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Electrolytes lecture Flashcards

1
Q

increase in total body fluid/Na

*increased weight; edema, ascites
ie HF

A

volume overload

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2
Q

wt loss, excessive thirst, postural hypotension and dry mucous membranes;
BOTH** water and salt are loss

ie..vomiting, diarrhea

A

volume depletion

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3
Q

refers to volume depletion with DISPROPORTIONATE WATER DEFICIT; may lead to increased Na, osmolality

A

dehydration

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4
Q

diarrhea; other heat related illnesses, fevers, vomiting

A

most common causes of dehydration

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5
Q

breakdown product of muscle energy metabolism; lower in women than men, reflects lean muscle mass. Good indicator of glomerular filtration.

A

Creatinine

0.6-1.2 mg/dL

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6
Q

end product of protein metabolism; excreted by kidney

A

blood urea nitrogen (BUN)

8-20 mg/dL

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7
Q

weakness, delerium, seizures

A

HYPOnatremia

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8
Q

arrhythmias, muscle weakness, cramps

A

HYPOkalemia

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9
Q

weakness, diarrhea

A

HYPERkalemia

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10
Q

cramps, arrhythmias, seizures

A

HYPOcalcemia

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11
Q

polyuria, constipation, lethargy/confusion

A

HYPERcalcemia

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12
Q

what is essential in patients with neuromuscular symptoms?

A

measurement of electrolytes

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13
Q

glucose, BUN, Cr, electrolytes (Na, K, Cl, HCO3), Ca, Mg, O2 sat

A

assessment of metabolic and renal status

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14
Q

Na under 130 meq/L

A

HYPOnatremia

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15
Q

most cases of HYPOnatremia result from ____ imbalance

A

water imbalance

NOT Na imbalance**

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16
Q

increased ADH secretion can lead to…

A

water reabsorption, and ultimately HYPO Na

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17
Q

very small increases in plasma osmolality (1-2%) result in…

A

ADH secretion

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18
Q

large changes in volume (5-10%), with concomitant decrease in BP, results in…

A

ADH release

  • mediated through baroreceptors in the circulation
  • free H20 is retained, leading to HypoNa
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19
Q

decreased Na with decreased extracellular volume can be caused by either….

*total body Na/H2O decreased

A

RENAL (diuretics) or EXTRARENAL (vomiting, diarrhea, volume loss)

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20
Q

ADH secretion is increased to maintain….

A

intravascular volume

*this drive OVERRIDES the need to sustain normal osmolality. pt often initially unable to take in adequate Na/H2O orally

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21
Q 
Pt has.....
decreased volume
total Na/H2O decreased
serum osmolal decreased
ADH secretion increased
renal status preserved
HYPOnatremia
HYPOkalemia

Rx?

A

isotonic fluids IV (normal saline/0.9% saline or ringers lactate) with KCL

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22
Q

If there is a mild volume decrease and oral intake intact…suggest what?

A

electrolyte drink (Gatorade) plus KCL

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23
Q

Hyponatremia with increased ECF seen in what kind of disorders?

A

Edema related*

ie…HF**, cirrhosis, nephrotic syndrome)

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24
Q

total body Na/H20 increased but CIRCULATING BLOOD VOLUME IS SENSED AS INADEQUATE BY BARORECEPTORS because of decreased CO and BP

