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Critically Ill > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

What is the reference range for Ca?

A

8.6-10.2

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2
Q

Why does corrected calcium need to be calculated?

A

mostly protein bound to albumin;
low albumin = falsely low Ca levels

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3
Q

What is the ionized/ active reference range for Ca?

A

1.12-1.3

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4
Q

What are s/s of severe hypocalcemia?

A
  1. tetany
  2. CV effects
  3. CNS effects
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5
Q

What IV form of Ca can only be given via the central line? Why?

A

CaCl2; vesicant

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6
Q

What IV form of Ca needs to be metabolized to become active?

A

Ca gluconate

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7
Q

What products cannot be given with Ca due to precipitation?

A

Phosphorus

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8
Q

How is symptomatic hypocalcemia treated?

A
  1. 1g CaCl IV followed by continuous infusion
  2. 3g CaGLU IV followed by continuous infusion
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9
Q

How is asymptomatic hypocalcemia treated?

A

1-2g CaGLU IV

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10
Q

How is hypercalcemia treated in ICU?

A
  1. IV fluids
  2. IV diuretics
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11
Q

What is the normal range of K?

A

3.5-5

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12
Q

How is hypokalemia treated?

A

KCl 20-80 mEq PO/IV

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13
Q

What agents temporarily treat hyperkalemia by driving K intracellularly?

A
  1. albuterol nebulizer treatments
  2. regular insulin 10U x 1 + IV dextrose 25g
  3. Sodium bicarb 50 mEq IV x 1
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14
Q

What agents permanently treat hyperkalemia by binding to K in the GI tract?

A
  1. sodium polystyrene sulfonate (KAYEXALATE) 15-60g PO
  2. Patiromer (VELTASSA) 8.4g PO QD
  3. sodium zirconium cyclosilicate (LOKELMA) 10g PO TID
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15
Q

What agents permanently treat hyperkalemia by renal excretion?

A

Furosemide 40mg IV x 1

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16
Q

What directly removes K from the blood?

A
  1. Hemodialysis
  2. CRRT
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17
Q

What agent is given for hyperkalemia to stabilize cardiac membrane and protect from arrhythmias?

A

Ca (Cl) 1g IV x 1

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18
Q

What is the best way to treat hyperkalemia?

A

combination of agents that temporarily redistribute and agents that remove K +/- IV Ca

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19
Q

What is the normal range for phosphorus?

A

2.7-4.5

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20
Q

What is the treatment of mild/ asymptomatic hypophosphatemia?

A

PO KPhos or NaPhos

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21
Q

What is the treatment of significant/ symptomatic hypophosphatemia?

A

1.5-2.7: 15 mmol IV
<1.5: 30 mmol IV

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22
Q

How much K is in 15mmol KPhos?

A

22 mEq

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23
Q

How much Na is in 15mmol NaPhos?

A

20mEq

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24
Q

What is the risk of precipitation when calcium/phosphate product >55-60 mg/dL?

A

calciphylaxis

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25
Q

What is the treatment of chronic hyperphosphatemia?

A

phosphate binders

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26
Q

What is the treatment of acute hyperphosphatemia?

A
  1. diuretics
  2. dialysis
  3. CRRT
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27
Q

What is the normal range of Mg?

A

1.5-2.4

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28
Q

Why is IV treatment preferred over PO for acute replacement of Mg?

A

oral replacement is slow, unreliable, and can further deplete Mg due to diarrhea

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29
Q

How is mild-moderate hypomagnesemia treated?

A

Mg Sulfate 1-4g IV x 1 slowly

30
Q

How is severe (< 1) hypomagnesemia treated?

A

Mg sulfate 4-8g very slowly

31
Q

What is third spacing?

A

fluid shifts from intravascular plasma to interstitial (extravascular space)

32
Q

What is a normal serum osmolality?

A

275-300 mOsm/kg

33
Q

What is the range for isotonic solutions?

A

250-375 mOsm/L

34
Q

What type of fluid contributes most to third spacing?

A

hypotonic

35
Q

Which crystalloid solutions are purely isotonic?

A
  1. 0.9% NS
  2. Dextrose 5% in 0.9% NS
  3. LR
36
Q

How many mEq are in 0.9% NS

A

154 mEq Na and 154 mEq Cl

37
Q

How many mOsm/L are in LR?

