Acute & Critical Care Medicine Flashcards
Crystalloids
Pass freely between semipermeable membranes - does not remain in the intravascular space, move into extravascular space
Less costly and fewer adverse reactions
5% Dextrose, 0.9% NACl, Lactated Ringers, Plasma-Lyte A
Colloids
Large molecules remain in the intravascular space and increase oncotic pressure - Greater intravascular volume expansion
More expensive and no clear clinical benefit
Albumin 5%, Dextran, Hydroxyethyl starch
Arginine Vasopressin Receptor Antagonists
Conivaptan (injection) or Tolvaptan (tablet) - SIADH and Hypervolemic hyponatremia
Correcting sodium more rapidly that 12 mEq/L over 24 hours can cause osmotic demyelination syndrome or central pontine myelinolysis; paralysis, seizures and death
Samsca Warnings/Side Effects
Tolvaptan
Limited to 30 days or less due to hepatotoxicity
Thirst, nausea, dry mouth and polyuria
Monitor rate of Na increase
Hypokalemia
Potassium < 3.5 mEq/L
Underlying cause: metabolic alkalosis, amphotericin b, insulin, overdiuresis
A drop of 1 mEq/L below 3.5 mEq/L represents a total body deficit of 100-400 mEq
Safe recommendations for IV K replacement - peripheral line; max infusion rate 10 mEq/hr or less and max conc. 10 mEq/100 mL
Fatal undiluted or IV push
Magnesium necessary for potassium uptake
Hypomagnesemia
When serum Mg is < 1 mEq/L with life-threatening symptoms (seizures or arrhythmias), IV replacement is recommended
Mg sulfate - IV replacement
Mg oxide - oral replacement
Hypophosphatemia
Severe and symptomatic < 1 mg/dL
IV phosphorus is used for replacement
IVIG
Carimune NF, Flebogamma DIF, Gammagard, Gamunex-C, Octagam, Privigen
Extracted from the plasma of a thousand or more blood donors (FDA’s minimum; typically IVIG derived from between 3,000-10,000 donors)
IVIG Warnings and Side effects
Acute renal dysfunction - more likely with products stabilized with sucrose; thrombosis; Use slower infusion rate in renal and CV disease
Headache, nausea, diarrhea, injection site reaction, infusion reaction (facial flushing, chest tightness, fever, chills, hypotension - slow/stop infusion)
