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PT: Nutrition Exam 2 > Electrolytes > Flashcards

Electrolytes Flashcards

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1
Q

Most K+ is located where in the body? Does this affect replacement frequency?

A

In the cells; Yes, you may need multiple bolus administrations to bring serum K+ up to normal when in a deficit due to unknown deficit in the tissues

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2
Q

As pH increases, how is K+ affected? pH decrease?

A

Increase in pH = more K+ into cell (Hypokalemia risk)

Decrease in pH = more K+ into serum (Hyperkalemia risk)

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3
Q

How does low K+ affect insulin? high K+?

A

Low K+ = inhibition of insulin release

High K+ = increased release of insulin

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4
Q

Hypokalemia severity classification

A

[K+] <3.5

a. Mild to Moderate = 3.5 to 2.5
b. Severe = <2.5

Digoxin therapy: Less than 3.5 = concern

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5
Q

Signs/Symptoms of hypokalemia

A
  1. muscle weakness
  2. myalgia
  3. decreased tendon reflex
  4. cardiac symptoms
    - HTN / EKG abnormalities / Arrhythmias
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6
Q

When do you initiate drug therapy of K+?

A

If patient is symptomatic

If patient has [K+] < 3.0 mEq/L (<3.5 for digoxin pts)

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7
Q

Whats the usual adult dosage for K+ supplementation?

A

20 to 80 mEq PO QD

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8
Q

Who should we be careful with K+ supplementation? Why?

A

Diabetics = insulin release issues
ACE-Inhibitor pts = may induce HYPERkalemia
Renal dysfunction = decreased excretion

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9
Q

K+ Infusion rate rules:

A

<10 mEq/hr does not need telemetry
10 to 20 mEq/hr requires telemetry
Max IV rate of K+ = 20 mEq/hr

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10
Q

Primary Intracellular electrolytes

A

Potassium
Magnesium
Calcium

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11
Q

Primary Extracellular electrolytes

A

Sodium
Bicarbonate
Chloride

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12
Q

What electrolyte problem must you correct to reduce K+ wasting?

A

hypomagnesemia; K+ needs Mg2+ for absorption

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13
Q

Hyperkalemia severity classification

A

Moderate: [K+] > 5.5 + T wave peak/PR prolongation
Severe: [K] > 7 + Prolonged QRS/VFib
Complete block @ [K+] conc. > 8mEq/L

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14
Q

How do you treat a symptomatic HYPERkalemic patient?

A
  1. IV Calcium STAT: 1 g push
  2. Insulin and GLU: promote increase K+ to cells and prevention of hypoglycemia via increased insulin release
  3. Loop diuretics to increase excretion
  4. Kayexelate to increase excretion
  5. Hemodialysis to excrete excess
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15
Q

Hypomagnesemia Signs/Symptoms

A

CNS: lethargy, weakness, confusion
CV: V-tach, V-fib, ventricular premature contraction

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16
Q

Treatment for Hypomagnesemia

a. Symptomatic and [Mg] <1
b. [Mg] <1 mg/dL w/o symptoms
c. [Mg] >1 mg/dL w/o symptoms

A

a. IV Mag Sulfate: 2 gram bolus + 0.5 to 1 mEq/kg/day to replenish stores over 2-5 days
b. . IV Mag Sulfate: No bolus! - continuous infusion
c. Oral Mag Supplement: Mag Oxide 400 to 800 mg QID

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17
Q

Hypermagnesemia Signs/Symptoms

A 
[Mg] > 8.0 mg/dL
Absent deep tendon reflexes
Muscle weakness
Sedative-like effect
Vasodilation
Diarrhea
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18
Q

Treatment for Hypermagnesemia

A

Discontinue magnesium treatment
Use Calcium to reverse effects
Give diuretic to promote excretion

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19
Q

Hypocalcemia severity classification

A

Mild to Moderate = <8.5 to 6.0mg/dL

Severe = Total serum [Ca] <6.0 mg/dL

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20
Q

Hypercalcemia severity classification

A

Mild to Moderate = >10.5 to 13 mg/dL

Severe = Total serum [Ca] >13 mg/dL

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21
Q

Calcium is 50% bound to what in the plasma? What does this influence?

A

ALBUMIN

  1. amount of active calcium
  2. pH of the blood is raised as more calcium is BOUND
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22
Q

What hormone increases calcium reabsorption to raise levels to normal?

