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Kaplan > Fluid Balance > Flashcards

Fluid Balance Flashcards

1
Q

Complications HyperNa

A
  • hemorrhage due to shrinking of brain and shearing of essels
  • central pontine myelinosis
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2
Q

Most common causes hyperna due to water gain

A
  • iatrogenic
  • improper mixing of forumula
  • hyperaldo
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3
Q

Presentation Hyperaldo

A

hypernatremia with hypokalemia and hypertension

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4
Q

Common cuase hyperna due to water loss

A
  • diabetes insipidus

- intake defciency

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5
Q

What is factitious hyponatremia? Dilutional?

A
  1. triglycerides

2. glucose

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6
Q

Causes hyperna due to water loss > na loss

A
  • crhonic renal disuse
  • obstructive uropathy
  • osmotic diuresis
  • skin or GI losses
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7
Q

What is the most common cause of hypovolemic hyponatremia

A

AGE

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8
Q

Causes hypovalemic hyponatremia

A
  • GI, skin, third spacing, kidney
  • diuretics
  • cerebral salt wasting
  • hypoaldosteronism
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9
Q

pathophys of hypervolemic hyponatremia

A

increased in ADH due to decrease in effective blood volume (cardiac, third spacing) resulting in water retention
-also increase in Na retention due to RAAS

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10
Q

Causes hypervolemic hyponatremia

A
  • CHF, cirhrhosis, nephrotic

- renal failure

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11
Q

Causes Euvolemic hyponatremia

A
  • SIADH
  • water intoxication if kidneys cant eliminate
  • glucocorticoid deficiency
  • hypothyroidism
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12
Q

Lab Findings SIADH

A

serum Na < 135
serum osm < 280
Urine Na > 25 (dumps Na due to slight increase in ECF)
Urine osmol > 100

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13
Q

What causes normal anion gap metabolic acidosis?

A
  • diarrhea

- RTA

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14
Q

What causes anion gap metabolic acidosis?

A
  • ketoacidosis
  • lactic acidosis
  • renal failure (photphate, urate, sulfate)
  • drugs: salicylates, ethylene glycol,metahnol, toluene
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15
Q

Best test to determine causes of meatbolic alkalsois?

A

low or high urinary chloride (low is < 15, high is greater than 20)

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16
Q

Causes chloride responsive (low chloride urine) metabolic alkalosis?

A
  • gastric losses
  • chloride losing diarrhea
  • thirazides
  • loops
  • cystic fibrosis
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17
Q

Pathophys chloride responsive metabolic alkalosis?

A
  • volume depletion causes increased resportion of Na and HCO3 in proximal tubule
  • increase in aldosterone due to volume depletion causes increase in HCO3 and H+ absorption in collecting ducts; hypokalemia
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18
Q

How do you separate the two types of chloride unresponive (high urine chloride) metabolic alkalosis?

A

elevated blood pressure or not

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19
Q

High BP chloride resistance metabolic alkalosis

A
  • adrenal hyperplasia or adenomas

- cushing

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20
Q

Normal BP chloride resistance metabolic alkalosis?

A
  • renovascular
  • bartter / gittelmann
  • AD hypoparathyroidsm
  • iatrogenics
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21
Q

What causes metabolic alkalosis in CF?

A

-loss of NaCl in sweat with dehydration causing metabolic alkalosis with hypokalemia; also hyponatremia

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22
Q

What is Bartter / Gitelman Syndrome

A

-defect in NaCl in loop of henle -> dehydration –> secondary hyperaldo–>hypokalemic metabolic alkalosis

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23
Q

What drugs can cause hyperkalemia in renal patients

A
  • K sparing diuretics
  • NSAIDs
  • heparin
  • acetylcholinesterase inhibits
24
Q

ECG Findings with Hyperkalemia in order

A
  • Peaked T waves
  • prolonged PR
  • flat p waves
  • wide QRS
  • V fib or asystole
25
Q

What can cause factitious hypokaelmia

A

leukocytosis

26
Q

Non renal causes hypok

A
  • diarrhea
  • laxatives
  • excessive sweat
  • anorexia / decreased intake
27
Q

