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Pharmacotherapeutics IX > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

(51 cards)

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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)

Study These Flashcards
A

NS or LR (200-300 mL/h)

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

22
Q

ISOvolemic Hypernatremia

Study These Flashcards
A

pure water loss

23
Q

ISOvolemic Hypernatremia (causes)

Study These Flashcards
A
  • Diabetes insipidus

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

24
Q

ISOvolemic Hypernatremia (tx)

Study These Flashcards
A
  • free water replacement (po or iv)

- treat diabetes insipidus (desmopressin, address cause)

25
HYPERvolemic Hypernatremia (causes)
sodium overload: - 3% NaCl, sodium bicarb, salt tabs, concentrated tube feedings, hypertonic dialysate, Na-containing meds - primary aldosterone
26
Hypokalemia
S&S: - muscular: weakness, respiratory distress, cramping, malaise, paralysis - cardiac: EKG changes, cardiac arrhythmias, heart block, sudden death
27
Hypokalemia (causes)
- total body K deficit - renal loss and IC shift - hypomagnesemia
28
total body K deficit
- excessive GI loss - D/V, NG suctioning, body drains - meds: laxatives, sodium polystyrene sulfonate, sorbitol - poor dietary intake of K
29
renal loss & IC shift
renal loss: - meds: diuretics, high-dose penicillin, mineralocorticoids, IC shift: - meds: B2 receptor agonists, theophylline, caffeine, insulin hormones: aldosterone excess high dose steroids
30
Potassium Replacement
- 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
Hyperkalemia
S&S: - muscular: twitching, cramping, weakness - cardiac: heart palpitations, EKG changes, cardiac arrhythmias
32
Hyperkalemia (causes)
- 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
Hyperkalemia (tx)
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
Hypomagnesemia
S&S: - muscular: muscle cramping, twitching, tetany - cardiac: arrhythmias, ECG changes - neuro: irritability, seizures, coma, death - electrolytes: refractory hypokalemia & hypocalcemia
35
Hypomagnesemia (causes)
- 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
Hypomagnesemia (tx)
oral: Mg oxide IV: Mg Sulfate
37
Hypermagnesemia
S&S: - GI: N/V, hypotension, bradycardia - muscular: muscle weakness - cardiac: bradycardia, heart block, asystole, hypotension - neuro: drowsiness, paralysis, coma
38
Hypermagnesemia (causes)
- renal failure - incr. oral intake - lithium therapy - hypothyroidism - addison's disease
39
Hypermagnesemia (tx)
- reduce Mg intake - enhance elimination (loop diuretics, renal replacement therapy, dialysis) - stabilize the heart (IV Calcium gluconate)
40
Hypophosphatemia
S&S: - CNS: irritability, weakness, numbness, paresthesia, dysarthria, confusion, obtunded, coma - cardiac: congestive cardiomyopathy, cardiac arrest - neurologic: delirium, hallucinations, paranoia, seizures
41
Hypophosphatemia (causes)
- 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
Hypophosphatemia (tx)
- oral: neutra-phos, neutra-phos-k | - iv: sodium phosphate, potassium phosphate
43
Hyperphosphatemia
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
Hyperphosphatemia (causes)
- 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
Hyperphosphatemia (tx)
- 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
Hypocalcemia
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
Hypocalcemia (causes)
- 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
Hypocalcemia (tx)
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
Hypercalcemia
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
Hypercalcemia (causes)
- cancer - primary hyperparathyroidism - other causes: immobility, Paget's disease, rhabdo, dehydration meds: thiazide, lithium, vit D, Ca supp
51
Hypercalcemia (tx)
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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