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Flashcards in Fluids-Electrolytes Deck (18):
1

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

2

What is the initial treatment for hypercalcemia?

IV hydration

3

What is the treatment for hypercalcemia due to immobilization?

IV hydration + loop diuretics

4

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

5

What crystals are associated with ethylene glycol poisoning?

Calcium oxalate crystals in the urine

6

What symptoms are associated with hypokalemia?

Constipation, lethargy, weakness

7

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

8

How is SIADH treated?

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

9

What are the two causes of diabetes insipidus?

Central diabetes insipidus
Nephrogenic diabetes insipidus

10

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

11

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

12

What is the formula for corrected calcium?

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

13

How is the sodium level affected by hyperglycemia?

Sodium decreases by 1.6 for every 100 increase in glucose

14

How do you calculate the anion gap?

Na+ - Cl- - HCO3-

15

What is the adjusted anion gap for hypoalbuminemia?

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

16

How do you calculate the expected PCO2?

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

17

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

18

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