Fluid and Electrolytes Water and Na Flashcards Preview

GI Exam 1 > Fluid and Electrolytes Water and Na > Flashcards

Flashcards in Fluid and Electrolytes Water and Na Deck (74):
1

Intacellular fluid comprises how much of the total BW

67%

2

Interstital fluid comprises how much of the total BW

20%

3

Intravascular fluid comprises how much of the total BW

8.3%

4

***Total BW for OLDER CHILDREN AND MEN LESS THAN 70

0.6 X body weight

5

***Total BW for WOMEN LESS THAN 80 AND MEN OVER 70

0.5 X body weight

6

***Total BW for WOMEN OVER 70

0.45 X body weight

7

Sodium maintenance needs

Closer to 2 mEq/kg

8

Potassium maintenance needs

Closer to 1 mEq/kg

9

5% loss Volume Depletion

Decreased skin turgor
Dry membranes
Pale skin
Diminished urine output
Normal BP
Normal to increased HR
Flat fontanelle
Consolable CNS
Capillary refill >2 seconds

10

10% Volume Depleted

Tenting skin turgor
Very dry membranes
Grey skin color
Severly decreased urine output
Normal to decreased BP
Increased HR
Soft fontanelle
Irritable CNS

11

15% Volume Depleted

Tenting skin turgor
Parched mucous membranes
Mottled skin color
Azotemic urine output
Decreased BP
Significantly increased HR
Sunken fontanelle
Lethargic/coma CNS
Tilt test increase by 30 beats/min
Capillary refill >3 seconds

12

Tilt Test Procedures

BP and HR are recorded after pt has been supine for 2-3 minutes
BP/HR are recorded after pt has be standing for 1 minu

13

Positive Tilt Test

Increased HR by 30 beats per minute or more (15% volume loss)
Presence of sx of cerebral hypoperfusion

14

Capillary refill

Time for the nail bed to return to the normal color is counted in seconds
Less than 2 seconds is normal

15

Urine output is an indicator of:

Organ perfusion if pt has normal renal function

16

Normal urine output is:

More than 1.0 mL/kg/hr

17

Reduce urine output is:

0.5-1.0 mL/kg/hour

18

Severely reduced urine output is:

Less than 0.5 mL/kg/hr

19

Lab values in volume depleted:

Albumin will increase unless hypoalbuminemic
Hemoglobin will increase unless anemic
BUN:SCr will increase >20:1 in pre-renal azotemia
Serum lactate > 3 mmol?L = severe shock

20

Replacement Fluids 1st thing you do:

Initiate a 20 mL/kg bolus over 30 of NS and repeat until improved hemodynamics

21

Example of how to calculate percent of fluid loss
5% loss in a 70 kg 35 yo man

MF: 1500+ (20 *50) = 2500
TBW: 0.6*70*0.05 = 2L

22

Replacement fluid rules

3/4 in the first 24 hours
Rest in the next 24-48 hours
Bolus is ALWAYS NS
RF can be 1/2 NS

23

Isotonic Crystalloids

Lactated Ringers
NS
100% extracellular

24

Hypotonic Crystalloids

Depending on osmolality fluid will move to intracellular space
D5W has no sodium or chloride
1/2 NS has some sodium and chloride
1/4 NS has even less sodium and chloride

25

Hypertonic Crystalloids

3% Saline
High sodium and chlroide

26

Isotonic Crystalloids

0.9% saline or NS
Has sodium and chloride

27

AE of Lactated Ringers

Hyponatremia
Hyperkalemia
Lactate --> bicarbonate (lactate will accumulate in liver disease)

28

D5W Uses

Uncomplicated dehydration or water deprivation
Dextrose is rapidly taken up by cells leaving free water

29

D5W AE

Hyponatremia

30

D10W

Not used in adults for replacement and is the last one able to be used in a peripheral line
- D35W has to be in a central line

31

Crystalloid Advantages

Cheap
Long shelf-life
No infectious risk
No antigenic/allergenic

32

Crystalloid Disadvantages

Not long lasting
2-4 times mor crystalloid is needed than colloid

33

Protein Colloid Solutions:

Albumin 5% or 25%
Plasmanate
Whole blood
PRBC
FFP
Cryoprecipitates

34

Non-Protein Colloid Solutions

Hetastarch 6%
Pentastarch

35

5% Albumin

Isotonic
Isooncotic with serum
2-4 potency of LF
Hypovolemic states

36

25% Albumin

Isotonic
Hyperoncotic
**Hypovolemia with edema
Can pull fluids from intracellular to intravascular

