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Critical Care I > Test 1 - Fluid and Electrolytes > Flashcards

Test 1 - Fluid and Electrolytes Flashcards

1
Q

Maintenance Fluids

Holiday Segar Method

A

Volume per day
0-10kg - 100mL/kg
11-20kg - 1,000 mL + 50mL/kg for each 1kg > 10kg
>20kg - 1,500 mL + 20mL/kg for each 1kg >20kg

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2
Q

Maintenance Fluids

4-2-1 method

A

Hourly calculations
0-10kg - 4ml/kg/hr
11-20 kg - 40ml/hr + 2ml/kg/hr (for weight over 10)
>20kg - 60ml/hr + 1/m/kg/hr (for weight over 20)

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3
Q

Maintenance Fluids

BSA method

A

Daily and can only be used in pt >/= to 10kg

1600ml/m2/day divided by 24 hours

critically sick
1200ml/m2/day divided by 24 hours

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4
Q

What is the required weight to use BSA in calculating fluids?

A

> = 10kg

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5
Q

if you have a pt with increased ADH, what does that mean when you are calculating maintenance fluids

A

decreased fluids needed

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6
Q

what are 5 conditions or situations that would require a decrease in maintenance fluids

A

increased ADH
At risk for AKI
Ventilators, Heating or Humidification (can decrease need by 20-50%)

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7
Q

rule of thumb number for increased maintenance fluids needs regarding insensible fluid loss

A

400ml/m2/day

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8
Q

What electrolyte is hydration based on

A

Na+

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9
Q

isotonic fluids

A

NS

LR

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10
Q

Hypotonic fluids

A

1/2 NS

1/4 NS

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11
Q

Hypertonic fluids

A

3%

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12
Q

Colloids

A

Albumin 5%

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13
Q

Is sweating considered insensible loss

A

no

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14
Q

what labs are helpful in assessing dehydration

A

Serum BUN and creatinine

BMP

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15
Q

A pt with volume depletion without renal insufficiency may cause what changes when looking at BUN and Creatinine

A

disproportionate increase in BUN with little or no change in creatinine (you may not see this in pt with poor protein intake) - Nelson pg 128

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16
Q

A significant elevation in creatinine concentration suggests

A

renal injury

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17
Q

The urine specific gravity is usually elevated (>/= ____) in cases of significant ________

A

> = 1.025
dehydration

This will correct after rehydration

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18
Q

what may show on urinalysis in dehydration?

A

hyaline and granular casts
a few WBCs and RBCs
30-100 mg/dL of proteinuria

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19
Q

A child with dehydration has lost water; there is usually a concurrent loss of ___ and ___

A

Na+

K+

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20
Q

when can you add potassium to IV fluids

A

After they void, unless significant hypokalemia is present

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21
Q

A pt with diarrhea who has been replacing with only water or has been receiving diluted formula is at risk for what type of dehydration

A

hyponatremic dehydration

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22
Q

What is considered overly rapid correction for hyponatremia and Hypernatremia and what does overly rapid correction put the pt at risk for

A

> 12mEq/L per 24 hours
Hyponatremia - Central pontine myelinolysis
Hypernatremia - cerebral edema

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23
Q

A pt with dehydration secondary to lack of access, poor thirst mechanism (neuro), intractable emesis or anorexia is at risk for what type of dehydration

