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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
Q

rapid correction of Hypernatremic Dehydration can cause

A

Cerebral edema

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26
Q

symptoms of cerebral edema

A

Headache
AMS
seizures
brain herniation

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27
Q

Oral rehydration guidelines using Oral Rehydration solution that contains glucose and electrolytes

A

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

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28
Q

Normal Na+

A

135-145

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29
Q

Na+ and ____ follow each other

A

H20

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30
Q

isotonic fluid that contains K+

A

LR

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31
Q

Symptoms of hyponatremia

A 
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

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32
Q

formula to correct hyponatremia

A

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

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33
Q

what are the 3 types of hyponatremia

A

Hypovolemic
Euvolemic
Hypervolemic

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34
Q

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

A

hypovolemic hyponatremia

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35
Q

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

A

euvolemic hyponatremia

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36
Q

In SIADH what type of hyponatremia do we see

A

euvolemic hyponatremia

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37
Q

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

A

Hypervolemic hyponatremia

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38
Q

labs to follow for Hyponatremia

A

Serum Na
Serum Osmols
Urine Osmols

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39
Q

causes of Hypernatremia

A

Excessive Na intake
Inappropriately concentrated formula
Excessive free H20 loss: Breastfeeding failure, diarrhea, DI

40
Q

Symptoms of Hypernatremia

A 
Weakness
lethargy
decreased deep tendon reflexes 
irritability
muscle cramps
renal failure
AMS
Seizures
41
Q

Formula for correcting Hypernatremia if hypovolemic

A

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
Q

normal K+

A

3.5-5.2

43
Q

Acidosis causes K+ to

A

increase

44
Q

Alkalosis causes K+ to

A

decrease

45
Q

Potassium is excreted by

A

kidneys

46
Q

What EKG changes occur with increasing severity of hyperkalemia

A

Normal EKG
Peaked T waves
Wide PR interval with Wide QRS duration and Peaked T waves

Loss of P waves and sinosoidal waves

47
Q

Hyperkalemia causes

A 
Acute or chronic renal failure
Tissue injuries (crush injuries)
Hemolysis
Acidosis
Medications (Spironolactone, Bactrim, Ace inhibitors)
48
Q

What medications can cause Hyperkalemia

A

Spironolactone
Bactrim
Ace inhibitors

49
Q

Peaked t waves, prolonged PR and QRS EKG changes are a precursor to

A

V. Fib

50
Q

How can you treat hyperkalemia

A 
Calcium Chloride
Sodium Bicarb
D25/50% with insulin
Kayexalate
Albuterol
51
Q

Where is the majority of magnesium stored

A

in bones

<1% is extracellular

52
Q

What is magnesium important for

A

ATP generation
DNA transcription
membrane stabilization
regulation of K excretion

53
Q

Normal magnesium levels

A

1.7-2.2

54
Q

causes of hypomagnesemia

A 
GI losses
Vomiting
Diarrhea
Refeeding syndrome
Pancreatitis
IBD
celiac disease
CF
Hypercalcemia
diuretic use
RTA
DM
DKA
Hyperaldosteronism
55
Q

symptoms of Hypomagnesemia

A

Anorexia
N/V
Seizures, Ataxia, hyperreflexia
EKG changes: Torsades de pointes, Long QT

56
Q

Diagnostic eval hypomagnesemia

A

Mg level
iCal
EKG

57
Q

Management of hypomangesemia

A

Repletion with Mag sulfate or Mag chloride

Consider K repletion

58
Q

Chloride has a direct relationship with

A

sodium

59
Q

Chloride has an inverse relationship with

A

bicarb

60
Q

what causes hypochloremia

A

CF
Bulimia
Diuretic usage

61
Q

Presentation of Hypochloremia

A 
rarely occurs by itself (usually hypernatremic as well)
Arrhythmias
decreased resp effort
seizures
tachycardia
62
Q

treatment of Hypochloremia

A

Find cause

Replace with K, Na or ammonium chloride, or arginine chloride - based on other electrolyte levels

