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Pharmacotherapeutics IX > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

Sodium

A

135 - 145 mEq/L

most abundant EC cation

major determinant of serum osmolality

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2
Q

HYPOvolemia signs

A
  • postural hypotension
  • tachycardia
  • decreased skin turgor
  • dry mucosal membranes
  • flat neck veins
  • oliguria (reduced urine output)
  • organ failure
  • elevated SCr
  • dehydration
  • absence of jugular venous pulsations at 45 degree angle
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3
Q

HYPERvolemia signs

A
  • hypertension
  • tachycardia
  • raised jugular venous distension (hands & neck)
  • edema (legs & pulmonary)
  • pleural effusions
  • weight gain
  • ascites
  • organ failure
  • S3 gallop w HF
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4
Q

Isotonic Hyponatremia

A

low Na with normal osmolality

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5
Q

Isotonic Hyponatremia (causes)

A
  • hyperlipidemia and hyperproteinemia
  • plasma cell dyscrasias and malignancy
  • chronic infections (HCV), (HIV)
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6
Q

Isotonic Hyponatremia (tx)

A

correct underlying cause

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7
Q

Hypertonic Hyponatremia

A

decreased Na with high osmololity

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8
Q

Hypertonic Hyponatremia (causes)

A

hyperglycemia

+ other osmoles (mannitol, glycine, sorbitol)

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9
Q

Hypertonic Hyponatremia (tx)

A

correct underlying cause (hyperglycemia)

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10
Q

Hypotonic Hyponatremia

A

low Na and low osmolality

evaluate volume status

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11
Q

Hypotonic HYPOvolemic Hyponatremia

A

reduced EC volume

S&S: orthostatic hypotension, hypotension, tachycardia, dry mucous membranes, CNS changes, oliguria
- high urine osmolality > 450 mOsm/kg

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12
Q

Hypotonic HYPOvolemic Hyponatremia (causes)

A

urine sodium >20 : renal loss, diuretics, ACEi, cerebral salt wasting

urine sodium < 20 : GI (D/V), burns, lung loss

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13
Q

Hypotonic HYPOvolemic Hyponatremia (tx)

A
  • fluid replacement: NS or LR bolus

- if severe consider hypertonic saline

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14
Q

Hypotonic ISOvolemic Hyponatremia (causes)

A

SIADH:

  • malignancy (lung, pancreatic, lymphoma)
  • CNS disorder: head trauma, stroke, meningitis, pituitary syndrome
  • pulmonary disease: TB, pneumonia, acute respiratory distress syndrome
  • medications: ACEi, Carbamazepine, TCAs, SSRIs, NSAIDs

Renal insufficiency
Adrenal insufficiency

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15
Q

Hypotonic ISOvolemic Hyponatremia

A

present: urine osmolality >100 mOsm/kg; (urine Na >20 mEq/L)
diagnosis: SIADH, renal/adrenal insufficiency
tx: fluid restriction (<1L/d), Na tablets, Tolvaptan, diuretics (IV furosemide)

present: urine osmolality < 100 mOsm/kg (urine Na <20 mEq/L)
diagnosis: psychogenic polydipsia, excessive hypotonic fluid intake
tx: treat underlying cause

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16
Q

Hypotonic HYPERvolemic Hyponatremia

A

excess ECF volume

presentation: edema, swelling

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17
Q

Hypotonic HYPERvolemic Hyponatremia (causes)

A
  • reduced renal excretion of sodium and water (renal dysfunction)
  • cirrhosis, HF
  • nephrotic syndrome (too much protein in urine)
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18
Q

Hypotonic HYPERvolemic Hyponatremia (tx)

A
  • Na & H2O restriction

- diuresis with loop diuretic

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19
Q

HYPOvolemic Hypernatremia

A

loss of H2O and Na

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20
Q

HYPOvolemic Hypernatremia (causes)

A
  • renal: osmotic diuresis, diuretic use, postop diuresis, high-output acute tubular necrosis
  • GI: D/V
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21
Q

HYPOvolemic Hypernatremia (tx)