37

Albumin should be used FOR SURE in:

Cirrhosis because that is the only place it is shown to decrease mortality

38

Normal Sodium

135-145 mEq/L

39

***Serum sodium never reflect:

TOTAL BODY STORES OF SODIUM

40

If your tank size increases, then

You are really hypervolemic and hypernatremic but your levels can show hyponatremic

41

If your tank size decreases, then

You are really hypovolemic and hyponatremic but your levels can show hypernatremic (because you have a higher salt to water ratio even though your salt didn't increase)

42

120-130 mEq/L of Na symptoms

N/V malaise

43

115-120 mEq/L of Na symptoms

Headache
Tremors
Loss of coordiantion**

44

Less than 115 mEq/L of Na

Seizures and coma**

45

Severity of hyponatremia is absed on:

Absolute decrease in sodium
Rapidity of onset

46

Hyponatremia Assessment Steps

Determine volume status
Calculate serum osmolality

47

Normal serum osmolality:

275-290 mOsm/kg

48

Causes of Hypertonic Hyponatremia

Hyperglycemia (need to correct sodium for elevated glc)
Mannitol or toxic alcohols

49

Pseudohyponatremia

If you have really high lipids (TG), then our serum sodium will be falsely lowered

50

Causes of Isotonic Hyponatremia

Hyperproteinemia
Hyperlipidemia
Bladder irrigation
Pseudohyponatremia

51

Causes of Hypotonic Hyponatremia

(↓ Na and ↓ osmolality)
Must consider volume status

52

Hypotonic Hyponatremia + Hypervolemic

HF
Cirrhosis
Renal insufficiency

53

Hypotonic Hyponatremia + Hypovolemic

Consider urinary sodium concentration
- Less than 20 = extra-renal causes such as sweating, diarrhea, vomiting
- Greater than 20 = renal causes typically diuretics

54

Hypotonic Hyponatremia + Euvolemic

Syndrome of Inappropriate ADH (SIADH)
Cancer --> SIADH
Hypothyroidism

55

Hypertonic and Isotonic HYPOnatremia Treatment

Underlying cause and consider fluids

56

Hypotonic Hypovolemic Hyponatremia Treatment

Calculate volume depletion and correct with NS or 3% if severely sympotomatic

57

***Sodium Rate of Corrects

0.33 mEq/L/hr or 8 mEq/L in 24 hours

58

Hypotonic Hypervolemic Hyponatremia Treatment

Underlying condition (diuretic for cirrhosis or CHF)
Fluid restriction to less than 1500 mL/day

59

Hypotonic Euvolemic Hyponatremia Treatment

Fluid restriction
IV 3% saline if severe symptoms
Demeclocycline
AVP receptor antagonists
Conivaptan (vaprisol)

60

Demeclocycline

Inhibits actiono f ADH in kidneys
Delay in onset so only good for chronic
- Nephrotoxicity, photsensitivity, hepatotocitiy

61

AVP Receptor Antagonists

Conivaptan
Lixivaptan
Tolvapatan

62

Conivaptan

$$$
Inhibits ADH
- Infusion site rxns, thirst, headache, vomiting
IV only

63

Asymptomatic Na Correction Rate

Less than 6 mEq/24 hrs
0.5-1 mEq/h

64

What happens if you correct hypo too fast?

Osmotic Demyelination Syndrome ODS

65

What happens if you correct hyper too fast?

Urical herniation (stop breathing)

66

Hypernatremia Symptoms

Anorexia, muscle weakness, restlessness N/V

67

Hypernatermia SEVERE symptoms

Altered mental status
Lethargy
Irritability
Coma

68

Hypernatremia + Hypovolemia Causes

Dehydration
Dermal: swaeting/burns
GI: vomiting/diarrhea
Diuretics

69

Hypernatremia + Hypervolemia Causes

Hypertonic saline
Tube ffeding
Sodium containing antibiotics

70

Hypernatremia + Euvolemia Causes

Low urine osmolality = diabetes insipidus

71

Hypernatremia Treatment Steps

Decrease Na by 0.33 mEq/hr
Determine water deficit and use 1/2 or 1/4 NS

72

Saline options for hypovolemic/hyponatremia

NS

73

Saline options for hypovolemic/ severe hyponatremia

3% NS

74

Saline options for hypovolemic/hypernatremic

1/2 NS (still with a bolus of NS)