fluid and electrolytes Flashcards
(94 cards)
1
Q
What body fluid is made up of K, Cl, Na, Ca, Mg, proteins, and HCO3?
A
extracellular fluid
2
Q
What body fluids are made up of Na, K, Ca, Mg, Cl, HCO3, proteins, phosphate, and organic ion?
A
intracellular fluid
3
Q
What type of IV fluids are made up of Na 154 and Cl 154?
A
NS
4
Q
What type of IV fluids are made up of Na 130 and Cl 109?
A
lactated ringers
5
Q
Lactated ringers prevents a____ from h___c___ when excessive r___ is needed
A
acidosis
hyperchloremia
resucitation
6
Q
What type of IV fluids are made up of Na 513 and Cl 513?
A
hypertonic fluids
7
Q
What type of fluids are made up of Na 77 + Cl 77 + Glucose 50?
A
D5 1/2 NA
8
Q
What type of blood product is made up of Na 100-160 + < 120 Cl?
a____
A
albumin
9
Q
Mild dehydration = ___ %
A
5
10
Q
Mild dehydration presents with f____, normal ____, and refusal of o___ i____
A
fatigue
V/s
oral intake
11
Q
Moderate dehydration = ___ %
A
10
12
Q
Moderate dehydration presents with mild ___ changes, th____, re____, ir____, reduced te___, and d___ m___ m____
A
v/s changes
thirst
restless
irritable
tears
dry mucous membranes
13
Q
severe dehydration = ___ %
A
15
14
Q
severe dehydration presents with le____, ___ alterations, c__/m____ extremities, deep br____, and minimal to no o____
A
lethargy
v/s alterations
cool/mottled extremities
deep breathing
output
15
Q
Isonatremic dehydration = ____ serum sodium ranging from ___-____
A
normal
135-145
16
Q
hypernatremic dehydration = serum sodium > ____
A
145
17
Q
hyponatremic dehydration = serum sodium < ____
A
135
18
Q
Dehydration management
* replace ______ slowly
*correct fluid losses over ___-__ hours
*monitor strict __/___
*monitor ____ closely
A
electrolytes
24-48
I/Os
electrolytes
19
Q
Severe hyponatremia is a serum sodium < ____
A
125
20
Q
Hyponatremia is caused by
S____, ad___ i____, hy____, hy____, excessive w ____ intake
A
SIADH
adrenal insufficiency
hypervolemia
hypovolemia
excessive water intake
21
Q
Severe hyponatremia will result in?
A
seizures
22
Q
Correct hyponatremia at __ mEq/L/hr
A
0.5
23
Q
If a patient with hyponatremia is experiencing seizures, correct hyponatremia with
1) n___ b___ at __ ml/kg
or
2)h____ s____ ___-___ ml/kg given centrally
A
NS bolus at 20
hypertonic saline 3-5 ml/kg
24
Q
If hyponatrmia is corrected to quickly the patient is a risk for ce___ po____ de_____ of wh___ ma___
A
central pontine demyelination of white matter
—called osmotic demyelination syndrome (ODS)
25
Severe hypernatremia is a serum sodium > ____
160
26
hypernatremia is caused by f___ l____, de____, excess s___ i____, D___
fluid loss
dehydration
salt intake
DI
27
Hypernatremia complications include s___ and al___ me___ s____
seizures and
altered mental status
28
In a patient with hypernatremia, reduce sodium at ___ mEq/L/hr
---reducing too quickly will cause s____
0.5 mEq/L/hr
--seizures
29
hyperkalemia causes
increased in____
decreased ex____ d/t r__ f___, b___ b___ use, ac____, t___ l___, rha____, congenital ad___ hy____, and r___ t____ a_____
intake
excretion
renal failure, beta blocker, acidosis, tumor lysis, rhabdomyolysis, congenital adrenal hyperplasia, renal tubular acidosis
30
hyperkalemia s/s include
___ changes such as
--p___ ___ w___, depressed s___, wide q___, absent __ w____
EKG
peaked T waves
depressed ST
wide QRS
absent P wave
31
When mild hyperkalemia is present, ensure your sample is not h___ before treating
hemolyzed
32
Mild hyperkalemia management includes removing or stopping all?