A

NS or LR (200-300 mL/h)

once intravascular volume is restored use D5W or 1/2 NS

22
Q

ISOvolemic Hypernatremia

A

pure water loss

23
Q

ISOvolemic Hypernatremia (causes)

A
  • Diabetes insipidus

- insensible loss of fluid (sweat, fever, respiratory infection, burns)

24
Q

ISOvolemic Hypernatremia (tx)

A
  • free water replacement (po or iv)

- treat diabetes insipidus (desmopressin, address cause)

25
Q

HYPERvolemic Hypernatremia (causes)

A

sodium overload:

  • 3% NaCl, sodium bicarb, salt tabs, concentrated tube feedings, hypertonic dialysate, Na-containing meds
  • primary aldosterone
26
Q

Hypokalemia

A

S&S:

  • muscular: weakness, respiratory distress, cramping, malaise, paralysis
  • cardiac: EKG changes, cardiac arrhythmias, heart block, sudden death
27
Q

Hypokalemia (causes)

A
  • total body K deficit
  • renal loss and IC shift
  • hypomagnesemia
28
Q

total body K deficit

A
  • excessive GI loss - D/V, NG suctioning, body drains
  • meds: laxatives, sodium polystyrene sulfonate, sorbitol
  • poor dietary intake of K
29
Q

renal loss & IC shift

A

renal loss:
- meds: diuretics, high-dose penicillin, mineralocorticoids,

IC shift:
- meds: B2 receptor agonists, theophylline, caffeine, insulin

hormones: aldosterone excess
high dose steroids

30
Q

Potassium Replacement

A
  • PO preferred > IV if asymptomatic
  • consider Mg before K
  • for every 10 mEq of K given, anticipate 0.1 increase in serum K
  • replace over 1-3 days to minimize SEs
  • potassium chloride
  • potassium phosphate
  • potassium bicarb or acetate
  • IV infused no > 10 mEq/hr in NS
  • re-evaluate 30 mins after infusion of 30-40 mEq
31
Q

Hyperkalemia

A

S&S:

  • muscular: twitching, cramping, weakness
  • cardiac: heart palpitations, EKG changes, cardiac arrhythmias
32
Q

Hyperkalemia (causes)

A
  • incr. K intake
  • redistribution into EC space (metabolic acidosis, DM, direct tissue damage, digoxin tox, beta blockers, hyperosmolality)
  • decr K excretion (kidney disease, adrenal insufficiency, Addison’s disease, low aldosterone levels, meds)

–> ACEi/ARBs, direct renin inhibitors, K-sparing diuretics, prostaglandin inhibitors (NSAIDs), digoxin, cyclosporine, bactrim, heparin, pentamidine

33
Q

Hyperkalemia (tx)

A
  1. remove meds and supp that incr. K
  2. determine severity
  3. stabilize the heart with Calcium (IV Calcium Gluconate)
  4. Shift K intracellularly
    - insulin (+ dextrose)
    - albuterol
    - Sodium bicarbonate
  5. increase K elimination
    - exchange resins (Na polystyrene sulfate, Patiromer, Na zirconium cyclosilicate)
    - loop diuretics
    - renal replacement therapy
34
Q

Hypomagnesemia

A

S&S:

  • muscular: muscle cramping, twitching, tetany
  • cardiac: arrhythmias, ECG changes
  • neuro: irritability, seizures, coma, death
  • electrolytes: refractory hypokalemia & hypocalcemia
35
Q

Hypomagnesemia (causes)

A
  • decr. GI absorption (bowl resection, short bowel syndrome, pancreatic insufficiency)
  • incr. GI loss (excess laxative use, V/D, NG suctioning)
  • renal causes (diuresis c diuretics, alcoholism, increased urinary excretion)
  • decr. oral intake (alcoholism, TPN, poor nutrition)
  • med: diuretics; amphotericin B, caspofungin, pip/tazo; lactulose; long-term digoxin or PPI use
  • trauma, burn, sepsis/critical illness
36
Q

Hypomagnesemia (tx)

A

oral: Mg oxide
IV: Mg Sulfate

37
Q

Hypermagnesemia

A

S&S:

  • GI: N/V, hypotension, bradycardia
  • muscular: muscle weakness
  • cardiac: bradycardia, heart block, asystole, hypotension
  • neuro: drowsiness, paralysis, coma
38
Q

