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Flashcards in Fluids and Electrolytes Deck (66)
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1

WHat percentage is our intracellular fluid?

Intracellular fluid: 2/3 total body fluid

2

WHat makes up our extracellular fluid? 3

1. Interstitial fluid
2. Plasma
3. Lymphatic fluid

3

Electrolytes controlled via Na-K ATPase?
6

ECF: Na+, Cl-, HCO3-
ICF: K+, Mg, Phosphates

4

What are the most common ions in the extracellular fluid? 2

INtracellular fluid?2

Na+ and Cl-

phosphate and K+

5

Water movement from ECF to ICF regulated by?

Starling forces—hydrostatic pressures and osmotic pressures

6

1. What is osmolality?

2. What is our normal plasma osmolality?

3. WHat is the most important plasma osmolality factor and why?

1. concentration of an osmotic solution when measured in osmols of solvent

2. Plasma: 280-295 mOsm/kg

3. Na+ most important plasma osmolality factor (Water essentially follows sodium)‏

7

WHat kind of electrolyte replacement is preferred when tretaing dehydration?

oral replacement

8

1. Intravenous solutions (IV)
2



2. How much can we put through a peripheral line?

3. What do can we only put through a central line?

1.
-Saline equivalents: crystalloids
(Normal Saline or Lactated Ringers)
-Water equivalents:
(D5W)

2. 900 mOsm/L Max through peripheral line

3. 3% Normal Saline (1028mOsm/L) centrally (hypertonic solution)

9

1. Whats the osmolarity of D5W?

2. NOrmal Saline?

3. What are the lactated ringer ions (5) and what is the osmolarity?

4. Parenteral colliods are which ones? 4

1. D5W : 252-278 mOsm/L

2. NS: 285-300 mOsm/L —also ½ NS available

3. Lactated Ringer’s :
250-273 mOsm/L
Na+, Cl-, lactate, Ca+, K+

4. Parenteral colloids:
-Albumin: 290-310 mOsm/L
-Blood products:
-Packed RBCs
-Fresh frozen plasma

10

Name the adverse affects of the following:

Normal Saline? 3

Lactated ringers? 3

Saline: 3%, 5%, D5W1/2NS? 4

Albumin? 2

Normal Saline:
1. Fluid overload
2. Hyperchloremic metabolic acidosis
3. Hypernatremia

Lactated Ringer’s:
1. Fluid overload
2. Hyponatremia
3. Hyperkalemia

Saline: 3%, 5%, D5W1/2NS:
1. ICF depletion
2. Fluid overload
3. Hypernatremia
4. Hyperchloremia

Albumin:
1. Allergic reactions
2. Possible infection transmission

11

How do we access the type of fluid loss?
3

1. History

2. Symptoms

3. Vital signs and physical exam

12

Disorders of Water Balance:
1. Hypervolemia is what?
2. Etiologies? 7






3. Volume contraction--What types of fluid can be missing? 5

1. Hypervolemia:
-Expansion of the effective arterial blood volume

2. Etiologies?
-kidneys arent working,
-CHF,
-cirrohssis,
-ADH issues,
-aldosterone,
-drinking too much water.
-diabetes insipididus.

3. Kinds:
-hemmorhaging,
-GI losses,
-dehydrated,
-diarrhea,
-vomiting.

13

What is edema?

Examples of edema? 3

Too much Na+ w/ water retention in the interstitial space

-acities in ab
-extremities- peripheral edema
-CHF

14

1. For oral fluid replacement what should we avoid?

2. What are some good options?

3. What should we tell the pt to do?

1. AVOID fluids with a high sugar concentration

2. Water and sports drinks or in children Pediolyte

3. Stop activities that create ongoing losses!

15

1. Assess degree of fluid loss:
History? 2

2. Symtpoms? 3

3. Clinical manifestations? 3

1. History:
-GI losses??
-Excessive exercise—Loss from??
-Renal losses ??

Symptoms:
1. Easy fatigability and thirst, muscle cramps
2. Postural dizziness (orthostatic vitals), abdominal pain, chest pain
3. Lethargy, confusion, decreased urination

Clinical manifestations:
1. Decreased skin turgor (may not be seen very young or obese)
2. Tachycardia
3. Dry mucous membranes

16

1. Name the hyponatremia etiologies of the following:

2. Hypovolemia? 2

3. Normovolemia? 3

4. Hypervolemia? 5

1. Hypovolemia:
-GI losses ??
-Renal losses—thiazide diuretics

2. Normovolemia:
-Syndrome of inappropriate ADH secretion (SIADH)
-Primary polydipsia/marathon runners
-Low dietary solute intake