Renal causes hypokaelmia

A
  • metabolic acidosis (DKA, RTA)
  • hypomagnesemia
  • metbolic alkalosis with contractions alkalosis
  • diuresis with obstructive nephropathy
  • tubulo interstitial
28
Q

ECG findings hypok

A
  • flattened T waves
  • depressed ST wave
  • U wave between T and P
  • v fib / torsades
29
Q

Mild Dehydration on exam

A
  • normal exam and tachycarida

- slight decrease UOP

30
Q

Moderate Dehydration on exam (5 to 10 infant, older child 3 to 6%)

A
  • lethargic, sunken eyes, sundken fontanelle
  • decreased tears and dry mucous membranes
  • decreased skin turgor
  • cap refill > 2 seconds
  • decreased UOP
  • tachy
31
Q

Breastfeeding contraindicated if women have these diseases

A
  • HIV (if formula available)
  • PKU
  • Galactosemia
  • hepatitis c
  • untreated active TB (can hand express)
32
Q

When can a mom not breastfeed but can give expressed milk

A

varicella

-untreated TB (2 weeks treatment and documented egative first)

33
Q

Mothers and substance use and breastfeeding

A
  • c/i if cocained or PCP etc
  • alcohol: must wait 2 hours after one drink
  • smoking is not contraindicated
34
Q

Contraindicated drugs breastfeedign

A
  • lithium
  • retinoids
  • ergotamine
  • bromocriptin
  • cyclophosphamide and most chemo agents
  • MTX
35
Q

Differences Milk and Cows milk proteins

A
  • human is whey dominant

- cow milk is casein

36
Q

When do we start iron fortification in babies?

A

4 to 6 months

37
Q

When do we use elemental formulas lik eneocate?

A

short gut, severel malabsorption syndrome, severed IBD, fistulas

38
Q

What nutrition deficiency are you at risk for for goat’s milk?

A

folic acid

39
Q

What vitamin deficiency are vegetarians at risk for?

A

vitamin b12

40
Q

Low magnesium causes secondary ***

A

hypocalcemia due to decreased released of PTH and function

41
Q

Zin Deficiency

A
  • growth deficiency
  • delayed healing
  • diarrhea
  • skin lesions: acrodermatitis enteropathica (mouth, perianal
42
Q

Copper deficiency

A
  • microcytic anemia
  • neutropenia
  • neurologic dysfunction
  • osteoporosis
  • skin/hair depigmentation
43
Q

Chromium Deficiency

A

-peripheral neuropathy
0encephalopathy
-glucose intolerance

44
Q

Vitamin A Deficiency

A
  • night blindness
  • dry scaly skin
  • xeropthalmia (cannot make tears)
  • increased ICP
45
Q

Hypervitaminosis A

A
  • pseudotumor cerebri (diplopia, HA, papilledema, emesis)
  • yellow skin
  • hepatosplenomegaly
  • desquamation palms and soles
  • alopecia
46
Q

Rickets Presentation

A
  • craniotabes
  • rachitic rosary
  • widening of epiphysis and wrists and ankles
  • non traumatic fractures
47
Q

Rickets on XR

A
  • thick epiphyses
  • metaphyseal fraying with cupping (loss of sharp border with concave edge)
  • widening of distal metaphysis
48
Q

Hyper Vitamin D

A
  • hypercalcemia
  • constipation
  • pancreatitis
  • CNS findings
  • polyuria
  • nephrocalcinosis
49
Q

Vitamin E Deficiency

A
  • hemolytic anemia
  • neuro symptoms: cerebellar and posterior column
  • retinal issue
50
Q

What factors are assd with vitamin K

A

II, VII, IX, X

51
Q

B6 deficiency

A
  • aka thiamine

- Beriberi (CNS, CV)

52
Q

Niacin deficiency

A
  • usually where corn is main staple

- peiroral dermatitis, dementia, diarrhea

53
Q

Where is vitamin b 12 absorbed

A

terminal ilieum

54
Q

What is strongest predictor of childhood obesity

A

parental obesity

55
Q

Test for protein losing enteropathy

A

stool for alpha 1 antitrypsin

Kaplan (8 decks)

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