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AP II Test 1 > Fluids and Electrolytes Part 2 > Flashcards

Fluids and Electrolytes Part 2 Flashcards

1
Q

Neurological symptoms of hyponatremia: (10)

A
  • N&V
  • visual disturbances
  • depressed consciousness
  • agitation
  • confusion
  • coma
  • seizures
  • muscle cramps
  • weakness
  • myoclonus
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1
Q

If Na < 123 mEq/L, then ____ ___ may result.

If Na < 100, then ___ ____ may result.

A

cerebral edema

cardiac symptoms

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2
Q

_____ _____ can cause pulmonary edema, HTN, and heart failure.

A

Hypervolemic hyponatremia

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3
Q

For _____, decrease MAC!

A

hyponatremia

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4
Q

Treatment for hyponatremia: (3)

A
  • water restriction
  • loop diuretic in case of water overload
  • hypertonic saline in the case of severe hyponatremia with neuro symptoms
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5
Q

Correct Na deficits very SLOWLY!!!!

Optimal rate of correction is ___-__mmol/L/hr until Na= 125 mEq/L, then proceed slower.

Replace half of the deficit in the first 8 hrs, and the rest over 1-3 days. Monitor sodium levels every 1-2 hrs.

A

0.6-1

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6
Q

Dose of Na (mEq) for hyponatremia:

A

(kg x (140-[Na]) ) x 0.6

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7
Q

Correct Na slowly because may cause ____ ___ ___

A

central pontine myelinolysis

Symptoms include: acute para- or quadraparesis, dysphagia, dysarthria, diplopia, loss of consciousness, and other neurological symptoms associated with brainstem damage.

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8
Q

An increase in ECF [Na] (above 145 mEq/L) which may be accompanied by the presence of low, normal, or high total-body Na content is called _____.

Major cause is:

A

hypernatremia

lack of fluid replacement

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9
Q

Signs of hypernatremia: (3)

A
  • Intense thirst (unless malfunctioning thirst mechanism)
  • Lethargy, mental status changes coma and convulsions.
  • Shock, peripheral edema, myoclonus, ascites, muscle tremor, hyperactive reflexes, pleural effusion, expanded intravascular fluid volume
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10
Q

Treatment of hypernatremia:

A
  • diuretics
  • hypotonic crystalloids restore normal osmolality and volume
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11
Q

Hypernatremia______the MAC of our anesthetics

A

increases

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12
Q

Potassium is the most abundant intracellular fluid cation. which maintains membrane potential. True or false?

A

true

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13
Q

What keeps K in check? (4)

A
  • kidneys
  • insulin (big factor)
  • hormones
  • HCO3
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14
Q

Increase in pH results in _____ in K and vice-versa.

A

decrease

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15
Q

______ HCO3 decreases K. Hyperventilation produces the same effect.

A

Increased

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16
Q

Beta2 adrenergic agonists ______ K indirectly due to ___ changes.

A

decrease

pH

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17
Q

Hypokalemia is present when K < ___ mEq/L

A

3.5

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18
Q

Causes of hypokalemia include: (4)

A
  • inadequate intake
  • excess renal loss
  • GI losses
  • ECF to ICF shift–such as beta agonist, vitamin b12, insulin
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19
Q

Inadequate intake of K resulting in hypokalemia results from: (4)

A
  • anorexia
  • starvation
  • alcoholism
  • hyperaldosteronism
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20
Q

Hypokalemia from excess renal loss results from: (6)

A
  • diuresis
  • chronic metabolic alkalosis
  • PCN
  • Nafcillin
  • renal tubular acidosis
  • hypomagnesium
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21
Q

Vomiting and diarrhea can result in hyperkalemia. True or false?

A

false

hypokalemia

22
Q

ECF to ICF shifts can be caused by: (6)

A
  • Beta 2 agonist
  • acute alkalosis
  • insulin
  • vitamin B12 therapy
  • lithium overdose
  • hyperventilation
23
Q

In the range of 2-2.5 mEq/L, hypokalemia can cause: (5)

A
  • muscle weakness
  • arrythmias
  • ST depression
  • T wave depression
  • appearance of a U wave

The changes do not correlate with the severity of Potassium depletion. Dysrrhythmias include a-fib and PVC’s.

