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fluids Flashcards

1
Q

ii. The normal osmolarity of serum is about

A

290

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2
Q

iii. At any temperature above absolute zero, electrolytes will

A

diffuse throughout a solution to achieve uniform osmolarity.

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3
Q

iv. In biological systems, fluid compartments

A

(e.g., the extracellular and intracellular compartments) are separated from each other by semi-permeable membranes

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4
Q

If you have two solutions of different concentrations that are separated by a semi-permeable membrane, the tendency of those solutions to equalize their concentration by moving water across the membrane is called the _________

A

osmotic pressure gradient.

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5
Q

vi. The movement of water is called

A

osmosis

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6
Q

vii. The effect osmolarity has on this process is called

A

tonicity

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7
Q

_________are fluids that are close to the normal serum osmolarity of 290 mOsm/L.

A

a. Isotonic fluids are

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8
Q

_______fluids are fluids that have a lower osmolarity than serum.

A

b. Hypotonic fluids

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9
Q

_______are fluids that have a higher osmolarity than serum.

A

Hypertonic fluids are fluids that have a higher osmolarity than serum.

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10
Q

small solutes; can move a little freely with this type of fluid

A

crystalloid

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11
Q

big solutes; like blood wit this type of fluid

A

colloid
protein
plasma

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12
Q

nml Na

A

a. Normal value: between 135-145 mEq/L.

Critical for fluid balance, nerve function, muscle function.

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13
Q

c. The #1 extracellular electrolyte.

A

Na

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14
Q

hypotonic crystalloid

A

D5W

of 1/2 NS (.45%)

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15
Q

Because sodium is so closely linked to serum osmolarity, sodium derangement leads to changes of the body’s osmotic pressure gradient.

This causes cells to ______ in hyponatremia

or ______ in hypernatermia

this phenomena is worse here

A

cells to swell (in hyponatremia), or to shrink (in hypernatremia).

g. While this phenomenon affects all cells, it has an outsized effect on brain cells.

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16
Q

hyponatremia is defined as

this is usually due to

A

Hyponatremia (Na <135)

May not see clinical signs until Na+ is <125.

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17
Q

sxs of hyponatermia

A

Symptoms include lethargy disorientation, muscle cramps, anorexia, hiccups, nausea/vomiting, seizures.

Patient may have weakness, agitation, stupor, hyperreflexia, orthostatic hypotension, delirium, coma, death

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18
Q

Extrarenal losses

A

losing fluids faster than they can replenish it

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19
Q

Treatment of hyponatermia is to

A

correct the water overload (or deficit) and/or raise the sodium. (hypertonic sollution 3%)

vii. Find the underlying cause.
viii. Fluid restriction and monitoring.
ix. May give hypertonic saline for severe symptoms

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20
Q

Careful of rapid correction of hyponatremia because

A

Careful of rapid correction—can cause central pontine myelinolysis (i.e., brain damage).

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21
Q

list the colloids

A 
blood
albumin
dextran
FFP 
PRBCs
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22
Q

dextran

A

glucose polysaccharide

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23
Q

hypernatremia is defined as and caused by

A

i. Hypernatremia (Na >145)

(1) inadequate fluid intake;
(2) excess water loss;
(3) iatrogenic (in the hospitalized patient).

