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Therapeutics 2 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Ideal Body Weight (males)

A

50 + (2.3*inches over 60)

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2
Q

Ideal Body Weight (females)

A

45.5 + (2.3*inches over 60)

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3
Q

when to use nutritional body weight?

A

When actual body weight is > 130% of IBW

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4
Q

what is the range for isotonic fluids?

A

275-290 mosm/L

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5
Q

What is the range for hypotonic fluids

A

<275 mosm/L

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6
Q

What is the range for hypertonic fluids

A

> 290 mosm/L

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7
Q

What is the clinical estimate for maintenance IV fluids?

A

30-40 mL/kg/day
rate = divide total by 24

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8
Q

What are the crystalloids?

A

NS, 1/2NS, D5W, LR, and balanced salt solutions

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9
Q

What are uses for NS?

A

intravascular fluid replacement (resuscitation)
sodium/chloride replacement

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10
Q

What are uses for 1/2 NS

A

maintenance fluids

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11
Q

What are uses for lactated ringers?

A
  • replacement of blood loss
    -resuscitation (trauma, burn, etc)
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12
Q

What is use for D5W?

A
  • replacement for free water
  • not a resuscitative fluid
  • not a MIVF
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13
Q

What are the examples of balanced salt solutions?

A
  • Lactated Ringers
  • Normosol-R
  • plasma-lyte
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14
Q

What are colloid solutions used for?

A
  • Increase plasma oncotic pressure
  • move fluid from interstitial compartment to plasma compartment
  • Volume expansion; intravascular repletion
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15
Q

What is albumin used for?

A
  • Volume expansion (5%)
  • shock
  • burns
  • supportive/symptomatic treatment
  • fluid and sodium restricted patients (25%)
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16
Q

Adverse effects of albumin

A
  • Hypervolemia
  • Azotemia
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17
Q

Synthetic Colloids Example

A
  • hetastarch
  • tetrastarch
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18
Q

Indication for using Packed Red Blood Cells as a colloid

A
  • acute blood loss
  • low hemoglobin <7-8 g/dL
  • 1 unit of RBCs increases hemoglobin by 1g/dL
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19
Q

What is the most common maintenance IV fluid?

A

D5W + 1/2 NS +20 mEq KCl/L
- increase plasma oncotic pressure
- similar composition to urine

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20
Q

Signs of dehydration

A
  • tachycardia and hypotension
  • weak peripheral pulses
  • decreased urine output <5 mL/kg/hr
  • BUN/Scr Ratio >20
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21
Q

What is the goal range for sodium?

A

135-145 mEq/L

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22
Q

What is hyponatremia?

A

Sodium levels below 135 mEq/L

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23
Q

What is isotonic hyponatremia?

A

Normal serum osmolality with low sodium levels
Serum osmolality =275-290 mosm

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24
Q

What causes isotonic hyponatremia

A
  • extreme elevations of lipids and proteins increase the total plasma volume
  • dilution effect on sodium
  • measured serum osmolality not affected; calculated Osm is low`
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25
Q

What is hypertonic hyponatremia?

A
  • High serum osmolality with low sodium levels
  • serum osmolality >290 mOsm
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26
Q

What causes hypertonic hyponatremia?

A

most frequently seen with elevated blood glucose

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27
Q

What is hypotonic hyponatremia?

A
  • low serum osmolality <275 with low sodium levels <135
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28
Q

What are the types of hypotonic hyponatremia?

A

hypovolemic hypotonic hyponatremia,
isovolemic hypotonic hyponatremia, hypervolemic hypotonic hyponatremia

29
Q

What needs assessed when a patient has hypotonic hyponatremia

A

volume status

30
Q

What is hypovolemic hypotonic hypernatremia

A
  • decrease in both total body water and sodium
  • normally caused renally by excessive diuresis and high Na+ concentrations in urine
  • can also be caused by trauma, blood loss, burns, and GI losses
31
Q

What is isovolemic hypotonic hyponatremia

A
  • increased total body water and normal or slightly elevated Na+
  • caused by SIADH (syndrome of inappropriate antidiuretic hormone release)
  • makes too much ADH; slight water retention; water intake exceeds capacity of kidneys to excrete water
  • drug induced
32
Q

What drugs most commonly cause SIADH?

A

Antipsychotics, carbamazepine, SSRIs

33
Q

Treatment of SIADH

A
  • remove underlying cause (medications)
  • free H20 restriction
  • may require vaptans as second-line
34
Q

What is hypervolemia hypotonic hyponatremia?

A
  • increased Na+ but increased TBW even more
  • edema
  • heart failure, kidney failure, cirrhosis
35
Q

Clinical presentation of hypovolemic hypotonic hyponatremia? Goal of treatment?

A

dehydration; restore volume deficit

36
Q

Clinical presentation of hypervolemic hypotonic hyponatremia?

