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CLIN MED3: GU/Renal > Electrolyte Disorders > Flashcards

Electrolyte Disorders Flashcards

(65 cards)

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1
Q

What is the normal serum osmolality

A

280-295mOsm/kg

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2
Q

what is Osmolality

A

concentration of all particles in water (body fluid)

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3
Q

what is tonicity

A

osmotic pressure caused by particle restriction to one side of the cell membrane

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4
Q

what are the values of isotonic

A

280 - 295 mOsm/kg

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5
Q

what are the values of hypotonicity

A

<280 mOsm/kg

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6
Q

what are the values of hypertonicity

A

> 300 mOsm/kg

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7
Q

what is normal sodium levels

A

135-145 mEq/L

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8
Q

what is sodiums function in the human body

A

conduct nerve impulses
contraction of muscles
tonicity

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9
Q

what is the concentration of hypnatremia

A

<135 mEq/L

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10
Q

what is most hyponatremia secondary to

A

dilution, not low total sodium

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11
Q

what are the three types of hyponatremia

A

isotonic hyponatremia
hypotonic hyponatremia
hypertonic hyponatremia

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12
Q

what is another name for isotonic hyponatremia

A

psuedohyponatremia

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13
Q

what are common causes of isotonic hyponatremia

A

elevated triglycerides
elevated LDL
Hyperproteinemia from Multiple Myeloma

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14
Q

what is the treatment of isotonic hyponatremia

A

treat hypertriglyceridemia and/or LDL
-statin, fibrates, niacin, fish oil
Multiple Myeloma
- immunotherapy

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15
Q

What is another name for hypertonic hyponatremia

A

translational hyponatremia

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16
Q

what is hypertonic hyponatremia

A

hyponatremia (< 135) with high osmolality (>280-295)

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17
Q

what is hypotonic hyponatremia defined as

A

serum sodium < 135 and low serum osmolality < 280

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18
Q

how is hypotonic hyponatremia further classified

A

by volume status:
-hypovolemia hypotonic hyponatremia
- euvolemic hypotonic hyponatremia
- hypervolemic hypotonic hyponatremia

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19
Q

what is hypovolemic hypotonic hyponatremia

A

result of renal or extra renal volume loss with hypotonic fluid replacement
ADH stimulated to maintain intravascular volume

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20
Q

what are the causes of hypovolemic hypotonic hyponatremia

A

extra renal salt loss: dehydration, diarrhea, vomiting
renal salt loss: diuretics, ACEIs, kidney disease, mineralocorticoid (aldosterone) deficiency, cerebral salt wasting

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21
Q

What is euvolemic hypotonic hyponatremia primarily related to

A

ADH dysfunction or free water replacement of losses

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22
Q

what are the causes of euvolemic hypotonic hyponatremia

A

wide range:
adrenal insufficiency
SIADH
Hypothyroidism
thiazide diuretics
NSAIDs
ACEIs
etc.

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23
Q

what is hypervolemic hypotonic hyponatremia

A

related to edema and third spacing
reduced intra-vascular volume - ADH secretion in attempt to maintain
results in retention of free water, fluid overload, dilutional hyponatremia

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24
Q

what are causes of hypervolemic hypotonic hyponatremia

A

cirrhosis
heart failure
nephrotic syndrome
advanced kidney disease (impaired in water excretion)

