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Clinical Med - Nephrology > Acid-Base / Electrolytes / Fluids > Flashcards

Acid-Base / Electrolytes / Fluids Flashcards

1
Q

What are the four primary acid-base disorrders?

A

Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis

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2
Q

Respiratory acid-base disorders bring primary changes in ___ and secondary (compensatory) changes in _____.

A

CO2

HCO3-

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3
Q

Metabolic acid-base disorders bring primary changes in ___ and secondary (compensatory) changes in _____.

A

HCO3-

CO2

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4
Q

What primary acid-base disorder is indicated by the ABG below….

7.21/30/100/15

A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis

A

A. Metabolic Acidosis

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5
Q

What is the compensatory response in a metabolic acidosis?

A

Decrease CO2 concentration through hyperventilation

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6
Q

What processes can result in a Metabolic acidosis?

A 
Lactic Acidosis
DKA
Ingestion (Methanol, Ethylene Glycol, ASA)
Renal Failure
Diarrhea (HCO3- Loss)
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7
Q

What primary acid-base disorder is indicated by the ABG below….

7.50/50/100/30

A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis

A

B. Metabolic Alkalosis

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8
Q

What is the compensatory response in metabolic alkalosis?

A

Increased CO2 concentration through hypoventilation

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9
Q

What processes can lead to metabolic alkalosis?

A
  1. TPN Administration
  2. Vomiting (H+ loss)
  3. Loop diuretics
  4. HCO3- Administration
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10
Q

What primary acid-base disorder is indicated by the ABG below….

7.14/56/100/27

A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis

A

C. Respiratory Acidosis

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11
Q

What is the compensatory response in a respiratory acidosis?

A

Increased HCO3- buffering in the kidneys

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12
Q

What processes can lead to a respiratory acidosis?

A 
Alveolar hypoventilation
V/Q mismatch
Alterations in CNS respiratory drive
Respiratory muscle fatigue
Pulmonary disease
Mechanical ventilation
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13
Q

If an intubated and mechanically ventilated patient developed a respiratory acidosis, would this be the result of hypoventilation or hyperventilation?

How could this be corrected?

A

Hypoventilation (The patient is not breathing fast enough)

This can be corrected through increasing the ventilation rate

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14
Q

What primary acid-base disorder is indicated by the ABG below….

7.56/25/100/18

A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis

A

D. Respiratory Alkalosis

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15
Q

What is the compensatory response to a respiratory alkalosis?

A

Decreased HCO3- production in the kidneys

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16
Q

Is respiratory alkalosis commonly due to hypoventilation or hyperventilation?

A

Hyperventilation

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17
Q

What processes can cause respiratory alkalosis?

A
  1. Pain
  2. CVA
  3. Anxiety
  4. Trauma (Flail Chest)
  5. Hypoxemia, Altitude
  6. Pulmonary Edema
  7. Heart Failure
  8. Sepsis
  9. Mechanical Ventilation
  10. Over-correcting Metabolic acidosis
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18
Q

What are causes of a WAGMA (Wide anion gap metabolic acidosis)?

A

MUDPILES

Methanol
Uremia (renal failure)
Diabetic ketoacidosis
Propylene glycol
Infection, inborn errors of metabolism
Lactic acidosis
Ethylene glycol
Salicylate
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19
Q

A 65 y.o. male s/p CABG is intubated and placed on ventilation in the ICU. Following intubation, an ABG is drawn which shows…..

7.27/55/250/25(-2)/100%

What is the primary acid/base disorder?

Is this likely a result of?

How could this be corrected?

A

Respiratory Acidosis

This is likely a result of hypoventilation (holding onto too much CO2)

Increase the ventilation rate

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20
Q

A 40 y.o female involved in a single vehicle MVA arrives in the ED. On exam she is found to have a fail chest. As respiratory failure seems imminent, she is intubated. Following intubation, an ABG is drawn which shows….

7.54/24/370/22/100%

What is the primary acid/base disorder?

Is this likely a result of?

How could this be corrected?

A

Respiratory Alkalosis

This is likely due to mechanical hyperventilation. (Losing too much CO2)

Decrease the ventilation rate

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21
Q

A 6 y.o. male is brought into the ED complaining of emesis, abdominal pain, and polyuria. A UA is ordered which shows a large amount of glucose and the presence of ketones. This is concerning and prompts an ABG draw, which shows…..

7.25/16/131/7/99%

What is the primary acid/base disorder?

