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Renal > SM_199a: IVF and Diuretics > Flashcards

SM_199a: IVF and Diuretics Flashcards

1
Q

Describe the normal values of electrolytes

A

Normal values of electrolytes

Na+: 140

K+: 4

Cl-: 102

HCO3-: 24

BUN: 10-20

Cr: 1.0

Glucose: 60-100

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2
Q

____ of total body water is intracellular, while is ____ of total body water is extracellular

A

2/3 of total body water is intracellular, while is 1/3 of total body water is extracellular

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3
Q

Of the extracellular water, ___ is intravascular (plasma), while ___ is extravascular

A

Of the extracellular water, 1/4 is intravascular (plasma), while 3/4 is extravascular

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4
Q

___ of extracellular water is plasma (intravascular)

A

1/4 of extracellular water is plasma (intravascular)

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5
Q

____ is the compartment we measure when we sample blood

A

Plasma is the compartment we measure when we sample blood

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6
Q

Kidney maintains the values in the ____ compartment in steady state

A

Kidney maintains the values in the plasma compartment in steady state

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7
Q

___ is the main cation in the extracellular compartment

A

Na+ is the main cation in the extracellular compartment

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8
Q

____ concentration controls the volume of the extracellular space

A

Na+ concentration controls the volume of the extracellular space

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9
Q

You would want to give IVF to _____, _____, or _____

A

You would want to give IVF to replete volume (give Na+ containing fluid), treat dehydration (give water), and maintenance if person not taking anything in by mouth

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10
Q

The calculation for serum osmolality is _______

A

The calculation for serum osmolality is 2*Na+ + BUN/2,8 + glucose/18

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11
Q

Normal serum osmolality is ______

A

Normal serum osmolality is 285-295

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12
Q

Types of IVF include _____ or _____

A

Types of IVF include glucose or Na+

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13
Q

5% dextrose (D5W) has osmolarity of ______

A

5% dextrose (D5W) has osmolarity of 278 (near serum)

(sugar is metabolized, leaving only the water to be distributed according to body water distribution)

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14
Q

After adding 1L of D5W, there is a _____ mL increase in ICF volume and a _____ mL increase in ECF volume

A

After adding 1L of D5W, there is a 667 mL increase in ICF volume and a 333 mL increase in ECF volume

(2/3 goes to ICF and 1/3 to ECF b/c near serum osmolality)

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15
Q

After adding 1L of D5W, there is a _____ mL increase in plasma volume

A

After adding 1L of D5W, there is an 83 mL increase in plasma volume

(1/3 goes to ECF and 1/4 of that goes to plasma so (1/3)*(1/4)*1000 = 83)

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16
Q

IVF is infused into the _____

A

IVF is infused into the plasma compartment

(IVF osmolarity should be similar to plasma to avoid injury to cells in plasma)

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17
Q

Normal saline is close to _____ with serum

A

Normal saline (0.9% saline) is close to isotonic with serum

(osmolality of 308 - 154 mEq of Na+ and 154 mEq of Cl-)

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18
Q

After adding 1L of normal (0.9%) saline, there is a _____ mL increase in ICF volume and a _____ mL increase in ECF volume

A

After adding 1L of normal (0.9%) saline, there is a 0 mL increase in ICF volume and a 1000 mL increase in ECF volume

(all of the saline goes to ECF b/c isotonic)

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19
Q

After adding 1L of normal (0.9%) saline, there is a _____ mL increase in plasma volume

A

After adding 1L of normal (0.9%) saline, there is a 250 mL increase in plasma volume

(all of the saline goes to the ECF, and the plasma volume is 1/4 of the ECF volume)

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20
Q

After adding 1L of half normal saline (0.45%), there is a _____ mL increase in ICF volume and a _____ mL increase in ECF volume

A

After adding 1L of half normal saline (0.45%), there is a 333 mL increase in ICF volume and a 667 mL increase in ECF volume

(think of as adding 500 mL pure water and 500 mL normal saline)

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21
Q

After adding 1L of half normal saline (0.45%), there is a _____ mL increase in plasma volume

A

After adding 1L of half normal saline (0.45%), there is a 167 mL increase in plasma volume

(167 + 500 = 667 mL go to ECF and 1/4 of that goes to the plasma)

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22
Q

After adding 1L of lactated ringers, there is a _____ mL increase in ICF volume and a _____ mL increase in ECF volume

A

After adding 1L of lactated ringers, there is a 100 mL increase in ICF volume and a 900 mL increase in ECF volume

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23
Q

After adding 1L of lactated ringers, there is a _____ mL increase in plasma volume

A

After adding 1L of lactated ringers, there is a 225 mL increase in plasma volume

(900 mL goes to ECF and 1/4 of that goes to plasma)

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24
Q

All IVF starts in the ______

A

All IVF starts in the vascular space

25
Q

If IVF contains glucose only, it redistributes according to _____

A

If IVF contains glucose only, it redistributes according to total body water

(good for treating dehydration, which is loss of water)

26
Q

Saline containing IVF will stay in the ______

A

Saline containing IVF will stay in the ECF

(better for treating hypovolemia, which is volume depletion causing issues with perfusion)

27
Q

D5W is good for treating ______

A

D5W is good for treating dehydration (loss of water)

28
Q

Saline containing IVF is good for treating _____

A

Saline containing IVF is good for treating hypovolemia (volume depletion causing issues with perfusion)

29
Q

Insensible water loss is water loss that is ______

A

Insensible water loss is water loss that is not easily measured (skin, respiratory losses)