24
Another cause of \_\_\_\_\_is stress induced by surgery. The increased catecholamine activity causes hypokalemia due to ____ action.
hypokalemia beta2
25
If potassium is below \_\_\_\_\_, treat with IV\_\_\_.
2.6 KCl
26
KCl must be diluted in NS (\_\_\_\_ mL) and should not be infused faster than \_\_\_\_mEq/hr in a peripheral IV, and \_\_\_mEq/hr through a CVL. Monitor the EKG continuously
250 10 20
27
Hyperkalemia indicated when \> \_\_\_mEq/L
5.3
28
Causes of hyperkalemia: (4)
* pseudohyperkalemia * altered interal K balance * drugs * altered external K balance
29
What causes pseudohyperkalemia? (2)
sample lysis technical issues
30
KNOW: What causes internal K balance changes? (4)
* acidosis * insulin deficiency * MH (malignant hyperthermia) * cell necrosis
31
What can succinylcholine, digitalis, non-selective B-blockers,** \_\_\_\_\_\_\_**, and spironolactone cause?
_ACE-inhibitors_ cause hyperkalemia
32
Decreased excretion from renal disease, transfusions, and hypoaldosterone can cause altered internal/external K balance resulting in this.
external hyperkalemia
33
Signs and symptoms of hyperkalemia: 6-7 mEq/L --\> 10-12 mEq/L --\>
muscle weakness peaked T waves and long PR interval wide QRS, ventricular fibrillation and asystole
34
Treatment for hyperkalemia is determined by presence of ECG changes. Stabilize heart with IV \_\_\_\_\_. Redistribute potassium into cells by IV glucose and insulin, (amp D50 + ____ units Insulin- lowers levels within 10 min and lasts 4-6 hours.
calcium 10
35
What are other treatments for hyperkalemia? (8)
* bicarb * hyperventilation * dialysis * diuretics * B agonists * aldosterone * agonists * kayexelate
36
What is responsible for endocrine and exocrine secretions, cell growth, transport and secretion of fluids and electrolytes, and muscle contractions?
calcium
37
Calcium is controlled by: (2)
PTH calcitonin
38
Calcium is a coagulation factor. True or false? Calcitonin tones down calcium. True or false? Blood products _______ Ca values.
true true decreases
39
Calcium exists in the body in 3 forms:
* bound to protein (40%) * ionized, physiologically active (50%) * nonionized chelated with anions: phosphate, sulfate, citrate (10%)
40
Ionized calcium does not vary with the albumin level, and therefore it is useful to measure the ionized calcium level when the serum albumin is not within normal ranges, or when a calcium disorder is suspected despite a normal total calcium level. True or false?
true
41
Calcium levels must be adjusted for low albumin. If Albumin is low, then the adjusted calcium value is lower than the measured serum calcium value. True or false?
false higher than
42
PTH causes increased calcium reabsorption in the kidney and decreased excretion. It also causes bone resorption, therefore increasing calcium. True or false?
true
43
Hypocalcemia calcium \< \_\_\_\_mg/dL (or 2.2-2.6 mmol) or ionized calcium levels \< \_\_\_\_\_mmol/L.
8. 5 1. 1-1.4
44
What are the causes of hypocalcemia? (4)
* low PTH * ineffective PTH * low albumin * iatragenic in OR
45
What causes low PTH?
hypoparathyroidism
46
What may cause ineffective PTH?
lack of vit. D
47
What may cause low albumin resulting in low Ca? (2)
critical illness liver disease
48
What may cause iatragenically low Ca in the OR? (3)
**acute hyperventilation** infusion of blood products parathyroid/thyroidectomy
50
Decrease in Ca is observed when blood is transfused because:
citrate binds to calcium
51
These symptoms describe what? The prognosis is overall poor. While some patients die, most survive and of the survivors, approximately one-third recover; one-third are disabled but are able to live independently; one-third are severely disabled.[11] Permanent disabilities range from minor tremors and ataxia to signs of severe brain damage, such as spastic quadriparesis and locked-in syndrome. Some improvements may be seen over the course of the first several months after the condition stabilizes.
central pontine myelinolysis from giving Na too fast
52
Acute severe ___________ causes an osmotic shift of water from the cells, leading to shrinkage of the brain and tearing of meningeal vessels and IC hemorrhage.
hypernatremia (as with Na replacement for hypoNa)
53
What are EKG changes for hyperkalemia?
peaked t waves

AP II Test 1 (12 decks)

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