What is the likely underlying condition this patient has?

How are they trying to compensate?

A

Metabolic Acidosis

This patient likely has undiagnosed DM and is now presenting in DKA

He was trying to compensate by hyperventilating and ‘blowing down’ his CO2 levels

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22
Q

_______ are IV fluids that contain water, dextrose, Na+, Cl-, and other electrolytes

A

Crystalloids

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23
Q

______ _____ contain mostly Na+ and Cl- but also have lactate, K+, and Ca2+

A

Lactated Ringer’s (LR)

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24
Q

______ contain packed red blood cells, pooled human plasma (5% albumin, 25% albumin), semisynthetic glucose polymers (dextran), and semisynthetic hydroxyethyl starch (hetastarch)

A

Colloids

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25
Q

Are colloids more likely to remain in the intravascular space or the interstitial space?

A

Intravascular

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26
Q

Why should colloids be avoided in patient who are requiring fluid resuscitation (ie: dehydration)?

A

Colloids will draw water out of the interstitial space

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27
Q

When would symptoms of intravascular fluid depletion likely manifest?

A

Once 15% (750 mL) of blood volume is lost

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28
Q

What is the recommended ‘fluid’ of choice in fluid resuscitation?

A

Crystalloids

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29
Q

What are the signs and symptoms of intravascular fluid depletion?

A
  1. Tachycardisa
  2. Hypotension
  3. Orthostatic
  4. AKI (Increased BUN/sCr)
  5. Dry Mucus Membranes
  6. Decreased Skin Turgor
  7. Reduced Urine Output
  8. Dizziness
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30
Q

____ water is also referred as D5W and is metabolized to water and CO2 in the body

A

Free Water (D5W)

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31
Q

What THREE things are considered when adjusting maintenance fluids?

A
  1. Input
  2. Output
  3. Insensible Loss
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32
Q

Which ‘fluid’ is commonly used for maintenance fluids?

A. Crystalloids
B. Colloids
C. Free Water (D5W)

A

C. Free Water (D5W)

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33
Q

Increased osmolarity would likely result in fluid shift ______ (out of/into the cell, cell _______ (hydration/dehydration and _______ (shrinkage/growth)

A

Out of

Dehydration

Shrinkage

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34
Q

Decreased osmolarity would likely result in fluid shift ______ (out of/into the cell, cell _______ (hydration/dehydration) and _______

A

Into

Hydration

Hemolysis

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35
Q

In what THREE ways can fluid be classified in terms of osmolarity?

A
  1. Hypertonic (Water out of the cells)
  2. Isotonic
  3. Hypotonic (Water into the cell)
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36
Q

What are TWO common uses for hypertonic saline?

A
  1. TBI with increased ICP and MAP

2. Symptomatic Hyponatremia (AMS, Coma)

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37
Q

When should hypertonic saline be AVOIDED?

A
  1. Chronic Asymptomatic Hyponatremia
  2. Hyponatremia with Hyperglycemia (ex: DKA)
  3. Hyponatremia with Hypovalemia (ex: CHF)
38
Q

What is the maximal safe amount of change in serum Na+ levels over 24 hours?

A

10-12 mmol/L

39
Q

What are common complications of hypertonic saline?

A
  1. Hypokalemia
  2. Hyperchloremic Acidosis
  3. Hypernatremia
  4. Phlebitis
  5. Heart Failure (Fluid Overload)
  6. Osmotic Demyelination Syndrome (Rapid Correction of Hyponatremia)
  7. Hypotension (Rapid Administration)
40
Q

What are complications of IV hypotonic fluids?

A
  1. Hemolysis of cells

2. Death

41
Q

IVF with an osmolarity less than ____ mOsm/L should be AVOIDED

A

150 mOsm/L

42
Q

________ hyponatremia is caused by excess Na+ and fluid, but the fluid excess predominates

A

Hypervolemic Hyponatremia

43
Q

________ hyponatermia normal total body Na+ but excess fluid, appears diluted

A

Normovolemic Hyponatremia

44
Q

_________ hyponatremia is a deficit of both fluid and Na+ but total Na+ is decreased more than total body water

A

Hypovolemic Hyponatremia

45
Q

What is an example of a disease or process(es) that can cause hypervolemic hyponatremia?

Normovolemic?

Hypovolemic?