30
Q

If a patient is not taking anything by mouth, give _____

A

If a patient is not taking anything by mouth, give D5W

31
Q

If the patient is volume depleted, need ____

A

If the patient is volume depleted, need Na+

(to replete vascular space and assist perfusion)

32
Q

_____ is a great choice for volume reuscitation of patients who are volume depleted

A

Normal saline is a great choice for volume reuscitation of patients who are volume depleted

(provides Na+ and Cl- the kidney needs to maintain volume)

(lactated ringers also works b/c provides K+ and Cl-)

33
Q

Administer either _____ or _____ for volume depleted patient

A

Administer either normal saline or lactated ringers for volume depleted patient

34
Q

If someone is volume depleted, you want to cover the _____ but also _____

A

If someone is volume depleted, you want to cover the volume already lost but also ongoing losses

35
Q

Giving normal saline as a maintenance fluid results in a _____

A

Giving normal saline as a maintenance fluid results in a large salt load

(lot of Na+ in normal saline)

36
Q

If euvolemic and hyperosmotic, give ____

A

If euvolemic and hyperosmotic, give IV D5W

37
Q

If hypovolemic and hyperosmotic, ____

A

If hypovolemic and hyperosmotic, replace the volume deficit via a salt-containing solution

38
Q

____ of Na+ is reabsorbed at the PCT, _____ at the TAL, and _____ at the DCT

A

60% of Na+ is reabsorbed at the PCT, 30% at the TAL, and 7% at the DCT

39
Q

_____ fine tunes Na+ reabsorption

A

Cortical collecting duct fine tunes Na+ reabsorption

40
Q

An example of a proximal tubule diuretic is ______

A

An example of a proximal tubule diuretic is acetazolamide

41
Q

Acetazolamide (proximal tubule diuretic) ______, inhibiting ______

A

Acetazolamide (proximal tubule diuretic) inhibits carbonic anhydrase, inhibiting Na+ reabsorption, HCO3- reabsorption, and H+ secretion

(carbonic anhydrase promotes absorption of Na+ with HCO3-)

42
Q

Acetazolamide causes less _____ and _____ reabsorption

A

Acetazolamide causes less Na+ and HCO3- reabsorption

(acidosis through decreased bicarbonate reabsorption)

43
Q

Describe characteristics of acetazolamide

A

Characteristics of acetazolamide

  • Works in proximal tubule
  • Weak diuretic because the rest of the nephron can compensate for the Na+ being lost
  • Causes a non-anion gap metabolic acidosis
  • Used to treat metabolic alkalosis, particularly if volume overloaded
44
Q

_____, _____, and _____ are loop diuretics

A

Furosemide (Lasix), torsemide (Demadex), and bumetanide (Bumex) are loop diuretics

45
Q

Loop diuretics act in the _____

A

Loop diuretics act in the thick ascending loop of Henle

46
Q

Loop diuretics inhibit the _____ in the _____

A

Loop diuretics inhibit the Na+/K+/2Cl- in the thick ascending limb of the loop of Henle

47
Q

Describe characteristics of loop diuretics

A

Characteristics of loop diuretics

  • inhibit the Na+/K+/2Cl- in the thick ascending limb of the loop of Henle
  • Side effects: fluid and electrolyte imbalances (hypokalemia, hypocalcemia, hypomagnesemia), volume depletion, ototoxicity, hyperuricemia, hyperglycemia, increased LDL and TG
  • Used for volume overload (rapid diuresis), HTN particularly in CKD
48
Q

_____, _____, and _____ are thiazides

A

Hydrochlorothiazide, chlorthalidone, and metolazone are thiazides

49
Q

Thiazides act in the _____

A

Thiazides act in the distal convoluted tubule

50
Q

Thiazide diuretics inhibit the _____ in the _____

A

Thiazide diuretics inhibit the Na+/Cl- in the distal convoluted tubule

51
Q

Describe characteristics of thiazides

A

Characteristics of thiazides

  • Inhibit the Na+/Cl- in the distal convoluted tubule
  • Side effects: impotence, fluid and electrolyte imbalances (hypokalemia, hyponatremia, hypercalcemia), impaired glucose tolerance, increased cholesterol
  • First line treatment in HTN
52
Q

_____ may cause hypokalemia and hypercalcemia

A

Thiazides may cause hypokalemia and hypercalcemia

53
Q

_____, _____, _____, and _____ are K+ sparing diuretics

A

Triamterence, amiloride, spironolactone, and eplerenone are K+ sparing diuretics

54
Q

K+ sparing diuretics act in the ______

A

K+​ sparing diuretics act in the cortical collecting duct

(trap more Na+ in urinary space)

55
Q

Trimaterene and amiloride inhibit ______

A

Trimaterene and amiloride (K+ sparing) inhibit renal epithelial Na+ channels in the late distal tubule and collecting duct

56
Q

Spironolactone and eplerenone inhibit the ______

A

Spironolactone and eplerenone inhibit the mineralocorticoid receptor on epithelial cells in the late distal tubule and cortical collecting duct

57
Q

Describe side effects of K+ sparing diuretics

A

Side effects of K+​ sparing diuretics

  • Amiloride and triamterence: hyperkalemia, nausea, vomiting
  • Spironolactone: hyperkalemia, gynecomastia

(adjunctive treatment with other diuretics to avoid hypokalemia)

58
Q

Describe the main points about diuretics

A

Diuretics

  • Evoke natriuresis through inhibition of ion channels in different sections of the nephron
  • Lower blood pressure by decreased intravascular volume, vasodilation with chronic use
  • Main side effects are electrolyte abnormalities and volume depletion

Renal (31 decks)

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