IMP: Neph fluids and lytes Flashcards by Alexander Christy

total body water goes _______ as we age

down:
infant 70%
adult 60%
elderly 50%
obese 45%

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(2) pathological circumstances when tissue perfusion and ECF volume becomes uncoupled

heart failure w/ edema (pickle lady)
cirrhosis of liver with ascites
In both conditions ECF is increased, but tissue perfusion is low

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under normal circumstances, ECF volume is regulated by changes in ________ ___________/___________

sodium excretion/retention

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If you think about serum Na+ levels, think _______

if you think about extracellular vol, think _____

water,

sodium

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when addressing electrolyte imballance and dehydration

FIRST think CIRCULATING BLOOD VOLLUME–IV fluids (normal saline, LR) then address electrolytes if they haven’t normalized themselves

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assess circulating blood volume via

VITAL SIGNS–P/E–peeing?

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the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity)

ascites

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too much water

hyponatremia

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hyponatremia (2) – treated differently

acute (^ water intake–cell lyce) vs. persistent (ex. SIADH)

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serum tonicity tested by

serum sodium

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The _______ and ______ of water movement into cells determines the degree of cell swelling and cellular dysfunction, and therefore the SEVERITY OF SYMPTOMS

speed and severity

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Tx of hyponatremia:
Mild asymptomatic:
Life threatening:

-FLUID RESTRICTION (take course of problem into account)
(Central Pontine Demyelination Syndrom)
-over 48-72 hrs raise Na+ w/ 3% IV solution (hypernormal saline)

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Dangers to change Na+

quickly

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_____ _____ _________ can produce a chemical that mimics ADH–> SIADH

Oat Cell Carcinoma

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Limit of ability to cope w/ hyponatremia– “danger zone”

seizure + other CNS symptoms

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key number for serum sodium – imp for differentiating SIADH from

20 (adequate)

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serum sodium >20

SIADH

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Hypernatremia think

not enough water–dehydration–> mental changes early (lethargy, irritability, seizure, coma)

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Cx of hypernatremia (4)

inability to access water
DI
diaphoresis, respiratory losses
Hyperglycemia (osmotic diuresis)

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hypernatremia –> hypertonicity of ECF –> ____ pulled out of ICF

water – thus mental changes

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state of perspiring profusely

diaphoresis

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water volume of volume depleted adult M/F

male: 50%
female: 40%

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ascites

the build up of fluid in the space between the lining of the abdomen and abdominal organs (the peritoneal cavity)

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Tx for hypernatremia

IV half normal saline–REPLACE THE WATER DEFICITE

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don't use "dehydration" use

low circulating blood volume

Don't make ADH

dehydration =

free water deficit-hypernatremia Tx w/ free water repleiton

volume depletion =

extracellular fluid or effective circulating blood volume depletion Tx w/ isotonic fluid replacement

for dehydration correct volume deficits first then

correct water imbalances (slowly)

hypovolemia def and cx (4)

any condition in which the ECF vol is reduced, | Cx: V/D, bleeding, 3rd spacing

normovolemic aka

euvolemic

hypovolemia cx

suboptimal circulating blood vol because of low PRELOAD

edema and ascites are signs of

sodium excess and an expanded ECF vol

SIADH pt's will be ________ _________ but euvolemic

hypotonic hyponatremia

Cx of hyperkalemia (4)

1. renal failure (can't get rid of dietary K+) 2. Iatrogentic (K+ sparring drugs) 3. extensive tissue destruction 4. acidiosis

S and Sx of hyperkalemia

primarrily EKG changes

tall peaked T waves --> wide QRS --> sine wave appearance --> asystole

Hyperkalemia

hyperkalemia tx emergent: life-threatening:

insuline--> drives K+ and glucose into cells, | dialysis

Hyperkalemia value

K+ > 5.0 mmol/L

normal K+

3.3-5.0 mmole/L

hypokalemia value

K+<3.3 mmole/L

hyokalemia cx

1. inadequate intake | 2. K+ loss (diuretics, V, NG suc, Burn)

EKG flatteing of T wave, more PROMINANT U WAVE

hypokalemia

severe hypokalemia (K+<3.0 mmole/L) S and Sx (2)

1. EKG effects | 2. muscle weakness--respiratory muscles

tumor popular for wheeping K+

colonic villous adenoma

__________ often accompanies hypokalemia and must be corrected to successfully replenish K+

hypomagnesmia

Prominent U wave think

hypokalemia

normal Ca rang

8.5-10.5 mmole/L

inoized Ca++ range

4.65-5.25 mg/dl

____% of Ca is bound to plasma proteins

60%

3 major facters influencing serum [Ca]

1. PTH-- (Ca reabsorp in kidney, gut & Bone resorption) 2. Vit D 3. Calcium ion itself and Phosphate

hypocalcemia most often caused by

disorder of PTH or Vit D

acid/base disturbance of serum [Ca]

1. acidosis-->reduces albumin/Ca binding--> ^free Ca | 2. alkalosis- ^ Ca binding w/ albumin--low free Ca

Mg deficiency can cx

hypocalcemia

S and Sx of hypocalcemia (4)

1. tetany 2. Trousseau's sign--carpopedal spasm w/ cuff inflation 3. Chostek's sign--spasm of facial m. w/ tapping 4. seizures

Ca percentage bound/unbound

60% bound--inactive | 40% ionized--active

hypercalcemia (2) major cx

1. hyperparathyroidism (parathyroid adenoma) | 2. malignancy (much higher than ^--bone tumor liberates Ca)

reccurent renal calculi think

hypercalcemia

Tx moderate-severe hypercalcemia

1. ^ saline hydration | 2. calcitonin (hormone from thyroid that opposes PTH, ^ renal excretion)

inhibit Ca release by interfering w/ bone reabsorption

Bisphosphonates

Mg homeostatis is a balance of _____ ______ and ______ ____

dietary intake and renal loss

T/F there is direct hormonal regulation of Mg levels

*Sx of hypermagnesemia (3)

1. Hyporeflexia 2. Hypotension 3. bradycardia

hypomagnesemia associated w/ (3)

1. alcoholism (poor nutrition--assume hypomagnesmeic) 2. chronic diarrhea 3. loop diurents

renal _______ ______ occurs in the face of hypomagnesemia

K+ wasting (*hypokalemia*)

severe hypomagnesemia classically results in

hypocalcemia

Cx of hypermagnesemia (3)

1. renal insufficiency 2. iatrogenic 3. excess dietary or supplimentation

ways to assess success of IV therapy for volume status (6)

1. P/E--vitls, turgor, axilla, perfussion 2. urine output 3. daily wgt. meausrements 4. intake and outputs (I&O's) 5. central venous pressure 6. Lab (specific gravity, Hct, Cr/BUN, serum/urine osmalality)

IMP: Neph fluids and lytes Flashcards

(68 cards)