Summer Final New

Question 1

What are crystalloid solutions?

Answer 1

NS and LR (only stay 25% in the vessels)

-used in med floors and ICUs (not outpt)

Question 2

When isn’t free water used? Contraindications?

Answer 2

not used directly
equivalent to D5W
*avoid in pts with ICP

Question 3

What are colloid solutions?

Answer 3

• include RBCs, albumin, dextrans, and hetastarch
• 100 ml of 25% albumin causes 500 ml increase in IV volume
• used in severe ICU cases when pt is fluid restricted

Question 4

Which is preferred colloid or crystalloid? What is the formula for maintenance fluid?

Answer 4

• no difference in terms of mortality but crystalloids are less expensive so first choice
• 1500 ml + (20 ml/kg for q kg >20 kg)

Question 5

What is the goal for do you treat acute hypotonic hyponatremia? Chronic?

Answer 5

• acute- 1-2mEq/L/hr until plasma Na>120 or neuro sxs subside
• chronic- 0.5-1mEq/L/hr with total increase not to exceed 8-12 mEq/L/day and no more than 18mEq/L/day in the first 48 hours

Question 6

What do you use for treating hypotonic hyponatremia?

Answer 6

3% saline or NS

Question 7

What drug can you use for chronic treatment of hyponatremia? Contraindications?

Answer 7

• demeclocycline
• vasopressin antagonist to increase water excretion
• takes 3-4 days to work
• cirrhosis

Question 8

What are types of aquaretics for euvolemic and hypervolemic hyponatremia?

Answer 8

• Conivaptan: IV,

- Tolvaptan: PO, ok for HF and cirrhosis, but titrate at hospital before discharge

Question 9

How do you treat hypovolemic hypernatremia? Infusion rate? Corrected Na?

Answer 9

• NS of 200-300mL/hr

- measured Na + (1.7 for q 100 dL/mg glucose over 200)

Question 10

What is used in the chronic treatment of hypernatremia (euvolemic)? Side effects?

Answer 10

• desmopressin (AVP agonist)

- increased bleeding time and PTT

Question 11

What drugs can we use for Na overload? Edema?

Answer 11

• NS first

- loops and thiazides

Question 12

How do you treat hypercalcemia?

Answer 12

1. loops and calcitonin–> dose depends on BP

2. bisphosphonates (-dronates)–> adjust for renal insufficiency

Question 13

How do you treat hypophosphatemia?

Answer 13

neutra-phos

Question 14

How do you treat hyperkalemia?

Answer 14

first diuretics, then laxatives (SPS)

Question 15

What is normal serum creatinine? What is the formula for creatinine clearance? For drug dosing which creat do you use? For kidney function what do you use?

Answer 15

males 0.6-1.2
females 0.5-1.1
- [(140-age)*Mass(kg)*0.8 if female]/(72*serum cr)
-drugs- serum creat
-kidney function GFR

Question 16

What is the normal BUN: creat ratio? What affects creat levels?

Answer 16

10-20:1 (if above may be dehydrated so give NS)

-muscle and age

Question 17

What is AKI? What is anuric v oliguric v nonoliguric?

Answer 17

abrupt decrease in GFR which leads to significant mortality and moribidity
-500

Question 18

What are the categories of AKI?

Answer 18

pre renal (volume depletion)--> give fluids
intrinsic (damage and necrosis)
postrenal (obstructive)

Question 19

What is hospital acquired AKI usually due to? CA?

Answer 19

ATN- use loops if edema but no oliguria (bumex)
volume depletion (V/D)

Question 20

What combo of drugs should you look for in ATN AKI?

Answer 20

NSAIDs and diuretics or ACE/ARB

Question 21

How should you treat ATN? How do you prevent?

Answer 21

-check serum creat/ crcl/ urine output,
adjust drug dose, withdraw meds prn
-hydration, antioxidants, glycemic control, withdrawal of causative agents

Question 22

How can you treat electrolyte imbalances in CKD?

Answer 22

-inc Ph:
binders like Ca carbonate and lanthanum carbonate
-dec Ca:
give cinacalcet (if Ca >8.4)
VitD analogue like calcitriol or active VitD in ESRD

Question 23

How can you treat anemia a/w CKD?

Answer 23

• Iron pills, eventually IV iron (dextran has highest risk of anaphylaxis)
• ESA when Hgb <10 with target 11-12

Question 24

How can you treat HTN a/w CKD?

Answer 24

ACE or ARB (volume overload use diuretics or dialysis)

as long as pt is still making urine