Day 2 nephrology Flashcards
(16 cards)
How to calculate total body water?
Fluid distribution?
electrolyte distribution in the ECF and ICF?
given times weight in kg.
60% intra, 40%extra(75% interstitial, 25% intravascular).
ECF- sodium and chloride, ICF- Potassium, phosphate
Hypotonic solution?
Isotonic?
Hypertonic?
less tonicity than plasma, casing water to shift into cells.
Normal
higher tonicity than plasma causing water to come out of the cells.
Whats the holiday seager method?
What to know about ADH?
What to know about ANP or BNP?
100 mL/Kg/Day for first 10 kg. 50 ml/Kg/day for next 10. 20 for every after that.
responds to increase in sodium, serum osmolaity, hypovalemia. Increases free water retention.
Responds to volume expansion. Lowers water and sodium in body.
What to know about aldosterone?
How do you treat severe rehydration? How about mild?
When to refer people for dehydration?
responds to increased potassium, lower sodium, blood pressure, and blood volume. Causes increased water and sodium in body.
Bolus until blood pressure and urine output starts. ORT.
age less than 6 months or less than 8 kg. visible blood in stool, high output diarrhea, persistent vomiting, chronic medical conditions, mental status changes, poor response to oral rehydration therapy, weight loss is more than 9% of body weight.
How to estimate fluid requirements?
Normal wt- present wt is used for what?
What is a crystalloid? Colloids?
100/mL/kg/day for first 10 kg, 50mL/kg/day for next 10. 20 mL/kg/day for anything more than 20 kg.
Estimate fluid deficit.
contain water, dextrose, na, cl, small electrolytes. molecules to large to cross the capillary membrane
Can you give sterile water alone intervenousily?
Are the 5 and 25% albumins interchangeable?
NO.
NO. Considered a plasma expander. Pooled from human serum.
Concerns for hypotonic solutions? Hypertonic solutions?
Preventing complications for hypotonic? Hypertonic?
What fluids to watch for for hypotonic? Hypertonic?
cell hemolysis, death. osmotic demyelination syndrome, hypokalemia, hypernatremia, phlebitis, fluid overload.
never adminster sterile water alone, avoid IV fluid with osmolarity <150 mOsm concern with 0.225% nacl. Recommend alternatives. D5W alone or with 0.225% nacl, oral water. Administer through central line if possible, do not correct sodium too quickly(safe rate), monitor sodium closely during administration(q1-4 hours)
sterile water and quarter normal saline. 1.8% and 3% sodium
0.9% NaCl tonicity and Na per liter? LR sodium content? 3%? D5W?
ISO tonic solutions? Hyper? Hypo?
NS & LR distribution?
D5W distribution?
ISO, 154 per liter. 130. 513. 0.
0.9% Nacl, LR. 3% NaCl. 0.45%, D5W.
100% in ECF, 25% IV and 75% interstitial
60% in ICF, ECF 40% (25% IV, 75% IS).
Hyponatremia symptoms?
How to evaluate hyponatremia?
How to treat hyponatremia, hypovolemic?
If mild-nausea, malaise(125-134). Moderate(115-124)- headache, lethargy, disorientation. Severe(110-114)- seizures, coma, respiratory arrest, brainstem herniation, death.
Assess serum sodium, assess serum osmolality, if hypotonic assess volume status in euvolemic.
shoot to get 120-125 mEq/L. Requires both volume and sodium replacement. Most cases treat with 0.9% NaCl. May also use hypertonic saline(3%)(usually in people with critically low sodium or are severely symptomatic).
What is osmotic demyelination syndrome?
What causes SIADH?
Treatment of SIADH?
goal correction is 6-12 mEq/L. Don’t overshoot that or you get this. if hyponatremia had rapid onset with symptoms and you may correct at 1-2 mEq/h.
Canceres like lung and pancreatic, pulmonary infection, CNS. ADH analogues(desmopressin,) Stimulate ADH release.
correct underlying cause. Can give demeclocycline(tetracycline inhibits tubular ADH activity). Conivaptan(vasopressin receptor antagonist)(IV only) Tolvaptan.
Can you get osmotic syndrome from too quick correction of hypernatremia?
Common causes of hypernatremia and hypovalemic?
Hypernatremia and hypervalemic?
Hypernatremia and Euvolemic?
YES.
Decreases Na and Water but water more. Caused by diuretics, osmotic diueresis, hypotonic GI losses, poor intake of water. Treat with saline solutions and free water replacement. Max decrease is 10-12 mEq/L. If not can cause cerebral edema.
sodium and water increase and sodium increases more. Sodium overload causes(tube feedings), treat with free water replacement and loop diuretics.
Water decreases only. Caused by diabetes insipidus. Treated with ADH agonists. Central diabetes is causes by CNS abnormalities, a lot of urination. Nephrogenic diabetes insipidus is caused by kidney failure. Results in ability of the kidneys to concentrate the urine.
How to treat Central DI? Nephrogenic?
Is 0.9%NaCl a crystalloid or colloid? How is it distributed? Amount of sodium and tonicity?
Is albumin 5% a colloid or crystalloid? How is it distributed? Amount of sodium? Tonicity?
Correct Na disorder, Desmopressin, carbamazepine, chrlopropamide, clofibrate. Correct Na, Ca, K disorders, Thiazide diuretics and salt restriction.
Crystalloid. 100% ECF. 0% Intracellular. 154, isotonic.
Colloid. 100% in IV space. So 100% ECF. 130-160, isotonic.
Is LR a colloid or crystalloid? How is it distributed? Amount of sodium and tonicity?
Is D5W a colloid or crystalloid? How is it distributed? amount of sodium and tonicity?
3% nacl sodium and tonicity?
Crystalloid. 100% ECF. Isotonic, 130.
Crystalloid. most common free water source, follows 60% ICF, 40% ECF(25% IV, 75% IS) rule. 0 and hypotonic.
513, hypertonic.
In sodium disorders where would you see dehydration? Treatment? What is the range you have to titrate them at?
Edema?
What is SIADH also known as?
Hypo, Hypo, Hypo. 9% NaCl. 6-12 mEq/D
Hypotonic, Hypervolemic, hyponatremia.
Hypotonic, Euvolemic, Hyponatremia. If acute use 3% NaCl until no longer symptomatic.
What is the key for hypervolemic and hypernatremia causes?
What can cause hypo-na?
Treat hypo-na?
Tube feedings.
Thiazides, desmopressin, NSAIDS, carbamazepine, SSRI’s, Antipsychotics.
demeclocycline, hypertonic saline, desmopressin, conivaptan, furosemide
What can cause hyper-na?
treats hyper-na?
What is the hypovolemic hypernatremia treatment max?
lithium, demeclocycline, hypertonic saline, furosemide, sodium bicarb.
thiazides, furosemide, carbamazepine
10-12 mEq/L.