A

Hypervolemic:

CHF
Cirrhosis

Normovolemic:

SIADH

Hypovolemic:

Emesis, Diarrhea, Fever
Third-Spacing
Diuretics

46
Q

How is hypervolemic hyponatremia treated?

A
  1. Na+ / Water restriction
  2. Treat underlying cause
  3. Vasopressin receptor antagonist
47
Q

How is normovolemic hypoonatremia treated?

A
  1. Remove offending agent (If applicable)
  2. Restrict fluids
  3. Demeclocyline (Tx SIADH)
  4. Vasopressin receptor antagonist
48
Q

How is hypovolemic hyponatremia treated?

A
  1. Fluid Resuscitation
49
Q

What are common causes of hyponatremia

A
  1. Increased ADH
  2. Volume Depletion / Hypoperfusion
  3. SIADH / Cortisol Deficiency
  4. Medication (Diuretics, SSRIs)
  5. Renal Failure
50
Q

What are clinical manifestations of mild hyponatremia (120-125)?

Moderate (115-120)?

Severe (<115)?

A

Mild:

Nausea, Malaise

Moderate:

HA, Lethargy, Obtundation, Confusion

Severe:

Delirium, Sz, Coma, Death

51
Q

What are common symptom manifestation of hypernatremia (>145)

A
  1. Lethargy, Weakness
  2. Twitching, Sz
  3. Coma
  4. Death (Late/Severe)
52
Q

What are common causes of hypernatremia?

A
  1. Loss of Water (Fever, Burns, Infection)
  2. Diabetes Insipidus)
  3. Sodium Retention
53
Q

What complications may occur if hypernatremia is corrected too rapidly?

A

Cerebral Edema
Seizures
Neurologic Damage
Death

54
Q

K+ is the primary ________ (intracellular/extracellular) cation while Na+ is the primary ________ (intracellular/extracellular) cation

A

Intracellular

Extracellular

55
Q

What are common causes of hypokalemia?

A
  1. Increased pH
  2. Insulin Load
  3. Hypothermia
  4. Increased GI Losses (vomiting, diarrhea, laxatives)
  5. Diuretics
  6. Hypomagnesemia
56
Q

What are symptoms and manifestations of hypokalemia?

A
  1. Muscle Weakness
  2. Flattened T waves
  3. Arrhythmias (Bradycardia, V Tach, V fib)
  4. Rhabdomyolysis
57
Q

How should a hypokalemic patient WITHOUT EKG chagnes be treated/managed?

A

PO K+ Supplementation

58
Q

At what K+ should hypokalemia be treated with IV replacement?

What else should be monitored?

A

< 2.5

These patients should likely have continuous EKG monitoring

59
Q

What are common causes of hyperkalemia?

A
  1. Increase K+ intake
  2. Acidosis
  3. Insulin Deficiency
  4. Kidney Dysfunction
60
Q

What are symptoms and manifestations of hyperkalemia?

A
  1. Muscle Weakness / Paralysis
  2. Peaked T-waves
  3. V Fib is Possible
  4. Additional Electrolyte abnormalities
61
Q

When would urgent and immediate treatment of hyperkalemia be indicated?

A
  1. K+ >6.5
  2. Severe muscle weakness
  3. EKC Change
62
Q

What is used to prevent hyperkalemia induced arrhythmias?

A

IV Calcium

63
Q

T/F: IV Ca2+ will decrease serum K+ levels

A

False

It only antagonizes the effect of K+ on cardiac conduction

64
Q

IV Ca2+ should be avoided in patients taking what anti-arrhythmic

A

Digoxin

65
Q

Other than IV Ca2++, what additional ‘primary’ treatment options are available to treat hyperkalemia?

What are the ‘secondary’ or additional treatment options are used to treat hyperkalemia?

A

Primary:

  1. Insulin / Glucose
  2. Sodium Bicarbonate (Avoid in renal disease)
  3. Beta-2 Adrenergic Agonists (Avoid in coronary ischemia)

Secondary:

  1. Diuretics
  2. Cation-resin Exchange
  3. Dialysis
  4. Kayexalate
66
Q

What are common causes of hypomagnesemia (< 1.7)?

A
  1. Impaired Absorption (UC, Diarrhea)
  2. Alcoholism
  3. Hypokalemia
  4. Diuretics
67
Q

What are signs and symptoms of hypomagnesemia?

A

Tetany, Twitching
Arrhythmia
HTN
Sudden Death

68
Q

What is a common cause of hypermagnesemia (>2.3)?