A

PTH: Parathyroidhormone

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23
Q

What medication is a common cause of elevated calcium levels?

A

THIAZIDE DIURETICS

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24
Q

Hypercalcemia Signs/Symptoms

A 
[Ca] > 10.5
Constipation, Nausea and Vomiting
Others:
Confusion
lethargy
weakness
HYPOreflexia
Renal chg: polyuria &amp; stones
CVD: HTN, heart
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25
Treatment of Hypercalcemia: [Ca] >12 or symptomatic
a. Hydration + mobilization: 0.9% NaCl bolus with LOOP diuretic that reduces calcium reabsorption b. Calcitonin = inhibits osteoclasts + increased renal excretion - Aredia/Zometa bisphosphonates c. Hemodialysis d. Sensipar = PTH gland receptor
26
Hypocalcemia Signs/Symptoms
``` [Ca] = <8.5 mg/dL High albumin levels Acute: Neuromuscular and Cardiac symptoms - Cramping - Spasms (eye twitch) Chronic: confusion, hair loss, psoriasis ```
27
Treatment for hypocalcemia a. Acute, Symptomatic b. Chronic
a. Ca-gluconate 3gm OR CaCl2 1gm IV push | b. Oral calcium/Vit D supplementation
28
A patient with end-stage renal disease has high albumin in the plasma. What is the concern with measured calcium levels?
Must correct calculated [Ca] using equation provided to re-assess whether there is a deficit or surplus of [Ca]
29
Hyperphosphotemia severity classification
``` Mild = >4.6 to 6.5 mg/dL Moderate = >6.5 to 7 mg/dL Severe = >7.0 mg/dL ```
30
Hyperphosphotemia Signs/Symptoms
``` [P] >4.6 Precipitation with Calcium = deposits in the arteries *Similar to HYPOcalcemia** Neuromuscular and Cardiac symptoms - Cramping - Spasms (eye twitch) Confusion, hair loss, psoriasis ```
31
Treatment of Hyperphosphotemia
AVOID PROCESSED FOODS, Renagel
32
Hypophosphotemia severity classification
``` Moderate = <2.5 to 1 mg/dL Severe = <1.0 mg/dL ```
33
Treatment for hypophosphotemia
Moderate: Oral Supplement - Neutra-phos K 1.25 g PO BID to TID Severe: 0.2 mmol/kg over 3 to 12 hours
34
Where is the majority of sodium located in the body?
Extracellular Fluid
35
Hyponatremia severity classification
Large, rapid changes = More severe Mild = < 134 mEq/L Moderate = <120 mEq/L Severe = <115 mEq/L
36
Hyponatremia Signs/Symptoms
Mild: Confusion, headache, agitation, nausea, vomiting | Mod to Sev: Seizures, coma, death
37
Treatment of Hyponatremia
Limit of 8 to 12 mEq/24 hours (0.33 to 0.5 mEq/hour) | Fluids: Restriction v 0.9% NS v 3% NaCl
38
What is Euvolemic hypotonic hyponatremia?
Having appropriate hydration but low osmolality and low sodium concentrations in the blood
39
SIADH
Syndrome of Inappropriate anti-diuretic hormone - Xs production of ADH - Xs water reabsorption Causes: SSRIs/SNRIs + Ecstasy Treatment: Only if [Na+] < 115 mEq/L - 3% NaCl to correct deficit - Chg in diuretic - Fluid restriction
40
How do you treat HYPOvolemic hypotonic hypernatremia?
Symptomatic: Start with 0.9% NS 200 - 300 mL/hour then use D5W (free water) and/or lower NS conc. ``` No symptoms: Use D5W (free water) and/or lower NS conc. + remove diuretics ```
41
Diabetes insipidus may result in which sodium alteration? Which fluid replacement would you use?
ISOvolemic Hypernatremia | Use D5W due to ICF loss = ECF loss
42
Hypernatremia severity classification
Mild to Moderate = >145 to 160 mEq/L | Severe = >160 mEq/L
43
Hypernatremia Signs/Symptoms
Mild to Moderate: polyuria and polydypsia Severe: Neurological distrubances - Confusion, rigidity, tremor, coma
44
% body water trend with age
Decreases with age (75-85% in newborns)
45
% body water trend with increasing body fat