A

273 mOsm/L

38
Q

Which crystalloid solutions are hypotonic?

A
  1. D5W
  2. D5W in 0.45% NS
39
Q

How many mOsm/L are in D5W?

A

252 mOsm/L

40
Q

Which crystalloid solutions are hypertonic?

A

3% NaCl (NS)

41
Q

How many mOsm/L are in 3% NaCl?

A

1027 mOsm/L

42
Q

What is the highest mOsm/L that can be given via peripheral line?

A

900

43
Q

What are isotonic solutions used for?

A
  1. fluid resuscitation
  2. maintenance fluids
44
Q

What are hypotonic solutions used for?

A
  1. correcting Na abnormalities
  2. treating conditions with intracellular dehydration
45
Q

When should hypotonic solutions NOT be used?

A

head injury patients

46
Q

What are hypertonic solutions used for?

A
  1. correcting Na abnormalities
  2. decreasing cerebral edema
47
Q

Which balanced electrolyte solutions have lower incidence of kidney injury/ renal replacement therapy?

A
  1. LR
  2. Plasma -lyte
48
Q

Why do colloids have lower incidence of third spacing compared to crystalloid solutions?

A

large molecules increase oncotic pressure and don’t redistribute as much

49
Q

What are the common colloid solutions?

A
  1. Albumin 5%
  2. Albumin 25%
  3. synthetic starch colloids
50
Q

What SEs are more common in synthetic colloids?

A
  1. bleeding
  2. need for renal replacement
  3. mortality
51
Q

What are signs of fluid depletion?

A
  1. hypotension
  2. tachycardia
  3. decreased skin turgor
  4. clammy extremities
  5. altered mental status
52
Q

What is a normal sodium range?

A

135-145

53
Q

What is a normal Cl range?

A

97-107

54
Q

Why does hyponatremia cause neurologic effects?

A

fluid diffuses into brain cells and they swell causing cerebral edema

55
Q

What is associated with hyponatremia?

A

low serum osmolality

56
Q

How is hyponatremic hypervolemia treated?

A
  1. fluid/water restriction
  2. changing fluids
57
Q

How is hyponatremic hypervolemia caused?

A
  1. cirrhosis
  2. CHF
  3. renal failure
  4. fluid overload
58
Q

What is the common cause of hyponatremic euvolemia?

A

SIADH

59
Q

What is the range that plasma sodium can be increased when treating hyponatremia?

A

6-12 mEq/L/day

60
Q

What is the range that plasma sodium can be increased when treating acutely symptomatic hyponatremia?

A

1-2 mEq/L/h AND 6-12 mEq/L/day

61
Q

How is hypovolemic hypernatremia treated?

A

hypotonic/isotonic fluids

62
Q

How is euvolemic hypernatremia treated?

A

water replacement

63
Q

How does hyperglycemia cause pseudo hyponatremia?

A

glucose draws water from muscle cells into vascular space; more water in the vasculature decreases concentration of Na

64
Q

For each 100mg/dL of glucose above normal, how much is plasma sodium decreased?

A

-1.6 mmol/L

65
Q

What is SIADH?

A

secretion of inappropriate antidiuretic hormone

66
Q

What drugs can cause SIADH?

A
  1. SSRIs
  2. NSAIDs
  3. opioids
  4. antidepressants
  5. antipsychotics
67
Q

What is diagnostic criteria for SIADH?

A
  1. serum osmolality <285
  2. serum Na <135
  3. urine osmolality >200
  4. euvolemic
68
Q

What is treatment of SIADH?

A
  1. fluid restriction <1500 mL/day
  2. low dose diuretucs
  3. oral NaCl 4-16 g/day
69
Q

What is diabetes insipidus?

A

decreased secretion of antidiuretic hormone leading to decreased retention of water

70
Q

How does diabetes insipidus present?

A

dilute urine output >250 mL/h

71
Q

How is diabetes insipidus treated?

A
  1. hypotonic solutions to replace free water
  2. Desmopressin 1-2 mg IV/SQ BID
  3. Vasopressin 1-15 U/h (not preferred)
72
Q

How much do we want sodium to decrease per hour when treating diabetes insipidus?

A

0.5 mEq/L/h

Critically Ill (20 decks)

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