oral/IV potassium sources
33
Severe hyperkalemia management
*perform e___
*obtain c___, c___, a___, u___
*remove e___ p___ a____
EKG
CBC, CPK, ABG, UA
exogenous potassium administration
34
Severe hyperkalemia management
-Stabilize myocardium by giving-
*C__ (10 %): ___ mg/kg IV
or
*C__ g___: ___-___ mg/kg/dose (max 3 grams)
CaCl 10% 20 mg/kg IV
Calcium gluconate 60-100 mg/kg/dose
35
Severe hyperkalemia management
-Enhance movement of K into cells by-
*giving s__ b___: __-__ mEq/kg IV (best way)
or
*g___: __ g/kg + i____ ___-___ units/kg
sodium bicarb 1-2 mEq/kg IV
Glucose 0.5 g/kg + insulin 0.1-0.3 units/kg
36
Severe hyperkalemia management
-Remove K from the patient by giving-
*k____ ( __ g/kg) PO, NG, rectally
-------use this as a last resort
*can also give d___ such as f____
**In the most severe cases of hyperkalemia give d____
kayexalte 1g/kg
diuretics such as furosemide
dialysis
37
Hypoglycemia is defined as a blood glucose less than ___ mg/dl
50
38
Neonatal causes of hypoglycemia
--d___ m___, a___c____ d____, i____ e____ of m_____, and h___p______
diabetic mom
adrenocortical deficiency
inborn errors of metabolism
hypopituitarism
39
Neonatal causes of hypoglycemia
---can be t_____
----are associated with a la___ of g___ su_____
transient
lack of glucose supply
40
childhood causes of hypoglycemia
---i____ e__, g___ de____, st____, h____ dysfunction, b___ b___ ingestion , inf____, and uncontrolled d____
inborn errors
GH deficiency
stress
hepatic dysfunction
beta blocker ingestion
infection
uncontrolled diabetes
41
hypoglycemia glucose replacement is ___-___ gram/kg (10% or 25%_
0.5-1 gram/kg
42
hypoglycemia s/s include
ir_____, ji____, se_____, vo____, he___
irritable
jittery
seizures
vomiting
headache
43
Before treating hypoglycemia, obtain the following labs STAT
-fr___ fa___ ac____, in____, be___ h___b___, cor____, acylcarnitine, la____, py____, gr___, a____, ur___ ke_____
free fatty acid
insulin
beta-hydroxybutyrate
cortisol
lactate
pyruvate
growth hormone
urine ketones
44
hypocalcemia causes
h__p____p___t_, di____, vi___ ___ deficiency, re____ insufficiency, massive tr_____, rh____, t___ ly____, et___/gl____ ingestion
hypoparathyroidism
DiGeorge
vitamin D
renal, transfusion
rhabdomyolysis
tumor lysis
ethanol/glycol
45
Hypocalcemia management caused by hypoalbuminemia
--correct Ca at ___ mg/dL for each __ g/dl the patients calcium is low
0.8 mg/dL
1 g/dL
46
Hypocalcemia management includes obtaining an e___
EKG
47
Replace calcium with either c___ c____ or c___ g___ IV slowly or via a central line
-----during replacement monitor for s____
calcium chloride
calcium gluconate
seizures
48
hypocalcemia s/s include
s____, tet____, m____ irritability, l__ q___, and par____
seizures
tetany
myocardial
long QT
paresthesias
49
for a child presenting with hypocalcemia, obtain p____ levels
parathyroid
50
in a newborn presenting with hypocalcemia, obtain f___ studies
FISH
51
If hypocalcemia is refractory to correction, ensure m____ levels are normal
magnesium
52
what acid-base imbalance is this?
Ph 7.5
PCO2 40
PO2 86
HCO3 36
metabolic alkalosis
53
Children with chloride-responsive metabolic alkalosis most often have the following diagnosis
-con____
-s/p di___ use
-s/p vo___
-s/p ga___ se____su____
-s/p st___ use
contractions
diuretics
vomiting
gastric secretion suctioning
steroid
54
Children with chloride-resistant metabolic alkalosis most often have the following diagnosis
---h___a____ state or
---severe ___ depletion
hyperaldosteronism
potassium
55
what acid-base imbalance is this?
