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Flashcards in Fluid Balance Deck (31):
1

What is the normal range for K+?

3.5-5

2

What is the normal range for Na+?

135-145

3

What is the normal range for Cl-?

98-107

4

What is the normal range for Mg++?

0.66-1.07

5

What is the normal range for Ca++?

1.13-1.32

6

What is the management of hyperkalaemia?

dextrose and insulin - make K+ go in the cells (can also use salbutamol 12 puffs)
calcium gluconate/carbonate - stabilise cell membrane
frusemide, resonium (30g), or dialysis - get rid of the K+

7

What should always be given with resonium?

20mL lactulose

8

What are the ECG signs of hyperkalaemia?

peaked T waves, flat and wide P waves, broad flat QRS complexes, torsades

9

What causes hyperkalaemia?

potassium sparing diuretics, potassium supplements, fluid with too much potassium

10

What causes hypokalaemia?

frusemide, refeeding syndrome

11

What is the management of hypokalaemia?

oral: slow K or chlorvescence
IV: 10mmol KCl in 100mL NS over 1 hour or 30mmol in 1L over 6-8 hours

12

What are the ECG signs of hypokalaemia?

T wave inversion, high and wide P waves, ST depression, long QT, torsades

13

How much K+ should you give in maintenance fluid therapy?

30mmol in every third bag/litre

14

What should you also give when topping up K+?

Mg++

15

What are the causes of hyponatraemia?

SIADH
too much water
drugs

16

What is the management of a hyponatraemic patient who is seizing?

100mL bolus of 20% saline

17

What is the complication of correcting sodium too quickly?

central pontine myelinolysis

18

What is the appropriate rate to correct sodium at?

8mmol per day

19

What three investigations are diagnostic for SIADH?

high urine osmolality
low serum osmolality
high urinary Na+

20

How do you treat hyponatraemia if they're also hypovolaemia?

0.9% normal saline 10hrly

21

How do you treat hyponatraemia if they're also euvolaemic?

fluid restrict - no free water (only fluids with solute in them e.g. tea, juice

22

How do you treat hyponatraemia if they're also hypervolaemic?

gently diurese

23

What do you do if you over correct sodium too quickly?

fill them with dextrose

24

What are the causes of hypernatraemia?

diabetes insipidus
being intravascularly deplete
too much hypertonic saline
tazocin/metoclopramide

25

What is the management of hypernatraemia?

5% dextrose 10 hourly
low salt diet

26

What is the cause of hypercalcaemia?

metastatic cancer (breast, prostate)
multiple myeloma
tumour lysis syndrome
paget's disease
too much PTH

27

What is the management of hypercalcaemia?

frusemide with normal saline
or bisphosphanates
or dialysis

28

What are the signs and symptoms of hypercalcaemia?

stones (kidney stones)
bones (bone related complications)
abdominal groans (indigestion, nausea)
thrones (constipation and polyuria)
psychiatric overtones (depression, psychosis, delirium)

29

What is magnesium used to treat?

pre eclampsia
refeeding syndrome
arrhythmias

30

What is the side effect of too much normal saline?

metabolic acidosis

31

What is the side effect of too much Hartman's solution?

hyponatraemia, high lactate