NCC content Flashcards
(37 cards)
how is total body water related to fat content?
inversely
how does total body water change with increasing gestational age?
it decreases
- around 24 weeks = 90%
- around term = 80%
does intracellular fluid and extracellular fluid decrease or increase with increasing gestational age?
- extracellular decreases
- intracellular increases
where is adh stored and why is it released?
- stored in posterior pituitary
- released when plasma osmolarity increases
how does adh work?
- acts directly on distal tubules and cortical/medullary collecting ducts
- increases permeability to free water
why is the premature infant’s response to adh blunted?
probably d/t end-organ insensitivity
what happens in SIADH?
-excess ADH secretion
clinical findings with SIADH
-weight gain, hyponatremia, decreased urine output, increased urine osmolality, decreased plasma osmolality
SIADH treatment
free water restriction
NaCl replacement
lasix therapy
what happens in DI?
-ADH deficiency
etiology of DI
- insensitivity of renal tubule to ADH
- congenital defects
clinical findings with DI
- increased Na
- hypotonic urine
- serum hypertonicity
- increased Ca
- decreased K
DI treatment
- hydrate
- electrolyte replacement
- diuretic therapy (thiazides)
How should fluids be managed for HIE babies?
- only replace IWL; too much fluid can cause worsening cerebral edema; kidney function may be compromised
- fluid restrict 60 ml/kg/day
normal sodium requirements
initial phase: 0-1 mEq/kg/day
pre diuretic phase: 2-3 mEq/kg/day
post diuretic phase (maintenance): 3-5 mEq/kg/day
values for hyponatremia
treatment for hyponatremia for symptomatic babies
-3% hypertonic saline: 1-3 ml/kg over 15 minutes, followed by 1-2 ml/kg/hr until Na > 120
treatment for asymptomatic hyponatremia
treat underlying cause and replace deficit
lab value for hypernatremia
serum Na >150
-over 160 = permanent CNS damage
what typically cause hypernatremia?
insensible water loss
how quickly should we try to decrease sodium levels?
- slower than when we increase sodium levels
- target correction over 12-48 hrs period
- should decrease no more than 0.5 mEq/kg/hr
normal requirements for K
- initial phase: none
- prediuretic phase: 1-2 mEq/kg/day
- postdiuretic phase: 2-3 mEq/kg/day
lab value for hypokalemia
serum K
correction for hypokalemia
- 0.5 mEq/kg/dose over 30-60 min only for true-life threatening arrhythmias
- if symptomatic but no life threatening, correct over 12-24 hours