Ph 7.1
PCO2 30
PO2 96
HCO3 10
Metabolic acidosis
56
Children with metabolic acidosis, try to compensate via h_____
---exhibited by low ____
-----seen in patient with d____
hyperventilation
----CO2
-----DKA
57
Children with metabolic acidosis will experience bi___ lo____
bicarbonate losses
58
In children with metaboic acidosis
---monitor for ___ and ____ abnormalities
potassium
sodium
59
Anion gap normal level
___ +/ __ mEq/L
12 +/2 mEq/L
60
The anion gap calculation is
___ - ( ___ + ___)
Na - (Cl + HCO3)
61
In nongap acidosis
--gap will be b___ n___
below normal
62
in gap acidosis
--gap will be a___ n___
above normal
63
NonGap Metabolic Acidosis medication causes
-sp____, pr____ in____, triamterene, amiloride, pe____, tri___, cyc____
spironolactone
prostaglandin inhibitors
pentamidine
trimethoprim
cyclosporine
64
Enteral nutrition
--nutrients via E___ or f___ to g__ t___
EBM or formula to GI tract
65
Start enteral nutrition within __-__ hours of l___ or a____
24-48 hours of life or admission
66
enteral nutrition has been shown to decrease h___ l___ of s___, improves o____, decreased i____, and improved i____
hospital length of stay
outcomes
infection
immunity
67
enteral nutrition contraindications
--b___ o____, recent g___ s____, U___ b___
bowel obstruction
recent GI surgery
UGI bleeding
68
In a child on vasopressors, enteral feeds should be ____ ___
slow drip
69
nutrition labs include
p__-a____
g___
ph____
and s___ st____
pre-albumin
glucose
phosphorus
stool studies
70
nutrition monitoring
*track w___
*calculate daily c___ i___
*calculate f___ needs
weights
caloric intake
fluid
71
Parenteral nutrition =
TPN
72
Begin parenteral nutrition when meeting n___ needs with e___ f____ is c____
nutritional needs
enteral feeds
contraindicated
73
Children on parenteral nutrition must have reliable access, ___ ___ preferred
Central line
74
Parenteral nutrition macronutrients ==
pr___, gl___, fa___
protein, glucose, fat
75
parenteral nutrition micronutrients ==
e___, m___, v____
electrolytes, minerals, vitamins
76
parenteral nutrition should be adjusted ___ and based on ___
daily
needs
77
Parenteral nutrition's long-term effects
-th___ formation, in____, cho____, bo___ disease, li___ disease especially in infants, and ac___ impairment
thrombosis
infection
bone
liver
activity
78
obesity if a BMI > ___% due to excess c___ i___
95%
caloric intake
79
obesity acute care concerns
--medication d____, d____, decreased wo___ he___, decreased pu___ mechanics, decreased gl____ control
dosing
DVT
wound healing
pulmonary
gluco0se
80
obesity labs
-c___ panel
-f___ g____
-H___ ___
-i___ level
cholesterol panel
fasting glucose
Hgb A1C
insulin level
81
Bulimia
-c___ r____ leading to excess h___/b___ and resultant self i___ v____
*weight may be?
calorie restriction
hunger/binge
induced vomiting
normal
82
Children with bulimia may use
l___, d___ or e____
laxatives
diuretics
enemas
83
Bulimia will eventually lead to e____ abnormalities
electrolytes
84
Bulimia + Anorexia management
*stabilize f___ status
---s/s include h___ and t____
*correct e____
---most often low _____
*obtain ___ evaluation
fluid status
--hypotension + tachycardia
electrolytes
---phosphate
psychiatric
85
Bulimia complications
*c___ a___
*severe h____p___
*a__/b__ disturbances
*de___ problems
cardiac arrhythmias
severe hypophosphatemia
acid/base
dentition
86
Anorexia nervosa = c__ r____
---body weight will be < ___%
calorie restriction
85%
87
Anorexia nervosa s/s inclue
e____ imbalances
i___v____ v___ depletion
m___ a_____
electrolytes
intravascular volume
metabolic acidosis
88
Anorexia complications
c___ a____, severe h__p_____,
a___/b___ disturbances, severe b_____
cardiac arrhythmias
hypophosphatemia
acid/base
bradycardia
89
90% of FTT is inorganic d/t
*inadequate c___ i___
*inadequate a____
*excessive m__ d____
caloric intake
absorption
metabolic demands
90
Refeeding syndrome
---hallmark lab finding =
hypophosphatemia
+ low mag and K
91
In refeeding syndrome monitor for c___ and a____
CHF and arrhythmias
92
What nutritional lab reflects the last 24-48 hours of nutrition?
Pre-albumin
93
obtain a pre-albumin level during acute n___ changes
nutritional
94
Children with glycogen storage depletion will have l___ intolerance and p___ catabolism
lipid
protein