A

fluid overload/edema

37
Q

General goal of treatment for hypotonic hyponatremia?

A

avoid rise in serum sodium >0.5mEq/L/hr or 8-12 mEq/L/day

38
Q

treatment for hypovolemia hypotonic hyponatremia

A

Hypertonic Nacl (3%) is symptomatic
Isotonic NaCl (0.9%) if asymptomatic

39
Q

treatment for isovolemic hypotonic hyponatremia

A
  • Furosemide and 3% NaCl if symptomatic
  • isotonic NaCl if asymptomatic and water restriction
40
Q

treatment for hypervolemic hypotonic hyponatremia

A

Furosemide and 3% NaCl in symptomatic patients

41
Q

acute vs chronic hyponatremia

A

acute more of a risk for brain herniation and death; not as urgent UNLESS symptomatic

42
Q

Treatment of acute symptomatic hyponatremia

A

Increase serum Na by 1-2 mEq/L/hr until symptoms resolve; goal 120 mEq/L
- maximum increase of 8-12 mEq/L in the first 24 hours

43
Q

Risk factors for demyelination

A

Serum Na < 105 mEq/L
Hypokalemia

44
Q

Rule of 8s

A

Replace 1/2 of sodium deficit in 8 hours, then remaining deficit within 8-16 hours

45
Q

What is hypernatremia?

A

Too much sodium (Na > 145 mEq/L)

46
Q

What is hypernatremia associated with?

A

hypertonicity; impaired thirst response or patients without access to water

47
Q

What is hypovolemic hypernatremia?

A

Loss of both H20 and Na+

48
Q

What is isovolemic hyponatremia?

A

often caused by diabetes; loss of H20; Na+ can go up or down

49
Q

What is hypervolemic Hypernatremia?

A

Fluid overload; mineralcorticoid excess
increased total body water but also increased sodium

50
Q

Hypovolemic hyponatremia treatment

A
  • restore hemodynamic status (if needed)
  • may give 0.9% NaCl
  • Calculate free water deficit
  • provide free water using D5W
  • follow rule of 8’s
  • goal of 0.5 mEq/L/hr decrease in Na serum
51
Q

Treatment for isovolemic hypernatremia (caused by diabetes insipidus)

A
  • Desmopressin
  • Vasopressin
52
Q

Hypervolemic hypernatremia treatment

A
  • stop hypertonic fluids/ cause
  • diuretic if needed
53
Q

What is the goal lab values for potassium?

A

3.5-5mEq/L

54
Q

Treatment for hypokalemia

A

3.5-4 mEq/L
- may treat in ICU patients until lab value above 4
3-3.4 mEq/L
- oral K+ for patients with cardiac conditions
<3 mEq/L
- always treat; PO route preferred
- May use IV for symptomatic patients who cannot take PO
- Attempt to correct Mg2+ deficit

55
Q

How to give IV K+

A
  • 10mEq/hr in 100mL of D5W (no cardiac monitoring)
  • 20 mEq/hr in 100mL of D5W (with cardiac monitoring)
  • Never give K+ IV push
56
Q

Hyperkalemia

A

mild: 5.5-6
moderate: 6-7
severe: >7

57
Q

Hyperkalemia treatment

A

C A BIG K Drop

58
Q

Hyperkalemia treatment

A
  1. Calcium
  2. Albuterol
  3. Bicarb
  4. Insulin + glucose
  5. Lokelma– safer than Kayexalate
  6. Diuretics (furosemide)
  7. Dialysis
59
Q

Chronic hyperkalemia treatment

A

Patiromer (Valtassa)

60
Q

Normal Mg2+ labs

A

1.5-2.5 mg/dL

61
Q

Mg2+ role in body

A

co-factor for enzymes
related to Ca2+ and K+ metabolism

62
Q

hypomagnesemia causes/ presentation

A

Diuretics (thiazide or loop)
with other electrolyte abnormalities

63
Q

hypomagnesemia treatment

A
  • asymptomatic patients: PO
  • milk of mag/ mag-ox
  • symptomatic patients: IV 1g/hour
64
Q

Calcium goal labs

A

8.5-10.5 mg/dL

65
Q

hypocalcemia treatment

A
  • ca chloride can be given IV push during code
  • calcium gluconate preferred for PIV administration
  • 1gm/hour = 3gm Ca gluconate
  • do not add to bicarb or phos solutions
66
Q

chronic hypocalcemia treatment

A

1-3 g of elemental Ca2+/day
calcitriol 0.25mcg po daily

67
Q

Phosphorus goal lab values

A

2.5-4.5mg/dL

68
Q

Hypophosphatemia treatment

A

use Kphos when K+ <4mEq/L
Use NaPhos when K+ >4mEq/L

Therapeutics 2 (9 decks)

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