63
Q

Hyperchloremia causes

A

diarrhea
Chloride administration
metabolic acidosis

64
Q

presentation of hyperchloremia

A 
Often no symptoms
Kussmaul respirations
lethargy
headache
confusion
65
Q

Treatment hyperchloremia

A

Find underlying cause

treat acidosis: can use sodium bicarb

66
Q

what can cause hypophosphatemia

A 
refeeding syndrome
DKA 
severe resp alkalosis
vit d deficiency
burns
67
Q

symptoms of hypophosphatemia

A

impaired energy utilization
diaphragmatic/resp muscle weakness
tissue hypoxia

68
Q

how to treat Hypophosphatemia

A

IV phos repletion

69
Q

causes of hyperphosphatemia

A

renal failure
phosphate containing enemas (fleet enemas)
Tumor lysis syndrome

70
Q

how to treat hyperphosphatemia

A

phosphate binders
mannitol
diuresis

71
Q

Calcium is found in what 3 forms

A

Bound to albumin (plasma protein)
Diffusible (CaCitrate or CaPhosphate)
Unbound ion

72
Q

Ca+ levels

A

9-10

73
Q

iCal hypocalcemia

A

<1.1

74
Q

Causes of hypocalcemia

A 
post PRBC infusions
hypoparathyroidism
sepsis
tumor lysis
DiGeorge syndrome
75
Q

symptoms of hypocalcemia

A 
Neuromuscular irritability
confusion
muscle cramps
numbness
tingling
Cardiac: prolonged QT, AV blocks, sinus tachycardia
76
Q

cardiac changes seen in hypocalcemia

A

Prolonged QT
AV blocks
Sinus Tach

77
Q

Diagnostic eval for hypocalcemia

A

Ca level (total and iCal)
CMP
PTH
EKG

78
Q

Acute repletion for hypocalcemia if symptomatic

A

Calcium chloride - 10-20 mg/kg/dose

Calcium Gluconate - 100mg/kg/dose

79
Q

Causes of hypercalcemia

A

Williams syndrome
excessive intake
immobility
malignancy

80
Q

Presentation of hypercalcemia

A 
nausea
anorexia
constipation
lethargy
headaches
seizures
arrhythmias
81
Q

Diagnostic for hypercalcemia

A

total cal
iCal
PTH
EKG

82
Q

Treatment for Hypercalcemia

A

Hydration
loop diuretic for diuresis
Calcitonin for rapid correction

83
Q

what does LR contain that the other fluids do not

A

K Ca, HCO3 and sodium lactate

84
Q

How much Na and Cl is in NS (g/L)
1/2 NS
1/4 NS

A

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
Q

what fluid choice has the highest and the lowest mOs ml/L

A

3% NS with 1027 mOs ml/L

1/2 NS with 154 mOS ml/L

86
Q

Fluid deficit formula

A

Pre-illness weight - illness weight

87
Q

ECG changes associated with hypokalemia

A

Flat or absent T waves
Long QT
Prolonged QRS
Presence of U waves

88
Q

symptoms of Hypokalemia

A 
Diastolic dysfunction
cramping
fatigue
ileus
often asymptomatic
check mag - prob low as well
89
Q

diagnose Hypokalemia

A

BMP with Mag level

Urine studies, osmols

90
Q

Management of hypokalemia

A

Identify cause - are they on a diuretic that is dumping k

Potassium repletion - KCL 0.5-1meq/kg/dose

91
Q

EkG changes seen in Hypomagnesemia

A

Torsades de Pointes

Long QT

92
Q

causes of hypermagnesemia

A

excessive intake of Mg containing laxatives or antacids
Chronic renal failure
tumor lysis

93
Q

Presentation of hypermagnesemia

A

Hypotonia
decreased reflexes
hypotension
flushing

94
Q

Management of Hypermagnesemia

A 
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
Q

is Cl acidic or basic

A

acidic

Critical Care I (27 decks)

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