Summer Final New Flashcards
(24 cards)
What are crystalloid solutions?
NS and LR (only stay 25% in the vessels)
-used in med floors and ICUs (not outpt)
When isn’t free water used? Contraindications?
not used directly
equivalent to D5W
*avoid in pts with ICP
What are colloid solutions?
- include RBCs, albumin, dextrans, and hetastarch
- 100 ml of 25% albumin causes 500 ml increase in IV volume
- used in severe ICU cases when pt is fluid restricted
Which is preferred colloid or crystalloid? What is the formula for maintenance fluid?
- no difference in terms of mortality but crystalloids are less expensive so first choice
- 1500 ml + (20 ml/kg for q kg >20 kg)
What is the goal for do you treat acute hypotonic hyponatremia? Chronic?
- acute- 1-2mEq/L/hr until plasma Na>120 or neuro sxs subside
- chronic- 0.5-1mEq/L/hr with total increase not to exceed 8-12 mEq/L/day and no more than 18mEq/L/day in the first 48 hours
What do you use for treating hypotonic hyponatremia?
3% saline or NS
What drug can you use for chronic treatment of hyponatremia? Contraindications?
- demeclocycline
- vasopressin antagonist to increase water excretion
- takes 3-4 days to work
- cirrhosis
What are types of aquaretics for euvolemic and hypervolemic hyponatremia?
- Conivaptan: IV,
- Tolvaptan: PO, ok for HF and cirrhosis, but titrate at hospital before discharge
How do you treat hypovolemic hypernatremia? Infusion rate? Corrected Na?
- NS of 200-300mL/hr
- measured Na + (1.7 for q 100 dL/mg glucose over 200)
What is used in the chronic treatment of hypernatremia (euvolemic)? Side effects?
- desmopressin (AVP agonist)
- increased bleeding time and PTT
What drugs can we use for Na overload? Edema?
- NS first
- loops and thiazides
How do you treat hypercalcemia?
- loops and calcitonin–> dose depends on BP
2. bisphosphonates (-dronates)–> adjust for renal insufficiency
How do you treat hypophosphatemia?
neutra-phos
How do you treat hyperkalemia?
first diuretics, then laxatives (SPS)
What is normal serum creatinine? What is the formula for creatinine clearance? For drug dosing which creat do you use? For kidney function what do you use?
males 0.6-1.2 females 0.5-1.1 - [(140-age)*Mass(kg)*0.8 if female]/(72*serum cr) -drugs- serum creat -kidney function GFR
What is the normal BUN: creat ratio? What affects creat levels?
10-20:1 (if above may be dehydrated so give NS)
-muscle and age
What is AKI? What is anuric v oliguric v nonoliguric?
abrupt decrease in GFR which leads to significant mortality and moribidity
-500
What are the categories of AKI?
pre renal (volume depletion)--> give fluids intrinsic (damage and necrosis) postrenal (obstructive)
What is hospital acquired AKI usually due to? CA?
ATN- use loops if edema but no oliguria (bumex) volume depletion (V/D)
What combo of drugs should you look for in ATN AKI?
NSAIDs and diuretics or ACE/ARB
How should you treat ATN? How do you prevent?
-check serum creat/ crcl/ urine output,
adjust drug dose, withdraw meds prn
-hydration, antioxidants, glycemic control, withdrawal of causative agents
How can you treat electrolyte imbalances in CKD?
-inc Ph:
binders like Ca carbonate and lanthanum carbonate
-dec Ca:
give cinacalcet (if Ca >8.4)
VitD analogue like calcitriol or active VitD in ESRD
How can you treat anemia a/w CKD?
- Iron pills, eventually IV iron (dextran has highest risk of anaphylaxis)
- ESA when Hgb <10 with target 11-12
How can you treat HTN a/w CKD?
ACE or ARB (volume overload use diuretics or dialysis)
as long as pt is still making urine