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25
what are severe symptoms of hyponatremia
seizure, coma, respiratory arrest
26
what are mild to moderate symptoms of hpyonatremia
headache, fatigue, lethargy, N/V, dizziness, ataxia, confusion and muscle cramps
27
what labs should be ordered for hyponatremia
serum electrolytes (CMP/CMP) Creatinine serum osmolality urine osmolality - thyroid function, LFTs, adrenal function testing
28
what are signs of hypovolemia
diminished BP and pulses tachycardia decreased skin turgor
29
what are the signs of hypervolemia
JVP edema orthopnea
30
what iis the treatment of hypotonic hyponatremia
restriction of free water or hypotonic solutions
31
what is the reatement of hypovolemic hypotonic hyponatremia
volume resuscitation isotonic fluids: LR or normal saline
32
what is the treatment of hypervolemic hypotonic hyponatremia
reduce volume diuresis with loops, dialysis or both
33
What is the treatment of isotonic hyponatremia
treat underlying cause: lower cholesterol, tx other protein pathologies check lab for potential lab errors
34
what is the treatment of hypertonic hyponatremia
correct glucose: insulin, isotonic fluid:NS discontinue any offending agents: mannitol, osmotic laxatives
35
when do you admit patients with hyponatremia for treatment
symptomatic patients or severe hyponatremia
36
what is the risk of rapid correction of hyponatremia
osmotic demyelination syndrome (ODS)
37
What is osmotic demyelination syndrome (ODS)
rapid rise in sodium concentration pulls water from the brain results in cerebral demyelination (can occur outside the pons) symptoms are progressive and often irreversible
38
what are symptoms of ODS
AMS weakness or paryalysis in arms and legs stiffness impaired sensation difficulty with coordination coma "locked in" syndrome death
39
what is the treatment of ODS
supportive care IV NS/5% dextrose DDAVP Plasmapheresis (?)
40
what are the different types of hypernatremia
always hyperosmolar state hypovolemic - loss of TBW >> sodium euvolemic - free water deficit hypervolemic - pure sodium increase (and water follows)
41
what are the primary causes of hypernatremia
free water loss hospitalized/institutionalized pt without free water access excess sodium intake (rare) primary hyperaldosteronism (usu mild and asymp)
42
what are symptoms of hypernatremia
signs of dehydration: orthostasis, oliguira lethargy, irritability, weakness are early signs hyperthermia, delirium, seizures, coma if severe sodium > 185
43
what test can be used to help identify cause of water losses
Fractional excretion of sodium FENa
44
what is the treatment of hypernatremia
admit symptomatic pts correct any cause of fluid loss hypovolemia - isotonic NS fluid Euvolemia- D5W - excretion of excess sodium in urine hypervolemia - D5W + diuretics
45
what is normal potassium levels
3.5 to 4.5 mEq/L
46
what is the function of potassium in the human body
maintain ICF maintain electrochemical gradient muscle contraction balance of pH nerve signal transmission cardiac refractory period
47
what is the lab volume that indicates hypokalemia
serum potassium < 3.5 mEq/L
48
what can hypokalemia be due to
inadequate intake movement of K+ from ECF -> ICF extra-renal K+ losses Renal K+ losses
49
what are causes of extrarenal K+ losses
diarrhea, vomiting, laxative abuse, Zollinger-Ellison syndrome, villous adenoma
50
what are causes of Renal K+ losses
aldosterone, loop diuretics, Cushings syndrome, renin-producing tumor dependent on Mg+ movements
51
what are symptoms of Hypokalemia
muscular weakness, fatigue, muscle cramping constipation or ileus if severe: flaccid paralysis, hyporeflexia, hypercapnia, tetany, rhabdomylosis
52
what diagnostic test can help ID causes of K+ losses
urinary potassium concentration < 20 mEq/L = extrarenal losses > 40 mEq/L = renal losses
53
what can be seen on EKG with hypokalemia
broadening of T waves prominent U waves PVCs depressed ST segments
54
what is the treatment of hypokalemia
oral supplementation (dietary/diuretic associated losses) IV potassium repletion (if severe)
55
what is the value for hyperkalemia
Potassium level > 5 mEq/L
56
what are causes of hyperkalemia
decreased K+ excretion (renal disease) shift of K+ from ICF- ECF excessive K+ intake pseudo-hyperkalemia
57
what are the signs/symptoms off hyperkalemia
muscle weakness urine, oliguria, anuria respiratory distress Decreased cardiac contractility ECG changes Reflexes, hyperreflexia or areflexia (flaccid)
58
what can you see on EKG with Hyperkalemia
Bradycardia prolonged PR interval Peaked T waves QRS widening Biphasic QRS complex
59
what is the treatment of hyperkalemia
withhold exogenous K+ ID and treat underling cause correction of hyperkalemia: shift K+ back to ICF, remove K+ from body, dialysis
60
what is a hyperkalemic emergency
muscle weakness/paralysis EKG changes and/or serum potassium > 6.5mEq/L
61
what is the treatment of a hyperkalemic emergency
calcium insulin, sodium bicarbonate, albuterol hemodialysis if due to renal disease/severe symptoms/serum K potassium binding medications Diuretics
62
What are potassium bidning medicatiosn
SCZ (Lokelma) Patriomer (veltassa)
63
what are the complications of hypotonic fluid
cell lysis - dont give wiht blood products diluation hyponatremia if prone to water retention risk of elevated ICP can exacerbate hypotension and hypovolemia
64
what are the indications for hypertonic fluid
Hyponatremia (NaCl) when we need calories too osmotic diuresis hypoglycemia
65
what are the complications of Hypertonic fluid
ICF - intravascular and interstitial -fluid overload pulmonary edema (3rd spacing) hyperglycemia if includes dextrose

CLIN MED3: GU/Renal (11 decks)

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