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Therapeutics > L 1-4: Fluids and Electrolytes > Flashcards

L 1-4: Fluids and Electrolytes Flashcards

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1
Q

IBW equations

A

Male: 50kg + (2.3 * over 60inch)
Female: 50kg + (2.3* over 60inch)

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2
Q

NBW equation

A

IBW + 0.25(wt-IBW)

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3
Q

Three main organ systems involved in fluid balance

A

Skin
Lungs
Kidneys

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4
Q

When to use NBW, and ABW

A

> 130% of BW = use NBW
if pt is less than IBW, use ABW

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5
Q

Fluid intake

A

Should = fluid losses

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6
Q

Sensible vs insensible fluid loss

A

Sensible: 1-1.5 L/day
Insensible 1L/day

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7
Q

NG output vs Diarrhea output

A

NG: loss of acid - alkalosis
Diarrhea: Loss of base - acidosis

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8
Q

Isotonic range

A

275-290 mOsm/L

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9
Q

Hypotonic and Hypertonic range

A

Hypo: <275 mOsmol/L
Hyper: >920 mOsmol/L

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10
Q

Total osmolarity equation

A

Total osmolarity = osmolarity of IV solution + Osmolarity of added electrolytes

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11
Q

0.9% NS osmolarity

A

154 mOsmol/L

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12
Q

Calculating MIVF

A

Clinical estimate:
30-40ml/kg/day

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13
Q

Crystalloids

A

Isotonic, Hypotonic, or hypertonic
-Flexible
NS
1/2 NS
D5W
LR
Balanced salt solutions

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14
Q

Colloids

A

Hypertonic
Albumin (5 or 25%)
Hetastarch
Tetrastarch
Blood
Plasmanate

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15
Q

NS place in therapy

A

Fluid replacement, NOT maintenance

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16
Q

1/2 NS place in therapy

A

Maintenance - lots of flexibility

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17
Q

LR place in therapy

A

Resuscitation - burns, trauma, etc

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18
Q

D5W place in therapy

A

Free water replacement
NOT maintenance by itself

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19
Q

Colloid solution place in therapy

A

Hypertonic -plasma expanders
-Get fluid out of cell into plasma

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20
Q

Albumin adverse effects

A

Hypervolemia - Too much water in body
Azotemia - too much waste in body

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21
Q

Albumin

A

Supportive/symptomatic treatment

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22
Q

Synthetic colloids problems

A

Black Box Warning: Severe sepsis

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23
Q

RBCs

A

Packed RBCs used when low hemoglobin (<7-8 g/dL)