A

Renal Insufficiency

69
Q

What are signs and symptoms of hypermagnesemia?

A
  1. Nausea, Emesis
  2. Bradycardia, Heart Block, Asystole
  3. Respiratory Failure
  4. Death
70
Q

How is hypermagnesemia treated?

A
  1. Discontinue Mg2+ containing medications
  2. IVF and Diuretics is Asymptomatic
  3. IV Ca2++ if cardiac symptoms
  4. HD in the setting of kidney disease
71
Q

What are common causes of hypophosphatemia (<2.5)?

A
  1. Increased Renal Elimination (Diuretics)
  2. Re-feeding Syndrome
  3. Respiratory Alkalosis
  4. DKA Treatment
72
Q

What are common signs and symptoms of hypophosphatemia?

A
  1. Tissue Hypoxia
  2. Neurologic (Confusion, Sz, Coma)
  3. Cardiopulmonary (Respiratory Failure, CHF)
73
Q

What are common causes of hypomagnesemia (< 1.7)?

A
  1. Impaired Absorption (UC, Diarrhea)
  2. Alcoholism
  3. Hypokalemia
  4. Diuretics
74
Q

What are signs and symptoms of hypomagnesemia?

A

Tetany, Twitching
Arrhythmia
HTN
Sudden Death

75
Q

What is a common cause of hypermagnesemia (>2.3)?

A

Renal Insufficiency

76
Q

What are signs and symptoms of hypermagnesemia?

A
  1. Nausea, Emesis
  2. Bradycardia, Heart Block, Asystole
  3. Respiratory Failure
  4. Death
77
Q

How is hypermagnesemia treated?

A
  1. Discontinue Mg2+ containing medications
  2. IVF and Diuretics is Asymptomatic
  3. IV Ca2++ if cardiac symptoms
  4. HD in the setting of kidney disease
78
Q

What are common causes of hypophosphatemia (<2.5)?

A
  1. Increased Renal Elimination (Diuretics)
  2. Re-feeding Syndrome
  3. Respiratory Alkalosis
  4. DKA Treatment
79
Q

What are common signs and symptoms of hypophosphatemia?

A
  1. Tissue Hypoxia
  2. Neurologic (Confusion, Sz, Coma)
  3. Cardiopulmonary (Respiratory Failure, CHF)
80
Q

What TWO diseases are commonly seen with hyperphosphatemia?

A
  1. CKD

2. Hypoparathyroidsm

81
Q

T/F: Patient with hyperphosphatemia are typically asymptomatic

A

True

82
Q

How is Hyperphosphatemia treated?

A
  1. Dietary restrictions
  2. Saline Infusion
  3. Dialysis
  4. Phosphate Binders (Calcium Carbonate, Calcium Acetate)
83
Q

What are common causes of hypocalcemia?

A
  1. CKD
  2. Hypoparathyroidism
  3. Vitamin D Deficiency
  4. Alcoholism
84
Q

What are some of the many treatment options for hypercalcemia?

A
  1. Isotonic Saline Hydration
  2. Calcitonin
  3. Bisphosphonates
  4. Loop Diuretics
  5. Glucocorticoids
  6. Dialysis
85
Q

What are the acute hypocalcemia Sx?

A

Acute:

Syncope
CHF
Angina

86
Q

What are the neuromuscular hypocalcemia Sx?

A 
Numbness
Tingling
Cramping
Tetany 
Wheezing
Hoarseness
87
Q

What are the neurologic hypocalcemia Sx?

A

Irritability
Fatigue
Sz

88
Q

What are the chronic dermatological hypocalcemia Sx?

A 
Coarse Hair
Brittle Nails
Psoriasis
Dry Skin
Poor Dentition
89
Q

What are the TWO most common causes of hypercalcemia?

A
  1. Malignancy

2. Hyperparathyroidism

90
Q

What are the CNS Sx of hypercalcemia?

GI Sx?

Renal?

Cardiac?

A

CHS:

Lethargy, Weakness, Confusion

GI:

Constipation, Nausea

Renal:

Polyuria, Nocturia, Stones

Cardiac:
Syncope, Arrhythmia

91
Q

What are some of the many treatment options for hypercalcemia?

A
  1. Isotonic Saline Hydration
  2. Calcitonin
  3. Bisphosphonates
  4. Loop Diuretics
  5. Glucocorticoids

Clinical Med - Nephrology (7 decks)

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