Decreases
46
For each 1 mEq decrease in serum [K+] below 3.5 mEq/L, the total body K+ deficit is ___ mEq
100-400 mEq
47
Acidosis effect on K+
Increases serum K+ as H+ is exchanged for K+ in the blood
48
Alkalosis effect on K+
Decreases serum [K+] as it drives it into cells (in exchange for H+ into the blood)
49
Insulin/K+ relationship
1. Hyperkalemia induces insulin release, which facilitates K+ movement into cells (+ Na/K ATPase activity) 2. Hypokalemia inhibits insulin release
50
Why might diuretics cause hyperglycemia in Type II diabetics?
Hypokalemia (diuretics cause loss of K+) inhibits the release of insulin, putting patient at risk for hyperglycemia
51
Beta-agonist/K+ relationship (albuterol, epinephrine)
1. Increases Na/K ATPase activity, which drives K into cells | 2. Increases glycogenolysis, which increases glucose and insulin, drives K+ into cells
52
Aldosterone/K+ relationship
Promotes K secretion @ distal convoluted tubule and collecting duct (increases Na/K ATPase activity, which keeps Na/water)
53
``` CAUSES: inadequate intake Cellular shifting vomiting NG suction Diarrhea Diabetic ketoacidosis ```
Hypokalemia
54
Drug-induced: amph B Laxatives Steroids Loop diuretics**
Hypokalemia
55
Mild-moderate hypokalemia: mEq/L
2.5-3.5 mEq/L
56
Severe/critical hypokalemia: mEq/L
<2.5 mEq/L
57
Who are we especially worried about when we see hypokalemia?
Digoxin users | Those with pre-existing arrhythmias
58
S/S of hypokalemia are not usually seen until [K+] < ____ mEq/L
3 mEq/L
59
"Patient complaints" of hypokalemia: (<3 mEq/L)
Muscle weakness Decreased tendon reflex Myalgia
60
EKG abnormalities of hypokalemia=
ST depression Inverted T waves Elevated U waves
61
``` Clinical observations: Cardiac arrhythmias EKG abnormalities Digoxin toxicity HTN ```
Hypokalemia
62
Non-symptomatic patient's [K+]= 3-3.5 mEq/L...treatment?
Non-pharmacologic intervention is OK | Diet switch to higher potassium foods (bananas, meat, broccoli, nuts)
63
Patient's [K+] < 3 mEq/L...treatment Y/N?
Yes
64
Patient is symptomatic of hypokalemia...do you proceed with treatment, Y/N? (Regardless of K lab value?)
Yes
65
Digoxin user with [K+]< ___ mEq/L warrants treatment.
< 3.5 mEq/L
66
5 general treatments for hypokalemia
1. Oral replacement products 2. IV replacement (NPO or moderate-severe deficiency) 3. K+ sparing diuretic (for diuretic-induced hypokalemia) 4. Correct hypomagnesemia 5. Evaluate acid/base balance
67
Preferred treatment for hypokalemia: Dose ADEs Caution IN
Oral replacement products (KCl, KPO4, K-acetate, K-citrate, K-gluconate) 20-80 mEq daily (for adults) Tastes like shit, N/V, gas, diarrhea Caution in diabetics, ACE-inhibitors, renal dysfunction
68
Treatment for hypokalemia for patients with NPO or symptomatic/severe deficits:
(<2.5 mEq/L) | IV replacement
69
IV replacement for hypokalemia infusion rate MAX
20 mEq/H (40 for life threatening situations only)
70
IV replacement for hypokalemia infusion rate with telemetry monitor (ICU)
10-20 mEq/H
71
IV replacement for hypokalemia infusion rate on non-telemetry wards
≤ 10 mEq/H
72
For diuretic-induced hypokalemia, which drug treatment could be considered? Who should this NOT be used for (or used with caution)?
K+-sparing diuretics | Diabetics, ACE-inhibitors, renal dysfunction (increased risk for HYPERkalemia)
73
What is the timeline of monitoring in a stable patient with oral therapy for hypokalemia? For a hospitalized patient with IV therapy?
Monthly...daily/PRN (read the room)
74