Hypermagnesemia (causes)

A
  • renal failure
  • incr. oral intake
  • lithium therapy
  • hypothyroidism
  • addison’s disease
39
Q

Hypermagnesemia (tx)

A
  • reduce Mg intake
  • enhance elimination (loop diuretics, renal replacement therapy, dialysis)
  • stabilize the heart (IV Calcium gluconate)
40
Q

Hypophosphatemia

A

S&S:

  • CNS: irritability, weakness, numbness, paresthesia, dysarthria, confusion, obtunded, coma
  • cardiac: congestive cardiomyopathy, cardiac arrest
  • neurologic: delirium, hallucinations, paranoia, seizures
41
Q

Hypophosphatemia (causes)

A
  • decr. GI absorption
  • reduced tubular reabsorption
  • internal redistribution
  • med (phosphate-binding, sucralfate, aluminum/Mg antacids, Ca supp, diuretics, parenteral nutrition, insulin
  • critical illness, hyperparathyroidism, cancer
42
Q

Hypophosphatemia (tx)

A
  • oral: neutra-phos, neutra-phos-k

- iv: sodium phosphate, potassium phosphate

43
Q

Hyperphosphatemia

A

S&S:

  • short-term: N/V/D, lethargy, tetany, prolonged QT, seizures
  • long-term: hypocalcemia, vascular and organ damage due to calcium-phosphate deposits/calcifications
44
Q

Hyperphosphatemia (causes)

A
  • renal failure
  • hypoparathyroidism
  • vitamin D toxicity
  • rapid tissue catabolism (rhabdo, trauma, tumor lysis, hemolysis)
  • IC shifts
  • immobility
  • diabetic ketoacidosis
  • excessive phosphorous intake (TPN, enemas containing phosphorous)
45
Q

Hyperphosphatemia (tx)

A
  • severe (hypocalcemia and tetany)
  • -> IV Ca Carbonate or Ca Acetate
  • mild-mod (no hypocalcemia)
  • -> phosphate binders (Ca acetate, Ca carbonate; sevelamer carbonate, sevelamer hydrochloride
46
Q

Hypocalcemia

A

S&S:
acute drop (neuromuscular symptoms)
- paresthesia, muscle cramps, tetany, and laryngeal spasm
- prolonged systole, heart block, heart failure symptoms, ventricular arrhythmias

chronic (CNS and dermatologic symptoms)

  • depression, anxiety, confusion, hallucination, tonic-clonic seizures
  • hair loss, grooved/brittle nails, eczema
47
Q

Hypocalcemia (causes)

A
  • hypoparathyroidism
  • vit D deficiency (liver failure, CKD, GID disease)
  • med: furosemide, calcitonin, biphosphates, po phosphorous agents
  • Mg deficiency, blood transfusions with citrated blood products, continuous renal replacement
48
Q

Hypocalcemia (tx)

A

po: Ca carbonate, Ca citrate

IV: Ca Chloride, Ca gluconate

  • Hypoparathyroidism (oral calcium + vit D)
  • malabsorption of Vit D (large vit D dosing)
  • CKD (vit D)
    Hypomagnesemia (replace Mg)
49
Q

Hypercalcemia

A

S&S:

  • GI: N/V, constipation
  • renal: polyuria, polydipsia, reduced renal function
  • neuro: confusion, fatigue, muscle weakness, disorientation, depression, insomnia, psychosis, coma
  • cardio: cardiac arrhythmias, shortened QT, slower conduction
50
Q

Hypercalcemia (causes)

A
  • cancer
  • primary hyperparathyroidism
  • other causes: immobility, Paget’s disease, rhabdo, dehydration
    meds: thiazide, lithium, vit D, Ca supp
51
Q

Hypercalcemia (tx)

A

chronic:
- remove supp/evaluate meds; remove tumor

acute:

  • NS 200-300 mL/hr x 48 hr
  • loop diuretic (furosemide)
  • calcitonin
  • IV bisphosphates (Pamidronate, Zolendronic acid)

Pharmacotherapeutics IX (2 decks)

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