A

Hypervolemic hypotonic HypoNa

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25
decreased cardiac output leads to decreased renal perfusion, which causes....
INCREASED ADH + activation of RAA system
26
Tx of hypervolemic HypoNa (i.e. HF, cirrhosis, nephortic syndrome)
Water restriction* diuretics tx underlying condition
27
``` euvolemic normal or mildly decreased Na serum osmolality decreased increased ADH secretion normal renal status hyponatremia increased urine osmolality ```
Euvolemic hypoNa *SIADH is the most common cause
28
Syndrome of inappropriate antidiuretic diuretic hormone secretion (SIADH) is the most common cause of...
euvolemic HypoNa
29
disorders of CNS (stroke), tumors (lung ca, others), pulmonary lesions (TB, lung abscess), drugs with ADH-like effects (SSRIs), post op pain, etc can all lead to...
Euvolemic HypoNa
30
Hyponatremia, decreased serum osmolality with inappropriate high urine osmolality is seen with...
Euvolemic HypoNa
31
* Absence of cardiac, liver, renal, adrenal or thyroid disease. * Urine Na greater than 20meq/L. Natriuresis (RAAS turned off) compensates for slight increase in volume from ADH. * Serum BUN and uric acid are low due to increased clearance (mild volume expansion).
SIADH
32
symptomatic HypoNa (Na under 120) is a....
medical emergency!!!
33
correction of hyponatremia must be done...
SLOWLY!! (less than 10-12 me/L/ day)
34
Osmotic demyelination of brainstem can occur if...
HypoNa correction occurs too quickly
35
Marked excess free H2O intake, greater than 10 L/d or more. *Seen in patients with psychiatric disease who may be on psychiatric meds (SSRI’s, others) that can interfere with H2O excretion.
psychogenic polydipsia
36
Euvolemia maintained via renal excretion of H2O and Na (urine Na more than 20 meq/L). * Serum ADH levels are low. * Urine osmolality is low.
Psychogenic polydipsia
37
post-op pain does what to ADH?
increased ADH secretion!
38
If post-op pt in pain receives hypotonic fluids, can cause....
severe HypoNa seizures HA
39
Treatment: Appropriate pain control with administration of isotonic fluids until patient able to take adequate fluids orally.
Post-op HypoNa
40
Seen with significant hyperglycemia in diabetics, especially if insulin dependent, with an acute rise in BS →↑osmolality. Water is drawn from cells into extracellular space
Hypertonic HypoNa
41
Na falls 2-4 meq/l for every 100mg/dL rise in glucose above 200mg/dL; resolves with insulin infusion and volume expansion.
Hypertonic HypoNa
42
20% of ambulatory and 50% of hospitalized patients with _____ have HypoNa
AIDS (HIV)
43
Pathophysiology: multiple mechanisms involved, often a combination of GI fluid and electrolyte loss along with inappropriate ADH secretion associated with CNS and/or pulmonary involvement from ____ infection.
HIV
44
Unusual with intact thirst mechanism and access to H2O. “Stranded in the desert/lost at sea.” *Appropriate H2O intake not possible (no H2O available or unconscious). Signs/Sx: Orthostatic hypotension, dehydration; oliguria.
HyperNa with concentrated urine
45
urine osmolality greater than 400 with intact renal function | *ADH levels increased
HyperNa with concentrated urine
46
Correct cause of fluid loss and replace volume, water and electrolytes as indicated. Replace water deficit slowly to avoid cerebral edema (brain cell adaptation to serum hyperosmolality). Fluid deficit should be replaced over 48-72 hours.
tx of HyperNa
47
CHF, nephrotic syndrome, renal failure, hepatic cirrhosis...all cause?
Hyponatremia with HYPERvolemia
48
SIADH, hypothyroidism, glucocorticoid excess..all cause?
Hyponatremia with EUvolemia
49
Renal and nonrenal sodium loss..all cause?
Hyponatremia with HYPOvolemia
50
lethargy, disorientation, muscle cramps, anorexia, hiccups, nausea, vomiting, seizures *weakness, agitation, hyporeflexia, orthostatic hypotension, Cheyne-Stokes respirations, delirium, coma, stupor
HYPOnatremia
51
*Diabetes Insipidus: ↑↑thirst, ↑↑H2O (polydipsia) | Urine osmolality
Hypernatremia with dilute urine
52
Major intracellular ion
K
53
K uptake by cells stimulated by _____ in the presence of glucose and facilitated by beta adrenergic stimulation.
insulin
54
RAA system is a major excretion of....
K+ | RAA system AKA Renal K modulation
55
Symptoms/signs: weakness, muscle cramps, fatigue, constipation. ECG: NSST-T* changes and “U” waves; PVC’s
HYPOkalemia
56
Aldosterone facilitates urinary K excretion; most important regulator of body K content. Most diuretics lead to renal K losses.
Renal losses of K+ (leading to HYPOkalemia)
57
Treatment for mild to moderate K losses
oral KCL
58
Severe hypokalemia treatment
SLOW** IV fluids/KCL | cardiac monitoring
59
Patients with renal insufficiency are at risk for which potassium disorder?
HYPERkalemia
60
Mild hyperkalemia may accompany which acid-base disorder?
Metabolic acidosis
61
- Severe renal insufficiency - Renal insufficiency plus K supplements (KCL), K sparing diuretic or ACEI - Combination of KCL + K sparing diuretic as Rx of hypokalemia: avoid for most patients
Risk factors for HYPERkalemia
62
Abnormalities in neuromuscular function: weakness, diarrhea, rarely paralysis. **Characteristic ECG findings may occur: Peaked T waves, widening of QRS, increased intervals, loss of P waves, etc.
HYPERkalemia
63
50% of this electrolyte is ionized and used for muscle and nerve function
Calcium
64
Important to measure serum ____ to determine if Ca levels reflect true deficiency.
albumin
65
Is ionized calcium effected by albumin levels?
NO!
66
For every 1 gram ↓of albumin, total Ca ↓s by ___ meq/L
0.8
67
Most common cause of HYPOcalcemia
renal failure
68
Signs/Sx: Increased excitation of nerve and muscle cells; cramps, tetany, paresthesias and convulsions. Chvostek’s sign, Trousseau’s sign * ECG: Prolonged Q-T interval/arrhythmias
HYPOcalcemia
69
If symptomatic: IV calcium gluconate via bolus and infusion. | If asymptomatic: Oral calcium and Vitamin D.
Tx for HYPOcalcemia
70
Etiologies include hyperparathyroidism, malignancy (tumors produce PTH related proteins), milk-alkali syndrome (Ca antacids + Vit D excess).
HYPERcalcemia
71
``` Signs/Sx: Often without sx if mild ↑Ca Renal/GI: polyuria (H2O* reabsorption is blocked by hypercalciuria), nephrolithiasis; nausea, constipation. Neuro changes (drowsiness, weakness, lethargy, stupor/coma) if severe ```
HYPERcalcemia
72
ECG findings: Shortened Q-T, PVC’s. | Lab: increased Ca with nl. or low PO4.
HYPERcalcemia
73
Treat underlying disease process. Promote Na rich diuresis which will be accompanied by excretion of Ca. Infusion of 0.9% Saline + IV furosemide will expand ECF volume and promote Na/Calcium rich diuresis. **Avoid Thiazide diuretics: Can worsen
HYPERcalcemia
74
Symptoms similar to hypocalcemia: weakness, muscle cramps, tremors, neurmuscular and CNS hyperirritability. Often associated with hyopK and hypoCa *can cause dangerous (ventricular) cardiac arrhythmias, esp if K is low.
HYPOmagnesemia
75
Very common in hospitalized patients, especially those on diuretics who are receiving continuous IV fluid support.
HYPOmagnesemia

Renal (15 decks)

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