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24
Q

FFP needed for

A

pts that would be bleeding a lot

coagulants

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25
PRBC
trauma -usually whole blood but not always
26
how to make decisions about fluids
do you need to make a decision right away
27
unstable pt start with
2 L NS responder or non responder
28
10% of body weight loss in an adult is what stage of dehydration
severe
29
mild and moderate dehydration looks like
6% | 8%
30
replenishing fluids in a pt with CHF or renal failure
really need to be slow with fluids
31
maintenance fluids what's normal
unlike resuscitation you're not trying to make up for significant loss usually NPO 100-150mL an hour small lil lady 90
32
70Kg adult looses
2500-3000 mL/day
33
4-2-1 for children
4mL up to 10Kg 2Ml for next 10Kg 1mL per Kg after that or broselow tape with weight and height
34
27 yo women in 1st trimester has been vomiting for 3 days BP 90/60 HR 120 skin turgur decreased what do we start with
need to know stable of unstable this woman is severely dehydrated but unstable 10-15 mL/kg bolus around 1 L given antiemetics after a second L of NS--> peeing too much NS can lead to acidosis
35
Parkland Formula
burn formula exposed tissue come with incredible amounts of bluid loss 4ml x % body surface area burned x weight for the first 8 hrs give 1/2 fluid at 8 hrs and then 1/2 that at 16
36
non focal LOC
infection-meningitis, encephalitis trauma seizure CVA overdose metabolic- hypoglycemia or hyponatremia alcohol
37
when you have someone with hyponatremia you need to
this is the neuro electrolyte will shrink or swell brain cells check a glucose
38
ADH effects of osmolarity
CONSERVES WATER hormonal control of Na too much ADH can lead to water intoxication
39
aldosterone effects on osmolarity
conserves SODIUM and too much leads to K loss and Na retention
40
pseudohyponatremia is due to
high concentrations of glucose lipids or proteins in the plasma makes the water want to leave the cells and rush into extracellular space making it look lik ehyponatremia water is drawn out and into plasma
41
each 100 mg/dL glucose elevation decreases the Na by
1.6- 1.8 mEq/L
42
treatment of pseudohyponatremia
manage the underlying cause consider volume status and serum osmoles
43
sxs of hypervolemic hyponatremia
confusion HA vomiting seizures coma and death
44
hypervolemic hyponatremia Rx
if stable need to restrict water and weight is seizing or coma would consider using hypertonic saline
45
hypovolemic and hyponatermia tx
seen with decreased extracellular fluid rx volume replacement with NS
46
central pontine myelinolysis what is the general rule to help avoid this
looks like pig on CT too rapid correction of hypovolemic hyponatremia Na that causes shrinkage fo the brain cells and leads to damage in general better to correct no faster than it occured (in chronic pts no more than .5 mEq/hour)
47
older woman LOC Na=164 BUN=55 Cr=2.5
dehydration and hypernatremia too little water or no ADH can lead to this as does sweating hyperventilation
48
hypernatremia sxs
when >155 -160 OR osm>350 Irritability restlessness seizures coma permanent neuro damage tx with NS or D5 1/2 NS
49
44 yo man that missed 2 dialysis treatments
NEED EKG first seen with peaked T waves the kidneys aren't filtering so the body is retaining potassium
50
5.5 mEq/L: EKG changes
Peaked T-waves (repolarization abnormalities).
51
>6.5 mEq/L ekg changes
: P wave flattens, PR prolongation (paralysis of atria).
52
>7.0 mEq/L EKG
QRS prolongation, ventricular arrhythmias.
53
> 9.0 mEq/L EKG
Cardiac arrest due to asystole, ventricular fibrillation, or PEA.
54
three goals of treating hyperkalemia
➤ Protect the cardiac conduction system; ➤ Shift potassium from the extracellular fluid compartment back into the cells; ➤ Remove excess potassium from the body.
55
what type of Ca do you give
calcium Chloride for Coding needs to be given through a central line need to avoid unless you're in a situation that really calls for it very caustic to the tissues calcium Gluconate for any other time
56
why do you give insulin
to move K into the cell if their sugars are high if they are normal given glucose and insulin
57
other than insulin what else moves Ca into the cell
ALBUTEROL
58
Intravenous calcium is given in hyperkalemia in order to
Intravenous calcium to antagonize the membrane actions of hyperkalemia (see 'Calcium' below)
59