``` Some causes include... Acute renal failure Blood stored for long periods of time Addison's disease Massive tissue damage Salt substitutes ```
Hyperkalemia
75
``` Drug-induced = K+ sparing diuretics NSAIDs ARBs ACE-inhibitors K+ supplements ```
Hyperkalemia
76
Main S/S of hyperkalemia:
CARDIOVASCULAR
77
Normal K= 3.5-5 mEq/L Moderate hyperkalemia: > ___ mEq/L EKG abnormalities=
> 5.5 mEq/L T waves peak PR prolongation
78
Severe hyperkalemia: ___ mEq/L | EKG abnormalities/arrhythmias=
7-8 mEq/L QRS complex prolongation V-fib
79
With [K+] at 8-10 mEq/L, what S/S would you expect?
Complete heart block Asystole (BAD, FATAL)
80
What is pseudohyperkalemia? Treatment?
False hyperkalemia finding due to bad blood sample with traumatized RBCs
81
List the 8 treatments for hyperkalemia in a symptomatic patient (general!)
1. IV calcium chloride 2. Insulin +/- glucose 3. Albuterol 4. Sodium bicarbonate 5. Elimination of K+ source 6. Loop diuretics 7. Polymeric exchange resins (Kayexelate, patiromer, Veltassa, ZS-9) 8. Hemodialysis
82
Why is calcium chloride given to symptomatic patients with hyperkalemia? What is the dose?
Counteracts K's effect on neuromuscular membranes (protects the heart!) 1 g IV push, repeated 5-10 minutes if no effect Repeated as needed as effect wears off
83
Why is insulin given to symptomatic patients with hyperkalemia? Dose?
Insulin promotes K+ entry into cells | 10-20 Units of short-acting insulin
84
If insulin is being administered to a hyperkalemic patient, should glucose be given also? If yes, why? Dose?
Yes, glucose is added if blood glucose is low or at normal levels to prevent hypoglycemia. 25 g of 50% dextrose solution given over 30 minutes (also stimulates endogenous insulin release!)
85
What could be given to a hyperkalemic patient exhibiting symptoms and acidosis? Why? Dose:
Sodium bicarbonate Promotes K+ entry into cells (acidosis pushes K+ into blood, alkalosis pushes K+ into cells) 50-100 mEq IV push
86
Should loop diuretics be given to patients with symptomatic hyperkalemia? Why, or why not?
Yes... and no. They promote renal elimination of K+, but their full effect occurs in 1-2 hours. Other interventions should be done along with this. Not suitable for renally impaired patients.
87
List 3 polymeric exchange resins used for hyperkalemia
1. Sodium polystyrene sulfonate (Kayexelate) 2. Patiromer (Veltassa) 3. Sodium zirconium cyclosilicate (FDA approval pending)
88
``` Sodium polystyrene sulfonate (Kayexelate): Indication Dose MOA Onset Contraindication ```
``` Hyperkalemia in symptomatic patients 15-60 g SPS powder in water PO or PR Exchanges ~ 1 mEq K for ~1 mEq Na Onset in ~ 1 hour, may repeat Q4H Avoid with GI immobility or dysfunction ```
89
``` Patiromer (Veltassa): Indication Dose Onset ADEs DDIs ```
Chronic hyperkalemia (symptomatic patient) 8.4, 16.8, 25.2 g packets for suspension Delayed onset!! (Not for acute hyperkalemia) ADEs= constipation, hypermagnesemia (5-10%) DDIs= administer 6 hours apart from other drugs
90
What is the indication for hemodialysis in a patient with hyperkalemia?
Used for more emergent cases (probably rare though?) or chronic/long-term use (patients already on hemodialysis)
91
Hyperkalemia treatment in asymptomatic patient:
1. Eliminate the K+ source 2. Loop diuretics (1-2 hours onset) 3. Patiromer (delayed onset, chronic cases)
92
Calcium normals= 8.5-10.5 mg/dL | What are the critical values (total Ca)?
< 6 mg/dL | > 13 mg/dL
93
Calcium (free/ionized) critical values | Normals= 1.18-1.30 mmol/L
< 0.9 | > 1.6
94
How is Ca binding to albumin influenced by pH? How much is normally bound to albumin?