A

Hypernatremic dehydration

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24
Q

symptoms of Hypernatremic Dehydration

A 
Lethargy
irritable
fever
hypertonicity
hyperreflexia
seizures
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25
rapid correction of Hypernatremic Dehydration can cause
Cerebral edema
26
symptoms of cerebral edema
Headache AMS seizures brain herniation
27
Oral rehydration guidelines using Oral Rehydration solution that contains glucose and electrolytes
50mL/kg within 4 hrs for mild dehydration 100mL/kg within 4 hrs for moderate dehydration Additional 10mL/kg for each diarrhea stool or emesis Maintenance of 100mL of ORS/kg in 24 hours until diarrhea stops Breastfeeding or formula feeding should be maintained and not delayed for more than 24 hours
28
Normal Na+
135-145
29
Na+ and ____ follow each other
H20
30
isotonic fluid that contains K+
LR
31
Symptoms of hyponatremia
``` Nausea/anorexia/vomiting malaise/lethargy confusion/agitation headache seizures decreased reflexes coma ``` may develop cheyne stokes respirations, muscle cramps and weakness (brain cell swelling is responsible for most of the neuro symptoms) more severe with rapid onset of
32
formula to correct hyponatremia
0.6 x kg x (target Na - measured Na) use Hypertonic (3%) which has 500mEq Na+ /L Raise 2-4 mEq/L in 4 hours or (10-20 q 24 hours) If seizing, Goal is to bolus for quick to 125. Then slow correction over 24 hours
33
what are the 3 types of hyponatremia
Hypovolemic Euvolemic Hypervolemic
34
type of hyponatremia where child has lost sodium from the body. Water balance may be positive or negative but there is a higher net sodium loss than water loss
hypovolemic hyponatremia
35
hyponatremia and no evidence of volume overload or volume depletion has _________ _______> These patients typically have an excess of total body water and a slight decrease in total body sodium
euvolemic hyponatremia
36
In SIADH what type of hyponatremia do we see
euvolemic hyponatremia
37
What type of hyponatremia is there an excess of total body water and sodium, although the increase in water is greater than the increase in Na
Hypervolemic hyponatremia
38
labs to follow for Hyponatremia
Serum Na Serum Osmols Urine Osmols
39
causes of Hypernatremia
Excessive Na intake Inappropriately concentrated formula Excessive free H20 loss: Breastfeeding failure, diarrhea, DI
40
Symptoms of Hypernatremia
``` Weakness lethargy decreased deep tendon reflexes irritability muscle cramps renal failure AMS Seizures ```
41
Formula for correcting Hypernatremia if hypovolemic
If hypovolemic, calculate free water deficit 0.6 x kg x (current Na / desired Na) - (0.6 x kg) correct over 24 hours usually 1/2NS or 1/4 NS and may change
42
normal K+
3.5-5.2
43
Acidosis causes K+ to
increase
44
Alkalosis causes K+ to
decrease
45
Potassium is excreted by
kidneys
46
What EKG changes occur with increasing severity of hyperkalemia
Normal EKG Peaked T waves Wide PR interval with Wide QRS duration and Peaked T waves Loss of P waves and sinosoidal waves
47
Hyperkalemia causes
``` Acute or chronic renal failure Tissue injuries (crush injuries) Hemolysis Acidosis Medications (Spironolactone, Bactrim, Ace inhibitors) ```
48
What medications can cause Hyperkalemia
Spironolactone Bactrim Ace inhibitors
49
Peaked t waves, prolonged PR and QRS EKG changes are a precursor to
V. Fib
50
How can you treat hyperkalemia
``` Calcium Chloride Sodium Bicarb D25/50% with insulin Kayexalate Albuterol ```
51
Where is the majority of magnesium stored
in bones | <1% is extracellular
52
What is magnesium important for
ATP generation DNA transcription membrane stabilization regulation of K excretion
53
Normal magnesium levels
1.7-2.2
54
causes of hypomagnesemia
``` GI losses Vomiting Diarrhea Refeeding syndrome Pancreatitis IBD celiac disease CF Hypercalcemia diuretic use RTA DM DKA Hyperaldosteronism ```
55
symptoms of Hypomagnesemia
