Fluid Balance

Question 1

What is the normal range for K+?

Answer 1

3.5-5

Question 2

What is the normal range for Na+?

Answer 2

135-145

Question 3

What is the normal range for Cl-?

Answer 3

98-107

Question 4

What is the normal range for Mg++?

Answer 4

0.66-1.07

Question 5

What is the normal range for Ca++?

Answer 5

1.13-1.32

Question 6

What is the management of hyperkalaemia?

Answer 6

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+

Question 7

What should always be given with resonium?

Answer 7

20mL lactulose

Question 8

What are the ECG signs of hyperkalaemia?

Answer 8

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

Question 9

What causes hyperkalaemia?

Answer 9

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

Question 10

What causes hypokalaemia?

Answer 10

frusemide, refeeding syndrome

Question 11

What is the management of hypokalaemia?

Answer 11

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

Question 12

What are the ECG signs of hypokalaemia?

Answer 12

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

Question 13

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

Answer 13

30mmol in every third bag/litre

Question 14

What should you also give when topping up K+?

Answer 14

Mg++

Question 15

What are the causes of hyponatraemia?

Answer 15

SIADH
too much water
drugs

Question 16

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

Answer 16

100mL bolus of 20% saline

Question 17

What is the complication of correcting sodium too quickly?

Answer 17

central pontine myelinolysis

Question 18

What is the appropriate rate to correct sodium at?

Answer 18

8mmol per day

Question 19

What three investigations are diagnostic for SIADH?

Answer 19

high urine osmolality
low serum osmolality
high urinary Na+

Question 20

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

Answer 20

0.9% normal saline 10hrly

Question 21

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

Answer 21

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

Question 22

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

Answer 22

gently diurese

Question 23

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

Answer 23

fill them with dextrose

Question 24

What are the causes of hypernatraemia?

Answer 24

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

Question 25

What is the management of hypernatraemia?

Answer 25

5% dextrose 10 hourly | low salt diet

Question 26

What is the cause of hypercalcaemia?

Answer 26

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

Question 27

What is the management of hypercalcaemia?

Answer 27

frusemide with normal saline or bisphosphanates or dialysis

Question 28

What are the signs and symptoms of hypercalcaemia?

Answer 28

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

Question 29

What is magnesium used to treat?

Answer 29

pre eclampsia refeeding syndrome arrhythmias

Question 30

What is the side effect of too much normal saline?

Answer 30

metabolic acidosis

Question 31

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

Answer 31

hyponatraemia, high lactate