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24
Q

Most common MIVF

A

D5W + 1/2 NS + 20 mEq KCl/L

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25
Dehydration warning urine output
<0.5 mL/kg/hr
26
Hyponatremia
Most common electrolyte disturbance in hospitalized patients -Brain injury, seizure, death Demyelation
27
Pseudohyponatremia
Extreme elevations of lipids and proteins increase the total plasma volume -Seen with hypertriglyceridemia or hyperproteinemia -We would not **treat** this (overcorrecting)
28
Hypertonic hyponatremia
High levels of osmolality
29
Hypotonic hyponatremia
Most complicated Most common - >90% of all hyponatremia Need to assess **ECF** volume: -Hypovolemic -Isovolemic -Hypervolemic
30
Osmolality
Number of particles per liter of water (mOsm/L)
31
Hypovolemic Hypotonic Hyponatremia
Decrease in BOTH total body H2O and Na+ -Renal (urine Na+ > 20 mEq/L) -Non renal (Urine Na+ <20 mEq/L(
32
Isovolemic Hypotonic Hyponatremia
TBW increase Normal/slightly increased total body sodium
33
Most common cause of Isovolemic Hypotonic Hyponatremia
SIADH
34
SIADH
Syndrome of Inappropriate Anti Diuretic Hormone release **water intake exceeds capacity of the kidneys to excrete water*** -Urine Osm generally > 100 mOsm/kg -Urine Na+ generally > 20-30mEq/L
35
SIADH primarily caused by
DRUGS Antineoplastics -Cyclophosphamide -Vinicristine, viblastine **Antipsychotics** Bromocriptine **Carbamazepine** Chlorpropramide Desmopressin Meperidine, morphine Nicotine NSAIDs (ibuprofen) Oxytocin **SSRis** -Fluoxetine -Sertraline TCAs -Amitriptyline Imipramine Tolbutamide
36
Treatment of SIADH
Remove underlying cause (e.g. medications) if possible First line - **Free water restriction**
37
HYPERvolemic Hypotonic Hyponatremia
Total body sodium increased but TBW increased MORE **EDEMA** -Cirrhosis -Heart failure -Kidney failure -Nephrotic syndromes
38
Goal of treatment for hypovolemic
Restore volume deficit DO NOT GIVE MORE THAN 8-12 mEq/L/day Hypertonic NaCl (3%) if symptomatic (500 mEq) Isotonic NaCl if asymptomatic
39
Goal of treatment for isovolemic
Furosemide and 3% NaCl if symptomatic 0.9% if Asymptomatic and water restriction
40
Goal of treatment for Hypervolemic
Furosemide and judicious 3% NaCl in symptomatic Furosemide in asymptomatic patients
41
Acute symptomatic hyponatremia
BRAIN SWELLS cerebral edema Irreversible and sometimes fatal Altered mental status and seizures
42
Treatment of Acute Symptomatic Hyponatremia
Increase serum sodium by 1-2 mEq/L/hr until symptoms resolve -Goal **120 mEq/L** -Complete correction is NOT necessary - if correction is too rapid can cause demyelation
43
What is the max sodium increase to treat Acute Symptomatic Hyponatremia in the first day?
8-12 mEq/L in the first 24 hrs
44
Demyelination risk factors
Serum Sodium <105 mEq/L Hypokalemia Alcohol use disorder Malnutrition Advanced liver disease
45
Rule of 8
Treat with hypertonic saline (3%) - replace half of sodium deficit in 8 hrs; then remaining deficit within 8-16 hrs
46
Acute symptomatic hyponatremia monitoring
Serial exam of heart, lungs, and neurologic status several times over the first 12 hours -Serum Sodium conc. q2-4 hrs until asymp -then q 6-8hrs until WNL
47
Hypernatremia
Always associated with Hypertonicity -Impaired thirst response or pts without access to water -Infants -Elderly -Persons with a disability **Loss of hypotonic fluids OR ingestion of sodium or hypertonic fluids** **Must assess volume status (ECF)**
48
HyPOvolemic HyPERnatremia
Restore hemodynamic status first -0.9 NACl Once intravascular volume restored: **Calculate free water deficit**
49
Replacing free water deficit
Provide free water -D5W continuous infusion -Enteral free water via feeding tube **Match I/O if possible** **DO NOT CORRECT TOO QUICKLY** Goal is 0.5 mEq/l/hr decrease in Naserum
50
Isovolemic Hypernatremia (Diabetes Insipidus)
Etiology: brain injury/trauma, nephrogenic (drug induced) TX: -**Desmopressin**: Acute administer SubQ/IV 0.25-.5 mL BID Chronic - Intranasally 0.05-0.2mL BID **Vasopressin**: Acute continuous infusion titrated hourly to goal UOP
51
Potassium (K) levels
Normal Level: 3.5-5 mEq/L
52
HYPERvolemic HYPERnatremia
Hypernatremia from hypertonic fluids is uncommon -**Hypertonic saline resuscitation** TX: -Stop hypertonic fluids/cause -Rapidly excreted -**Diuretic if needed** **Match I/O** **Too much fluid - kick it out**
53
Potassium use
Primary intracellular cation Responsible for cell metabolism Glycogen and protein synthesis Determines the resting potential across cell membranes in cardiac and non-cardiac tissue **Hypo and hyper associated with fatal arrythmias**
54
Factors affecting potassium
Na/K ATPase pump -Insulin -Glucagon -Catecholamines -Aldosterone **Kidneys** **Arterial pH/acid-base returns**
55
Hypokalemia - causes
