused by

water intake \> water output → renal failure

hyponatremia is usually asymptomatic until it drops to

\< 120 mEq/L

sx of hyponatremia (3)

lethargy nausea muscle cramps cerebral edema

causes of hypernatremia (3)

stroke → impaired thirst mechanism water loss w.o Na loss → burns/fever dehydration

urine sodium can be measured by (2)

spot testing 24 hr urine

urine sodium helps evaluate

renal vs nonrenal hyponatremia

increased urine Na can indicate (5)

dehydration diuretics adrenocortical insufficiency siadh ckd

decreased Na can indicate (2)

chf diarrhea

hyponatremia flow chart

classifications of volume status

hypovolemia euvolemia hypervolemia

hyponatremia w. normal osmolality is called

isotonic hyponatremia

isotonic hyponatremia is associated w.

hyperproteinuria hyperlipidemia

hyponatremia w. low osmolality is called

hypotonic hyponatremia

hyponatremia w. elevated osmolality is called

hypertonic hyponatremia

hypertonic hyponatremia is associated w. (2)

hyperglycemia radiocontrast agents

hypovolemic hyponatremia is associated w. (3)

dehydration diarrhea vomiting

euvolemic hyponatremia is associated w. (2)

siadh postop hyponatremia

hypervolemic hyponatremia is associated w. (3)

edema → chf advanced renal failure liver ds

primary intracellular cation

K+

fxn of K+

cardiac muscle fxn

is K+ reabsorbed from kidneys

no! ***it is excreted***

why does K+ need to be given IV to pt's who can not eat

it is not reabsorbed by kidneys

as __ is reabsorbed \_\_ is lost

Na reabsorbed → K+ is lost

sx of hypokalemia (3)

malaise skeletal m weakness arrythmias

ekg findings of hypokalemia

flattened or inverted t waves

causes of hypokalemia (6)

diet diuretics burns glucose administration licorice hyperaldosteronism

causes of hyperkalemia (6)

renal failure acidosis diet ACEI acute or chronic renal failure hemolysis

in metabolic acidosis, K+ is driven

out of the cell

sx of hyperkalemia (4)

arrythmias cardiac arrest numbness/tingling weakness

ekg findings of hyperkalemia

peaked t waves

most abundant extracellular anion

chloride

chloride is regulated by \_\_ and exchanged for \_\_

proximal tubules bicarb ions

Cl is indirectly regulated by (2)

Na water

is Cl test alone helpful

no!

causes of increased Cl (2)

dehydration metabolic acidosis

causes of decreased chloride (3)

overhydration siadh vomiting

what do lytes help us determine (2)

acute vs chronic renal failure fluid therapies

mc cause of acute renal failure

nephrotoxins → **meds**

t/f arf is usually reversible

sx of arf (3)

n/v ams edema

prerenal causes of arf (4)

hypovolemia hypotn chf renal artery stenosis

renal causes of arf (2)

nephrotoxins ai dz

postrenal cause of chf

obstruction

key parameter for renal fxn management

GFR

\_\_ and \_\_ are easier to measure than GFR, but are less reliable

BUN Cr

aki definition

acute increase in SCr 0.5 mg/dl or higher OR over 50% of baseline

classification for aki

rifle

rifle criteria: risk

SCr increased 1.5 x OR GFR \> 25% decrease from baseline

rifle criteria: injury

SCr increased 2x OR GFR \> 50% decrease from baseline

rifle criteria: failure

SCr \> 3 x OR SCr \> 4 x w. acute increase \> 0.5 OR GFR decrease \> 75% from baseline

other labs in evaluation of aki (4)

urine Na Fena (fractional excretion of Na) urine osmolality BUN:Cr ratio

urine Na: \> 20 Fena: \< 1% urine osmolality: 500 BUN:Cr: 20:1

prerenal aki

urine Na: \> 40 Fena: 1-2% urine osm: 250-300 BUN:Cr: \< 15:1

intrinsic aki

ckd gfr parameters

in arf, CrCl will be

decreased

in arf K+ will be

elevated → hyperkalemia

UA in arf will be positive for (2)

protein blood

mild - mod decrease in gfr over time w.o presence of uremic sx

chronic renal failure

2 mc causes of ckd

htn dm

sx of progressed ckd (3)

fatigue malaise vomiting

labs elevated in ckd (2)

BUN Cr

\_\_ and \_\_ are usually normal until advanced ckd

UA lytes

primary buffer system of body

carbonic acid/bicarbonate system

CO2 is regulated by \_\_ bicarb is regulated by \_\_

lungs kidneys

equation of ife

•HCO3¯+H⁺«----»H2CO3«----»CO2+H2O

increase in blood CO2

respiratory acidosis

decrease in blood CO2

respiratory alkalosis

increase in blood bicarb

metabolic alkalosis

decrease in blood bicarb

metabolic acidosis

what does anion gap tell you (2)

lyte balance acid-base balance

what does mudpiles cat stand for

**reasons for metabolic acidosis:** methanol uremia dka paraldehyde iron, isoniazid lactic acidosis ethanol, ethylene glycol salicylate/asa carbon monoxide aminoglycosides theophyline