Alkalosis increases binding, 50% bound
95
Corrected Ca=
(4-current albumin)*0.8 + (current Ca)
96
Causes of hypercalcemia (5)
``` Hyperparathyroidism Lung/breast cancer Vitamin D toxicity Calcium carbonate toxicity (or just excess administration?) Thiazide diuretics ```
97
Patient complaints of hypercalcemia usually do not occur until [Ca2+] > ___ mg/dL
> 13 mg/dL
98
Confusion, lethargy, weakness, hyporeflexia, polyuria, renal stones Short QT, V-tach, atherosclerosis, HTN, *constipation, N/V*
S/S of hypercalcemia
99
List the treatment options for hypercalcemia (Ca > 12 mg/dL or symptomatic) (7)
1. Hydration with 0.9% NaCl given by infusion or bolus, then a loop diuretic 2. Calcitonin 3. Hemodialysis 4. Bisphosphonates (delayed, but prolonged effect) 5. Glucocorticoids (in cancer) 6. Calcimimetic (Cinacalcet) 7. Monoclonal Ab (denosumab)
100
What is the indication for calcitonin? Administration? MOA?
HYPERcalcemia Intranasal or parenteral (CAUTION: ALLERGY TEST BEFORE) Inhibits osteoclasts and promotes renal excretion of calcium
101
Hypercalcemia treatment with a delayed, but prolonged effect | Inhibits osteoclast activity
Bisphosphonates
102
Hypercalcemia treatment more indicated for cancer/non-emergent cases: MOA?
Glucocorticoids | Tumor lysis, decrease Ca absorption from GI, inhibit vitamin D synthesis
103
Hypercalcemia treatment for renal disease or parathyroid cancer patient: MOA?
Calcimimetic= Cinacalcet (Sensipar) | Binds Ca-sensing receptor on parathyroid gland and increases its sensitivity to Ca (decrease PTH, decreases serum Ca)
104
Cinacalcet (Sensipar): Indication Monitoring DDIs
``` Hypercalcemia (renal disease, parathyroid cancer) Monitor PTH/Ca/PO4 weekly until maintenance dose, then every 1-3 months CYP3A4 substrate (erythromycin, -azoles) CYP2D6 inhibitor (tri-cyclics, flecainide) ```
105
Indicated for osteoporosis & bone tumors, with an off-label indication for hypercalcemia: Dose? MOA? Cautions?
Monoclonal Ab- denosumab (Prolia, Xyera) 60 mg SQ every 6 months Binds RANKL, inhibits osteoclasts, inhibits Ca release Caution with CrCl < 30
106
Asymptomatic hypercalcemia, Ca < 12 mg/dL treatment:
Observe/monitor | Correct reversible causes
107
Can be caused by drugs, such as furosemide, bisphosphonates, phenobarbital/phenytoin Hypomagnesemia Renal failure Hypoparathyroid hormone
Hypocalcemia
108
Hypocalcemia labs: | Normals= 8.5-10.5, 1.18-1.3
Total Ca < 8.5 mg/dL | Ionized serum Ca < 1.1
109
Acute hypocalcemia S/S:
``` Neuromuscular & cardiac: Tetany** Paresthesia Cramping Spasms ```
110
Chronic hypocalcemia S/S:
CNS & skin: Confusion Hair loss Psoriasis
111
Treatment for acute hypocalcemia (or symptomatic):
1. Treat underlying condition | 2. 3 g calcium gluconate OR 1 g calcium chloride by slow vein push (over 10 minutes)
112
Treatment for non-acute hypocalcemia:
Oral daily supplements of calcium (1-3 g elemental Ca) & vitamin D (0.5-3 mcg 1,25 dihydroxyvitamin D3)
113
``` Ca acetate= __% calcium, __ mEq Ca/g Ca carbonate= ___ % calcium, __ mEq Ca/g Ca ___= 6.5% calcium, 3.3 mEq Ca/g Ca gluconate = ___ % calcium, 4.5 mEq Ca/g Ca ___= 21% calcium, 10.5 mEq Ca/g ```
``` 25%, 12.5 40%, 20 Glubionate 9%, 4.5 Citrate ```
114
``` Causes: Acute/chronic renal failure Excess administration Hypoparathyroidism Rhabdomyolysis Diabetic ketoacidosis ```
Hyperphosphatemia
115
Moderate hyperphosphatemia | Normal= 2.7-4.6 mg/dL
> 6.5 mg/dL
116
Severe hyperphosphatemia | Normal= 2.6-4.6 mg/dL
> 7 mg/dL
117
S/S of hyperphosphatemia:
X-ray CaPO4 deposits (Ca x PO4 > 55 at risk) | Hypocalcemia (due to Ca precipitation...tetany, paresthesia, cramping, spasms, confusion, hair loss, psoriasis)
118
Treatment for severe hyperphosphatemia (> 7 mg/dL):
IV calcium (to form CaPO4 precipitates)
119
Treatment for mild/moderate hyperphosphatemia
``` Phosphorous binders Dietary restriction (low protein) ```
120
Examples of phosphorus binders. | Indication?
Sevelamer (Renagel) Lanthanum carbonate (Fosrenal) Sucroferric oxyhydroxide (Velphoro) Hyperphosphatemia
121
``` Causes: Malnourishment (re-feeding) Acute respiratory alkalosis Diabetic ketoacidosis Antacids ```
Hypophosphatemia
122
S/S: hemolysis, leukocyte dysfunction, muscle weakness, rhabdomyolysis, irritability, weakness, seizures, coma
Acute hypophosphatemia
123
S/S of chronic hypophosphatemia:
Bone pain | Osteomalacia
124
Treatment for moderate hypophosphatemia (1-2.5 mg/dL):
Oral therapy (Neutra-phos 1.25 g BID-TID or Fleets phospho soda)
125
Treatment for severe hypophosphatemia (< 1 mg/dL)
IV therapy | 0.2 mmol/kg over 3-12 hours
126
Associated causes are renal disease, SIADH, CHF, cirrhosis
Hyponatremia
127
Associated causes are renal disease, adrenal disease, diabetes insipidus
Hypernatremia
128
Mild hyponatremia labs | Normal= 134-145 mEq/L
< 134 mEq/L
129
Moderate hyponatremia labs | Normal= 134-145 mEq/L
< 120 mEq/L
130
Critical hyponatremia labs | Normal= 134-145 mEq/L
< 115 mEq/L
131
S/S: mild- headache, confusion, agitation, N/V, disorientation
Hyponatremia
132
S/S: moderate-severe- seizures, coma, death
Hyponatremia
133
Rule for serum Na correcting:
No more than 8-12 mEq/L per 24 H or else there is risk for central pontine myelinolysis
134
Calculating the sodium deficit in HYPOnatremia:
(Na,desired-Na,current)*(body water)= mEq to replace
135
``` % H20: Child Male <70 Male ≥ 70 Female < 70 Female ≥ 70 ```
0. 6, 0. 6, 0. 5, 0. 5, 0. 45
136
Once you calculated the Na deficit (mEq to replace), how do you find the infusion rate of 3% NaCl? When to use this fluid?
513 mEq= X Na deficit to replace (mEq) 1000 mL. Y mLs Y mls/24 hour= infusion rate Use 3% NaCl when patient is hyponatremic AND euvolemic (or doesn't need excess fluid)
137
Once you calculated the Na deficit (mEq to replace), how do you calculate the infusion rate of 0.9% NaCl? When would you use this fluid?
154 mEq = X Na deficit to replace (mEq) 1000 mL. Y mls Y mls/24 hours= infusion rate Use 0.9% NaCl when patient is hyponatremic and hypovolemic (or needs more fluids)
138
Calculate the change in [Na] if 1 L of 3% NaCl was administered: UNITS?
``` *(IV,na-S'na)/(BW + IV,vol)= mEq/L* IV,na= [Na] of infusion, 513 mEq/L S'na= initial [Na] of patient BW= body water IV, vol= 1 L ```
139
Calculate the change of [Na] if 1 L of 0.9% NaCl was administered:
``` (IV,na-S'na)/(BW + IV,vol)= mEq/L IV,na= [Na] content of infusion, 154 mEq/L f S'na= initial [Na] of patient BW= body water IV, vol= 1 L ```
140
How do you calculate the infusion rate after finding the change in [Na] after 1 L of fluid administered?
Solved X Na change mEq= *desired change in [Na]* 1000 mls. Y mL Y ml/24= infusion rate
141
Hypotonic hyponatremia (serum Osm < 280 mOsm): euvolemia causes
``` Water intoxication (either too much intake or decreased excretion) SIADH (too much ADH, too much water reabsorption) ```
142
Condition caused by SSRIs and SNRIs, MDMA, and ecstasy
SIADH (syndrome of inappropriate anti-diuretic hormone) with too much production of ADH Euvolemic hypotonic hyponatremia
143
Condition caused by NSAIDS, hypoglycemic agents (1st gen.), carbamazepine, cyclophosphamide