Hypervolemia:
-CHF
-Cirrhosis
- hypothyroidism,
-primary adrenal insufficiency,
-drugs

17

1. Whats the normal Na+ serum osmolality?

2. What level is our "panic value"?

3. At what level does treatment depend on symtpoms and situation?

4. At what levels is treatment not indicated?

1. lower than 135


Assess severity:
2. = 120 meq/L panic value***
3. 120-130—depends on symptoms and situation
4. >130 generally not directly treated

18

1. What is the normal serum osmolality?
2. What is the main determinansts of plasma osmolality? 3

1. 285-295 mOsm/kg

2. Na, glucose, urea

19

Hyponatremia—Clinical Manifestations:
Chronic Hyponatremia

Cerebral adaption

20

Cerebral adaptation as a result of Chronic Hyponatremia causes what symtpoms?
8

1. Fatigue,
2. nausea,
3. dizziness
4. Confusion,
5. lethargy,
6. muscle cramps
7. Gait disturbances,
8. forgetfulness

21

Hyponatremia—Clinical Manifestations:
Acute Hyponatremia

acute hyponatremic encephalopathy

22

1. Pathophysiology of acute hyponatremic encephalopathy?

2. What are usually the first symtpoms? 2

3. Later symtpoms? 5

4. Permanent damage? 2

1. Cerebral over hydration related to degree of hyponatremia

2. Fatigue and malaise usually first symptoms

3.
-HA,
-lethargy,
-coma,
-seizures
-eventually respiratory arrest

4. Acute hyponatremic encephalopathy may cause permanent neurologic damage or death

23

Hyponatremia Classification
3

Hypovolemic
Normovolemic
Hypervolemic

24

What are some examples of
1. Hyponatremic-hypovolemic? 2
2. Hyponatremic-normovolemic? 2
3. Hyponatremic-hypervolemic? 2

1. Hypovolemic:
-GI losses
-renal losses (thiazides)

2. Normovolemic:
-SIADH;
-low Na+ intake

3. Hypervolemic:
-CHF;
-cirrhosis

25

1. Acute hypotonic, hyponatremia: can result in symtpoms of what? 2

2. Can cause what symptoms? 5

1. Can result in symptoms of
-neuronal cell expansion and
-cerebral edema

2.
-Nausea,
-HA,
-seizure,
-coma,
-death***

26

The two ADH etiologies of hyponatremia:
Inability to suppress ADH:
Causes? 3

Appropriate suppression of ADH secretion:
Causes? 3

1. True volume depletion (GI or renal losses—thiazide diuretics)
2. Decreased tissue perfusion (reduced cardiac output or systemic vasodilation in cirrhosis for instance)
3. Syndrome of inappropriate ADH secretion (SIADH)

1. Primary polydipsia*
2. Low dietary solute intake
3. Advanced renal failure (elevated BUN/Cr)

27

Hypovolemic Hyponatremia
Causes? 2

How do we treat? 4

1. Such as with GI or renal losses
2. If serum Na+ has not dropped critically low quickly

1. Usually just volume replacement orally or IV if more severe
2. Normal saline/isotonic saline
3. Depending on patient status may do slow bolus
4. Then maintenance depending on ongoing losses**

28

Hypervolemic Hyponatremia
examples? 3

Treatment? 3

1. CHF
2. Cirrhosis
3. Renal failure

1. Restrict fluids: 1000-1200 ml/day
2. Restrict sodium: 1000-1200 mg/day
3. Utilize loop diuretics to remove excess fluid

29

1. What kind of hyponatremic presentation is SIADH?
2. Can be induced by drugs such as? 4
3. Can be induced by diseases such as? 4

4. Treatment? 4

1. Eu/hypervolemic hypotonic hyponatremia presentation

2. Drug-induced:
-Carbamazepine,
-SSRIs,
-haloperidol,
-thorazine

3. Disease-induced:
-Malignancies,
-CNS disorders,
-post-surgery,
-pulmonary infections

4. Treatment:
-Treat underlying cause
-Fluid restriction mainstay**
-May use oral salt tablets
-Loop diuretics

30

Therapy for Severe Hyponatremia:
1. What is the pt at risk for?
2. Treatment?
3. WHat is our goal?
4. How often should we measure the serum Na+?
5. What else should we measure?

1. Severe hyponatremia patient at risk for brain herniation!

2. Tx—3% hypertonic saline:
3. Goal to increase Na+ by 4-6 meq/L in 24 hr. period
4. Measure serum Na+ every hour
5. Measure urine output