Fluids and Electrolytes

Question 1

What is the normal sodium range?

Answer 1

135-145

Question 2

What is the normal potassium range?

Answer 2

3.5-5

Question 3

What is the normal Calcium range?

Answer 3

8.5-10.5

Question 4

What is the normal phosphate range?

Answer 4

2.5-4.5

Question 5

What is the normal magnesium range?

Answer 5

1.5-2.5

Question 6

A patient is hypernatremic. What is the first thing you look at?

Answer 6

Volume status–are they hypovolemic, isovolemic, or hypervolemic?

Question 7

A patient is hyponatremic. What is the first thing you look at?

Answer 7

Osmolarity

Question 8

A patient has hypertonic hyponatremia. What now?

Answer 8

Is there blood glucose high? Calculate corrected Na status (Na + (glucose-100)/100). Treat hyperglycemia with insulin

Question 9

A patient has isotonic hyponatremia. What now?

Answer 9

The patient has pseudohyponatremia. High lipids/proteins are causing an inaccurate lab reading

Question 10

A patient has hypotonic hyponatremia. What now?

Answer 10

Assess the patient’s volume status (hypovolemic, isovolemic, hypervolemic)

Question 11

What might cause isovolemic hypotonic hyponatremia?

Answer 11

SIADH,

Question 12

What drugs can cause SIADH?

Answer 12

antipsychotics, antidepressents (sertraline and fluoxetine), carbamezapine

Question 13

How do you treat isovolemic hypotonic hyponatremia?

Answer 13

1. Stop administering the drug that you suspect is causing SIADH
2. Administer Diuretic (furosemide)
3. Administer vaptans, as secondary line of treatment

Question 14

What is the characteristic TBW and Na of isovolemic hypotonic hyponatremia?

Answer 14

TBW is increased

Na is also increased, but not as high

Question 15

What might cause hypovolemic hypotonic hyponatremia?

Answer 15

Dehydration, fluid loss, burns,

Question 16

How do you treat hypovolemic hypotonic hyponatremia?

Answer 16

1. Administer fluids–NS
   Calculate sodium deficit to determine amount to administer
   Do not correct by more than 12 mEq/day
   Follow rule of 8’s: Half in first 8 hours, then a quarter in the next 8 and a quarter in the next 8

Question 17

What causes hypervolemic hypotonic hyponatremia?

Answer 17

Fluid retention?

Question 18

How do you treat hypervolemic hypotonic hyponatremia

Answer 18

Diuretics

Question 19

A patient has has hypovolemic hypernatremia. What do you do?

Answer 19

Calculate FWD. (TBW(Naserum/140)-1)

Administer 1/2 the FW over the first 24 hours, and the remaining half in the next 1-2 days

Question 20

What cause hypovolemic hypernatremia?

Answer 20

Fluid loss

Question 21

A patient has hypervolemic hyponatremia. What do you do?

Answer 21

Diuretics

Question 22

What do you do if a patient has hypokalemia and is asymptomatic?

Answer 22

Administer Potassium orally. Can come in liquid or solid dosage forms, as KCl, K acetate, etc.

Question 23

How much does 10mEq of potassium increase serum potassium?

Answer 23

by 0.1 mEq

Question 24

What do you do if a patient has hypokalemia and is symptomatic?

Answer 24

IV K+
Increase by no mare than 10mEq/hr
20mEq/hr if the patient is on continuous cardiac monitoring

Question 25

What do you do if a patient has hypomagnesemia and is asymptomatic?

Answer 25

Administer Mag Orally. | Milk of Mag or Ox-Mag

Question 26

What do you do if a patient has hypomagnesemia and is symptomatic

Answer 26

Administer Mag by IV. If Mag is 1-2: 0.5 mEq/L If mag is <1: 1 mEq/L

Question 27

What do you do if a patient has hypermagnesemia?

Answer 27

1. Administer CaCl 2. If normal renal function: Forced diuresis and 3. If renal dysfunction: Hemodialysis

Question 28

What do you do if patient has hyperkalemia?

Answer 28

1. Administer CaCl (to antagonize heart contractions) 2. Administer Insulin/Dextrose/albuterol/NaHCO3 (to draw the K into the cell) 3. Administer hemodialysis, diuretics, or polystyrene (to excrete K)

Question 29

What do you do if a patient has chronic hyperkalemia?

Answer 29

Administer Promitene--to decrease potassium absorption from GI tract

Question 30

What do you do if a patient has hypocalcemia?

Answer 30

1. Fix underlying Magnesium problem | 2. Administer Ca--Calcium gluconate preferred, CaCl possible if dire situation (administers faster--1 gm/3gm)

Question 31

What do you do if a patient has hypercalcemia?

Answer 31

1. Volume expansion/Loop diuretics 2. Calcitonin (decrease bone resorption and renal tubular reabsorption) 3. Bisphosphonate (decrease bone resorption) 3. Glucocorticoids (decrease GI absorption)

Question 32

What do you do if a patient has hypophosphatemia?

Answer 32

Administer phosphate: NaPHO if K >4 KPhos if K <4 Follow potassium administration rules

Question 33

What do you do if a patient has hyperphosphatemia?

Answer 33

Administer Ca gluconate | Reduce GI absorption of phosphate