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Flashcards in Fluids-Electrolytes Deck (18):

What are the complications of hypercalcemia?

"Bones, stones, abdominal moans, psychiatric overtones."

Bones: osteoporosis, osteomalacia, fractures, osteitis fibrosis cystica
Stones: Nephrolithiasis, nephrocalcinosis and nephrogenic diabetes insipidus
Abdominal groans: nausea, vomiting, constipation
Psychiatric overtones: coma, delirium, depression, fatigue, psychosis


What is the initial treatment for hypercalcemia?

IV hydration


What is the treatment for hypercalcemia due to immobilization?

IV hydration + loop diuretics


What are the symptoms of hypocalcemia?

Ca level < 8.5
iCal < 4.5

Paresthesias, tetany, seizures that do not respond to benzodiazepines, laryngospasm, prolonged QT


What crystals are associated with ethylene glycol poisoning?

Calcium oxalate crystals in the urine


What symptoms are associated with hypokalemia?

Constipation, lethargy, weakness


What are the findings in SIADH?

- Excess ADH secretion -> excess water retention -> increased total body water
- Decreased urine output
- Serum hyposmolality and hyponatremia
- Concentrated urine
- Normal/high urine sodium


How is SIADH treated?

- Fluid restriction
- Demeclocycline (diuretic) or Fludrocortisone if fluid restriction is not working and sodium level is persistently less than 120


What are the two causes of diabetes insipidus?

Central diabetes insipidus
Nephrogenic diabetes insipidus


What are the features of central diabetes insipidus?

- Insufficient ADH -> constant water loss
- Hypernatremia when the patient does not have access to free water
- Polyuria and dilute urine
- Treat with DDAVP/ADH


What are the features of nephrogenic diabetes insipidus?

- X-linked recessive
- Massive urine output
- No response to DDAVP/ADH supplementation
- Hypernatremia
- Tx: hydrochlorothiazide, salt restriction


What is the formula for corrected calcium?

Add 0.8 to the calcium level for every drop in albumin of 1 g/dL


How is the sodium level affected by hyperglycemia?

Sodium decreases by 1.6 for every 100 increase in glucose


How do you calculate the anion gap?

Na+ - Cl- - HCO3-


What is the adjusted anion gap for hypoalbuminemia?

(4-pt albumin) x 2.5 = x
12-x = anion gap max normal


How do you calculate the expected PCO2?

(1.5 x HCO3-) + 8 +/- 2


How do you calculate for sodium correction?

(desired Na - measured Na) x wt(kg) x 0.6 + 3 mEq/kg (for maintenance Na requirements) = amount of sodium needed in 24 hours
* Note: never correct more than 12 mEq/day


How do you calculate FeNa?

- A calculation that tells you how much Na+ is excreted as compared to reabsorbed

= (UNa+ / UCr) / (PNa+ / PCr)

<1% = prerenal disease, low renal perfusion
>2% = tubular/glomerular damage