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Renal > Fluid and Electrolytes Part I > Flashcards

Fluid and Electrolytes Part I Flashcards

1
Q

How much fluid is gained from enteral liquids?

A

500-1500 mL/day

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2
Q

How much fluid is gained from enteral solids?

A

500-1000 mL/day

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3
Q

How much fluid is gained from metabolism?

A

300 mL/day

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4
Q

How much sensible fluid is lost daily?

A

1.0 - 1.5 L

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5
Q

What are sensible fluids?

A

Urine

Stool

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6
Q

How much insensible fluids are lost daily?

A

< 1.0 L

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7
Q

What are insensible fluids?

A

Lungs
Sweat
Fever

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8
Q

What are other ways to lose fluids?

A

Burns

Nasogastric tube

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9
Q

What is the calculation for daily maintenance fluid requirements?

A

1500 mL + 20 mL/kg for every kg > 20kg

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10
Q

What is the average adult daily fluid requirement?

A

30 - 35 mL/kg

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11
Q

What are the sx of hypovolemia?

A 
Acute weight loss
Tachycardia, orthostasis
Dry mouth, dry skin
Decreased skin turgor
BUN:SCr > 20:1
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12
Q

What are the sx of hypervolemia?

A

Acute weight gain

Edema: pulmonary, extremities, ascites, anascara

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13
Q

What is normal serum osmolality?

A

275 - 290 mOsm/kg

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14
Q

What is normal urine sodium?

A

25 - 250 mEq/L

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15
Q

What is normal urine osmolality?

A

100 - 900 mOsm/kg

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16
Q

What is the primary cause of hyponatremia?

A

Disorder of water balance

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17
Q

What hormone is hyponatremia associated with?

A

Vasopressin

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18
Q

What are the classifications for hyponatremia?

A 
Mild: 130 - 135
Moderate: 125 - 129
Profound: < 125
Acute: < 48 hours
Chronic: > 48 hours
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19
Q

What is the clinical presentation of hyponatremia?

A 
Nausea
Malaise
HA
Lethargy
Restlessness
Disorientation
Seizures
Coma
Depressed reflexes
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20
Q

What are the sx of moderately severe hyponatremia?

A

Nausea w/o vomiting
Confusion
HA

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21
Q

What are the sx of severe hyponatremia?

A 
Vomiting
Cardiorespiratory distress
Abnormal and deep somnolence
Seizures
Coma (Glasgow Coma Scale = 8)
22
Q

What is the treatment for a patient that has hypovolemic hyponatremia that is asymptomatic and/or serum Na > 120?

A

Isotonic fluids

23
Q

What is the treatment for a patient that has hypovolemic hyponatremia that is symptomatic and/or serum Na < 120?

A

Hypertonic fluids

24
Q

What is the goal for serum increase rate?

A

< 10 mEq/L in 24 hours

25
Q

What happens if the sodium correction rate is too rapid?

A

Risk of central pontine demyelination

26
Q

What is central pontine demyelination?

A

Too rapid correction of sodium in hyponatremia would cause the extracellular fluid to be relatively hypertonic. Free water would then move out of the cells. This leads to paralysis.

27
Q

What is another name for euvolemic hyponatremia?

A

SIADH

28
Q

What does SIADH stand for?

A

Syndrome of Inappropriate Anti-Diuretic Hormone

29
Q

What are the causes of SIADH?

A

Lung cancer
Pituitary tumor
Drugs (carbamazepine, vincristine, SSRIs)
**Absolute increase in body water

30
Q

What is the gold standard treatment for SIADH?

A

Fluid restriction: < 1 L/d x several days

31
Q

What are treatment options for SIADH?

A

Fluid restriction
Vasopressin receptor antagonists
Demeclocycline

32
Q

How do vasopressin receptor antagonists work?

A

Works at the collecting ducts of the nephron and increases free water excretion

33
Q

What are the vasopressin receptor antagonists?

A

Conivaptan

Tolvaptan

34
Q

What is demeclocycline?

A

ADH receptor antagonist (delayed onset)

35
Q

What are the causes of hypervolemic hyponatremia?

A

Renal failure
Liver failure
Heart failure
Nephrotic syndrome

36
Q

What is the treatment of hypervolemic hypernatremia?

A

Sodium AND fluid restriction
Sodium 1 - 2 g/d
Fluids < 1 L/d

37
Q

What are the sx of hypernatremia?

A 
Lethargy 
Weakness
Confusion
Restlessness
Irritability
38
Q

What are the signs of hypernatremia

A

Consistent with volume status

Increased or decreased output of concentrated or dilute urine - dependent on cause

39
Q

What is the pathophysiology of hypovolemic hypernatremia?

A

Loss of hypotonic fluids (sweat, urine, diarrhea)

Patient not able to replenish fluid

40
Q

What types of fluids do we give hypovolemic hypernatremia?

A

Hypotonic fluids to correct water deficit (1/2 NS or D5W)

If patient is hypotensive use NS

41
Q

What is the risk if the sodium correction is too fast in hypernatremia?

A

Risk of cerebral edema

42
Q

What is the goal serum sodium decrease rate?

A

< 12 mEq/L in 24 hours

43
Q

What is the cause of euvolemic hypernatremia?

A

Diabetes Insipidus (DI) - decrease in ADH secretion or a decrease in renal response to ADH

44
Q

What is the cause of central DI?

A

Familial
Neuosurgery
Head trauma
CNS malignancy

45
Q

What is the treatment for central DI?

A

Desmopressin (via intranasal route)

46
Q

What are the types of DI?

A

Central

Nephrogenic

47
Q

What are the causes of nephrogenic DI?

A 
Lithium toxicity
Hypercalcemia
Hypokalemia
Foscarnet
Demeclocycline
48
Q

What are the treatments of nephrogenic toxicity?

A

Remove/treat underlying cause
Sodium restriction < 2 g/d
Thiazide diuretic

49
Q

What is the cause of hypervolemic hypernatremia?

A

Sodium overload - caused by excess hypertonic fluid or excess intake of sodium

50
Q

What is the treatment of hypervolemic hypernatremia?

A

Loop diuretics

Renal (8 decks)

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