hypokalemia looks like what on a EKG (4)
i. Flattened T waves ii. Prolonged QT interval iii. U waves iv. Ventricular arrhythmias muscle WEAKNESS
60
Tx of hypokalemia
Not an emergency unless cardiac manifestations are present. Replete potassium (50 mEq will raise serum K+ by 1.0) Can give orally, which is safer but slower. When giving IV, need to use a large vein (potassium is is very irritating) v. Give up to 20 mEq/hr.
61
what causes hypokalemia
i. Diuretics ii. Vomiting iii. Diarrhea also alkalosis insulin albuterol and beta adrenergic
62
hypokalemia defined as
Defined as potassium less than 3.5 mEq/L
63
other than excessive excretion what else can cause hypokalemia
b. Can be caused by potassium being shifted into the cells i. Alkalosis 1. Insulin and glucose use 2. Use of beta-2 agonists (e.g., albuterol).
64
27yo woman presents to the ED with tingling around her mouth for two days. She also has some facial twitching. ii. PMH: had thyroid surgery two weeks ago. PE: Normal vitals. LABS you want
Chem 7 TSH CBC But her calcium is 6.4 (normal is 8.5-10.5).
65
normal Ca levels
8.5-10.5 CC looks like an 8
66
Hypocalcemia Ca++ defined as
<8.5
67
what's more common hypo or hyper Ca
hypo more common than hypercalcemia.
68
causes of hypo Ca
Most commonly results from a chronic disease, with chronic kidney disease being the most frequent cause. 1. Hypoparathyroidism 2. Acute pancreatitis - -> fatty sludge chelates to the Ca 3. Alkalosis 4. Massive blood transfusions
69
EKG with hypoCa
prolonged QT interval that may progress to Torsades de Pointe.
70
sxs of hypoCa
1. Dry skin and brittle nails 2. Muscle cramping 3. Pruritus 4. Shortness of breath 5. Numbness and tingling 6. Syncope, angina, heart failure 7. Hyperreflexia, tetany, clonus
71
Chvostek’s sign
Tap the patient’s face just in front of the ear. A positive Chvostek’s sign is when the patient’s lip twitches on the same side where you’re tapping.
72
Trousseau’s sign
hyperca evaluation Apply a blood pressure cuff, inflate it above the patient’s systolic blood pressure, and leave it on for 3-5 minutes. A positive Trousseau’s sign is when the patient’s hand and forearm muscles go into spasm.
73
TX of hypoCa
1. ABCs 2. Treat severe hypocalcemia with IV calcium gluconate or calcium chloride. 3. Mild hypocalcemia can be treated outpatient with oral calcium replacement and Vitamin D supplements.
74
Ca plays essential role in
Important in transmission of nerve impulses, muscle contraction, cardiac electrical conduction, and other things
75
There are multiple complex interrelated mechanisms that contribute to serum calcium homeostasis. These involve
``` Vitamin D levels the small intestine renal tubules parathyroid hormone (PTH) and bone. ``` The most direct of these mechanisms, is PTH. If PTH is high, then calcium is high and phosphorus is low. If PTH is low, then calcium is low and phosphorus is high.
76
causes of hyperCa
1. Elevated PTH 2. Cancer with bony metastases 3. Elevated Vitamin D 4. Thiazides 5. Sarcoidosis 6. Many other possible causes….
77
sxs of hyperCa
Stones, Bones, Groans, Moans, Thrones, and Psychiatric Overtones.” 1. Nephrolithiasis 2. Bone pain 3. Lethargy and fatigue 4. Abdominal pain 5. Polyuria and polydipsia 6. Confusion, depression, irritability, anxiety, hallucinations…
78
tx of hyper Ca
1. IV fluids a. Large amounts of isotonic crystalloid to restore volume. 2. Increase calcium excretion with a loop diuretic (NOT a thiazide). 3. Drugs that decrease the release of calcium from bone a.Calcitonin, mithramycin, corticosteroids, bisphosphonates
79
not typically on a chem panel but need to order these if you suspect any electrolyte abnormalities
magnesium and phosphorus
80
hypo phophorus sxs
muscle dysfunction weakness decreased cardiac output confusion delirium sxs usually occur with levels less than 2mg/dL
81
treat hypophos
underlyinG DKA/diarrhea anatacid vit d TX with oral repletion until level <1mg/dL then give IV
82
hyperphosphorus
usually asymptomatic secondary to laxatives/enemas renal failure prolonged exercise diet/phosphate binders if indicated
83
what is a blous
however big the IV is will determine how fast the pt gets it when the line is wide open ALWAYS think about this the bolus is as fast as it will go in you can say this but if you want to go slower you have to specify 150cc an hour is crazy slow (7 hours per liter)

Emergency Medicine (28 decks)

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