Anorexia N/V Seizures, Ataxia, hyperreflexia EKG changes: Torsades de pointes, Long QT
56
Diagnostic eval hypomagnesemia
Mg level iCal EKG
57
Management of hypomangesemia
Repletion with Mag sulfate or Mag chloride | Consider K repletion
58
Chloride has a direct relationship with
sodium
59
Chloride has an inverse relationship with
bicarb
60
what causes hypochloremia
CF Bulimia Diuretic usage
61
Presentation of Hypochloremia
``` rarely occurs by itself (usually hypernatremic as well) Arrhythmias decreased resp effort seizures tachycardia ```
62
treatment of Hypochloremia
Find cause | Replace with K, Na or ammonium chloride, or arginine chloride - based on other electrolyte levels
63
Hyperchloremia causes
diarrhea Chloride administration metabolic acidosis
64
presentation of hyperchloremia
``` Often no symptoms Kussmaul respirations lethargy headache confusion ```
65
Treatment hyperchloremia
Find underlying cause | treat acidosis: can use sodium bicarb
66
what can cause hypophosphatemia
``` refeeding syndrome DKA severe resp alkalosis vit d deficiency burns ```
67
symptoms of hypophosphatemia
impaired energy utilization diaphragmatic/resp muscle weakness tissue hypoxia
68
how to treat Hypophosphatemia
IV phos repletion
69
causes of hyperphosphatemia
renal failure phosphate containing enemas (fleet enemas) Tumor lysis syndrome
70
how to treat hyperphosphatemia
phosphate binders mannitol diuresis
71
Calcium is found in what 3 forms
Bound to albumin (plasma protein) Diffusible (CaCitrate or CaPhosphate) Unbound ion
72
Ca+ levels
9-10
73
iCal hypocalcemia
<1.1
74
Causes of hypocalcemia
``` post PRBC infusions hypoparathyroidism sepsis tumor lysis DiGeorge syndrome ```
75
symptoms of hypocalcemia
``` Neuromuscular irritability confusion muscle cramps numbness tingling Cardiac: prolonged QT, AV blocks, sinus tachycardia ```
76
cardiac changes seen in hypocalcemia
Prolonged QT AV blocks Sinus Tach
77
Diagnostic eval for hypocalcemia
Ca level (total and iCal) CMP PTH EKG
78
Acute repletion for hypocalcemia if symptomatic
Calcium chloride - 10-20 mg/kg/dose Calcium Gluconate - 100mg/kg/dose
79
Causes of hypercalcemia
Williams syndrome excessive intake immobility malignancy
80
Presentation of hypercalcemia
``` nausea anorexia constipation lethargy headaches seizures arrhythmias ```
81
Diagnostic for hypercalcemia
total cal iCal PTH EKG
82
Treatment for Hypercalcemia
Hydration loop diuretic for diuresis Calcitonin for rapid correction
83
what does LR contain that the other fluids do not
K Ca, HCO3 and sodium lactate
84
How much Na and Cl is in NS (g/L) 1/2 NS 1/4 NS
154 and 154 77 and 77 34 and 34 3% 513 and 513 LR has 130Na and 109 CL along with 4K and 28 bicarb
85
what fluid choice has the highest and the lowest mOs ml/L
3% NS with 1027 mOs ml/L | 1/2 NS with 154 mOS ml/L
86
Fluid deficit formula
Pre-illness weight - illness weight
87
ECG changes associated with hypokalemia
Flat or absent T waves Long QT Prolonged QRS Presence of U waves
88
symptoms of Hypokalemia
``` Diastolic dysfunction cramping fatigue ileus often asymptomatic check mag - prob low as well ```
89
diagnose Hypokalemia
BMP with Mag level | Urine studies, osmols
90
Management of hypokalemia
Identify cause - are they on a diuretic that is dumping k | Potassium repletion - KCL 0.5-1meq/kg/dose
91
EkG changes seen in Hypomagnesemia
Torsades de Pointes | Long QT
92
causes of hypermagnesemia
excessive intake of Mg containing laxatives or antacids Chronic renal failure tumor lysis
93
Presentation of hypermagnesemia
Hypotonia decreased reflexes hypotension flushing
94
Management of Hypermagnesemia
``` Stop any mag intake fluid for volume expansion inotropes for BP management Vent assistance for muscle weakness For rapid removal, dialysis can be used or exchange transfusion ```
95
is Cl acidic or basic
acidic

Critical Care I (27 decks)

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