SIADH (syndrome of inappropriate anti-diuretic hormone) with increased renal sensitivity Euvolemic hypotonic hyponatremia
144
Treatment of ACUTE euvolemic hyponatremia (hypotonic): | Na levels < ____ mEq/L and/or symptomatic
< 115 mEq/L 3% NaCl infusion +/- diuretics Fluid restriction (not ideal)
145
Treatment of non-acute euvolemic hyponatremia (hypotonic): | Na levels > ___ mEq/L and/or asymptomatic
``` > 115 mEq/L Fluid restriction Chronic therapy OF.... Diuretics Salt or urea tabs Demeclocycline (SIADH go-to) ADH receptor antagonist (conivaptan IV, tolvaptin oral) ```
146
``` Hypervolemic hypotonic hyponatremia: EABV Conditions Water relation to Na Kidney response ```
Decreased EABV CHF, cirrhosis, nephrosis Water >> Na Kidney senses volume depletion (edema), so aldosterone levels are increased
147
Treatment of hypervolemic hyponatremia (hypotonic, 4 steps):
1. Treat underlying disease 2. Diuretics (spironolactone would counter aldosterone increase) 3. Increase oncotic pressure (help with edema) 4. Fluid restriction
148
Hypovolemic hyponatremia (hypotonic) has high urine osmolarities. If sodium content in urine is HIGH, this indicates:
Kidneys are the problem (renal losses) Diuretics Adrenal insufficiency
149
Hypovolemic hyponatremia (hypotonic) has high urine osmolarities. If sodium content in urine is LOW, this indicates:
Kidneys are functioning properly | GI/skin/lung loss
150
Hypovolemic hyponatremia (hypotonic) treatment
Volume replacement with 0.9% NaCl
151
``` Loss of water Associated causes: Diabetes insipidus Skin losses Osmotic diuresis Polydipsia ```
Isovolemic HYPERnatremia
152
Associated causes: sodium overload, mineralcorticoid excess
Hypervolemic HYPERnatremia
153
Associated causes: renal loss, adrenal, GI/skin/lung loss Water loss >> Na loss Exercise, infection
Hypovolemic HYPERnatremia (dehydation)
154
Hypernatremia labs (+ critical)
> 145 mEq/L | > 160 mEq/L (CRITICAL)
155
Mild-moderate hypernatremia S/S:
Polyuria, polydipsia, thirsty
156
Severe hypernatremia S/S
``` *Neurologic* Confusion Rigidity Tremors Coma Stupor ```
157
Calculate the water deficit in a hypernatremic patient: Variables? Generally, what fluid is used?
Water deficit= TBW,current * [(S'na/S2na)-1] TBW, current= current weight * %h20 S'na= current serum Na S2na= desired [Na] D5W
158
Hypernatremia case: Water losses in ECF=ICF Usually asymptomatic
Isovolemic (most common)
159
Diabetes insipidis is associated with which type of hypernatremia?
Isovolemic
160
Diabetes insipidis with 3-15 L urine/day
Central DI (decreased ADH production)
161
DI with 3-4 L urine/day
Nephrogenic DI (decreased renal sensitivity)
162
``` These meds are associated with ___. Aminoglycosides Lithium Glyburide Colchicine Amph B Cisplatin Demeclocycline Methoxyflurane ```
Diabetes insipidis (isovolemic hypernatremia)
163
Treatment of isovolemic hypernatremia:
1. Replace water deficit with D5W - central DI maintenance= desmopressin - nephrogenic DI maintenance= NSAIDS, thiazides
164
Water and sodium excess treatment
(Hypervolemic hypernatremia) 1. Replace deficit with D5W (or lesser concentration of NaCl, or combination) 2. Loop diuretic to remove excess Na and water 3. Hemodialysis if renal failure
165
Water loss >> Na loss | Symptomatic treatment:
(Hypovolemic hypernatremia) 200-300 mL/H of 0.9% NaCl THEN replace water deficit with D5W (or less conc. Of NaCl or combo)
166
Water loss >> Na loss | Asymptomatic treatment:
(Hypovolemic hypernatremia) | D5W to replace water deficit (or less conc. NaCl or combo)

PT: Nutrition Exam 2 (10 decks)

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