Fluids and Electrolytes

Question 1

How to evaluate hyponatremia

Answer 1

look at osm first, then look at volume status if hypotonic

Question 2

Hypertonic hyponatremia - common cause

Answer 2

elevated glucose - therefore use corrected Na equation

Question 3

2 main causes of hypovolemic hypotonic hyponatremia

Answer 3

diuresis, blood loss,

Question 4

How to treat symptomatic hypovolemic hypotonic hyponatremia

Answer 4

3% NaCl

Question 5

How to treat asymptomatic hypovolemic hypotonic hyponatremia

Answer 5

0.9% NaCl

Question 6

Common cause of Isovolemic hypotonic hyponatremia

Answer 6

SIADH

Question 7

common causes of SIADH

Answer 7

carbamazepines; antipsychotics; SSRIs

Question 8

How to treat symptomatic Isovolemic hypotonic hyponatremia

Answer 8

3% NaCl and furosemide

Question 9

How to treat asymptomatic Isovolemic hypotonic hyponatremia

Answer 9

use isotonic NaCl and fluid restrict

Question 10

causes of Hypervolemic hypotonic hyponatremia

Answer 10

Kidney failure/heart failure

Question 11

how to treat symptomatic Hypervolemic hypotonic hyponatremia

Answer 11

3% NaCl and furosemide

Question 12

how to treat asymptomatic Hypervolemic hypotonic hyponatremia

Answer 12

only furosemide

Question 13

How to asses Hypernatremia

Answer 13

look at volume status

Question 14

How to treat hypovolemic hypernatremia

Answer 14

give free water - use free water equation (rule of dosing is give 1/2 over first day, last 1/2 over next 1 -2 days)

Question 15

how to treat isovolemic hypernatremia

Answer 15

(aka diabetes insipidus) give desmopression or vasopression

Question 16

how to treat hypervolemic hypernatremia

Answer 16

stop hypertonic fluid or give diuretic

Question 17

Common causes of hypokalemia

Answer 17

diuretics; metabolic alkalosis; Mg depletion

Question 18

Infusion rate for K+

Answer 18

10 mEq/hr (max with no cardiac hook up)

Question 19

common cause of hyperkalemia

Answer 19

metabolic acidosis

Question 20

3 steps to take care of SEVERE HYPERKALEMIA ( >7)

Answer 20

1 - antagonize membrane effects
2 - decrease extracellular K+ concen (push K+ into cells)
3 - excrete K+ out of the body

Question 21

Drugs that will help treat hyperkalemia - will antagonize membrane effects

Answer 21

calcium chloride

Question 22

Drugs that will help treat hyperkalemia - will push K+ into cells

Answer 22

insulin/D5W; NaHCO3; albuterol

Question 23

Drugs that will help treat hyperkalemia - will get K+ out of the body

Answer 23

furosemide; dialysis; patiromer; sodium polystyrene sulfonate

Question 24

Hypomagnesemia is often associated with?

Answer 24

low Ca and low K

Question 25

Common causes of hypocalcemia

Answer 25

Large volumes of blood products (citrate in it will bind to Ca2+); hypoalbunemia

Question 26

when to use the corrected calcium equation

Answer 26

when albumin is low

Question 27

2 IV ways to treat hypocalcemia

Answer 27

Calcium chloride or calcium gluconate

Question 28

when to use: calcium chloride vs calcium gluconate

Answer 28

cl: more concentrated - during code... | gluconate - less concentrated - less risk for necrosis/extravasation

Question 29

Possible ways to treat hypercalcemia

Answer 29

volume expansion/diuretics (push Ca out); calcitonin; bisphosphanates; glucocorticoids

Question 30

3 main reasons hypercalcemia occurs

Answer 30

increased bone resorption; increased GI absorption; decreased kidney elimination

Question 31

1 mMol of NaPhos has _____ mEq of Na and Phos

Answer 31

1.33

Question 32

1 mMol of KPhos has _____ mEq of K and Phos

Answer 32

1.47

Question 33

NaPhos or KPhos will effect an electrolyte level heavily?

Answer 33

K+

Question 34

adverse effects of albumin

Answer 34

hypervolemia; azotemia

Question 35

Common indications for Albumin uses

Answer 35

volume expansion; burns; shock; ARDS;

Question 36

What does the hemoglobin level have to be at to use blood

Answer 36

7 - 8 g/dL

Question 37

How much does a unit of RBC increase hemoglobin

Answer 37

1 g/dL

Question 38

what is the "most common MIVF"

Answer 38

D5W + 1/2NS + 20mEq KCl

Question 39

Treating Hypocalcemia - ACUTELY

Answer 39

100 - 300 mg elemental Ca IV over 5 - 10 min | Dont add bicarb or phos!!!!

Question 40

Ways to treat hypercalemia

Answer 40

furosemide/volume expansion glucocoritcoids Calcitonin bisphosphanates