Diuretic loss B-agonist medications NG drainage Metabolic alkalosis Diarrhea **Magnesium depletion** -**Co-factor for Na/K ATPase**
56
Which will kill a patient quicker hyper or hypokalemia
Hyperkalemia - do not want to overcorrect when treating: goal: **normalize**
57
Hyopkalemia treatment
3-3.4 Treatment debatable PO K+ for patients with cardiac conditions <3 mEq - ALWAYS treat -PO route preferred IV for symptomatic patients or pts who **cannot take PO** **Should attempt to correct Mg2+ deficit**
58
IV K+
Do not give potassium push via IV - can kill someone **Arrhythmia or cardiac arrest if given too quickly**
59
Infusion rate of IV K+ without cardiac monitoring
10 mEq/hr
60
Hyperkalemia
>5.5 mEq/L **Cardiac arrythmias**
61
Goals of therapy for hyperkalemia
**C a big K drop** **FIRST: Manage cardiac arrest** THEN: 1. Antagonize the membrane actions 2. Decrease the extracellular K+ concentrations 3. Remove K+ from body
62
C a Big K drop
1. Antagonize the membranes (Calcium) 2. A BIG Decrease EC K+ concentrations (Albuterol, Bicarb, Insulin and Glucose - push K+ back into cell where it belongs) 3. K DROP -Remove K from the body -Kayexalate/Lokelma -Diuretics (furosemide) -Renal unit of dialysis Of Patient (3rd step not always necessarry)
63
Acute tx of hyperkalemia: need to know
**Give calcium chloride whenever possible** (one gram over 1-2 minutes) **DO NOT GIVE INSULIN WITHOUT DEXTROSE** could have seizures --Study chart in notes!!
64
Chronic tx of Hyperkalemia med
Patiromer (Valtassa) MOA: Binds K+ in the GI tract and decreases absorption
65
Magnesium normal levels
1.5-2.5 mg/dL
66
Magnesium role in body
Important role in neuromuscular function -Cofactor for ATP and Alkaline phosphatase Related to Ca2+ and K+ metabolism Regulated by intake and kidney excretion
67
Hypomagnesemia
<1.5 mg/dL -Usually associated with disorders of the GI tract or kidneys -Diarrhea -Decreased intestinal absorption -Severe malnutrition **Drugs** -**Diuretics (thiazide or loop)**
68
Goals of therapy for hypomagnesemia
-Resolution of symptoms -Identify correct underlying causes -Restoration of the NL MG2+ concentration -Correction of concomitant electrolytes **Don't forget to treat associated electrolyte disturbances**
69
Tx of hypomagnesemia
PO -Asymp with MG > 1 -Milk of mag (5-10 mL PO QID) Mag-OX 800 mg PO daily or 400 mg PO TID w/meals IV -Symptomatic pts (or cannot tolerate PO) Mg 1-2 mg/dL - 0.5 mEq/kg Mg <1mg/dL **1 mEq/kg**
70
Calcium Range in body
8.5-10.5 mg/dL
71
Calcium role in body
-Necessary for bone formation and neuromuscular function -Serum concentrations are controlled mainly by the PTH, vitamin D, and calcitonin -Organs involved in calcium metabolism: Bone, kidneys, and the intestine
72
Hypocalcemia
More frequently seen in hospitalized pts Etiologies: **Mg deficiency** Large volumes of **blood products** **Hypoalbuminemia** (must correct calcium)
73
Calcium correection
Measured calcium + (4-measured albumin) * 0.8)
74
Hypocalcemia Clinical presentation
Neuromuscular -Muscle cramps, tetany CNS -Depression, anxiety, memory loss, confusion, hallucination, seizures Dermatologic -Hair loss, eczema Cardiac -QTC prolongation, arrythmias
75
Acute treatment hypocalcemia
100-300 mg **elemental** Ca IV over 5-10 min **1 gram CaCl = 3 grams Ca gluconate (270 mg elemental Ca)** Cl can be admin IV push during code -Gluconate is preferred for PIV admin (+) lower % of elemental Ca (-) less predictable increase in Ca2+ concentration (+) Less risk for extravasation (necrosis) **Usual admin rate - 1gm/hr** **Correct hypomagnesemia**
76
Chronic treatment hypocalcemia
PO Calcium 1-3 g/day of **elemental** Ca2+ -Vitamin D supplementation -Calcitriol 0.25 mg PO daily or every other day
77
Phosphorous range in body
2.5-4.5 mg/dL
78
Phosphorous role
**Critical for structure and function** -respiratory and cardiac muscle function -Enzymatic rxns that control carbohydrate, fat, and protein metabolism -Source of high energy bonds of ATP -Modulates the oxygen carrying capacity of hemoglobin -Regulated by intake, vitamin D, PTH and renal function **Makes ATP**
79
Hypophosphatemia
Mild to moderate 1-2 mg/dL Severe: <1 mg/dL Etiologies: -Decreased intake -Impaired absorption -Intracellular shifts
80
4, 3, 2 rule
Keep K+ above - 4 Keep P above 3 Keep Mag above 2
81
Treatment of Hypophosphatemia - mild to moderate
Oral PO4 Phos-Nak -> 30-60 mMol/day in 2-3 doses (cannot handle all at once) Fleets Phospho-soda (4.1 mMol/mL) 5 mL diluted 2-3 times/day
82
Treatment of Hypophosphatemia - severe
IV PO4 **Use KPhos when K+ < 4mEq/L** **Use NaPhos when K+ > 4mEq/L**
83
**Phos replacement**
1 mMol NaPhos = 1.33 mEq Na+ & 1.33 mEq Phos 1mMol KPhos = 1.47 mEq K+ & 1.47 mEq Phos Admin: Give PO doses as divided doses **Infuse IV doses no faster than 7 mMol/hr** **Never push KPHOS - only given as piggyback**

Therapeutics (63 decks)

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