Module Test 4 Set 1

Front 1

Distribution of Total Body Water (4)

Back 1

1)67% in ICF (intracellular)
2)33% in ECF (extracellular)
2a)25% of ECF is intravascular
2b)75% of ECF is interstitial

Front 2

_____ (2) is responsible for over 90% of ECF osmolality making....

Back 2

Sodium accompanied by chloride or bicarb, making it the primary "effective osmole"

Front 3

Albumin role w/ body water

Back 3

hold water in intravascular space

Front 4

Primary effective osmole in the ICF

Back 4

potassium

Front 5

Salt ____

Back 5

sucks (water w/ it)

Front 6

Water regulation by 2 mechanism

Back 6

1)ADH
2)thirst

Front 7

ADH fxn (5)

Back 7

1)produced by hypothalamus and stored in pituitary
2)released from pituitary when serum osmolality rises
3)released when blood volume is reduced
4)causes kidneys to reabsorb water in collecting duct to normalize osmolality
5)upregulates aquaporins

Front 8

Thirst fxn

Back 8

1)stimulated by rising serum osmolality as sensed by the hypothalamus

Front 9

Physiologic reasons to alter water distribution (2)

Back 9

1)maintain adequate ECF for perfusion and oxygenation
2)maintain osmotic equilibrium (ECF and ICF osmolality are =)

Front 10

Salt regulation via aldosterone (2)

Back 10

1)released following activation of renin-angiotensin-aldosterone system (RAAS)
2)pulls more salt back into body and thus more water

Front 11

Goal of salt regulation is to...

Back 11

maintain adequate tonicity of ECF

Front 12

Salt regulation and ECF tonicity (2)

Back 12

1)tonicity primarily determined by sodium
2)this directly effects dist. b/w ICF and ECF

Front 13

% water that
a)newborns are...
b)adults are...

Back 13

a)80%
b)50%

Front 14

IV fluids can only...

Back 14

manipulate the ECF

Front 15

3 types of IV fluids and effect on water dist.

Back 15

1)isotonic (stays in ECF)
2)hypotonic (partially to ICF)
3)hypertonic (in ECF and draws from ICF)

Front 16

D5W
a)tonicity
b)indications
c)cautions

Back 16

a)hypotonic
b)provides free water and increases ICF
c)impair glc control

Front 17

0.45% NaCl
a)tonicity
b)indications
c)cautions

Back 17

a)hypotonic
b)provides free water and Na and ICF
c)may lead to hyponatremia

Front 18

0.9% NaCl
a)tonicity
b)indications
c)cautions

Back 18

a)isotonic
b)provides ECF volume
c)may cause ECF overload

Front 19

Ringers Lactate
a)tonicity
b)indications
c)cautions

Back 19

a)hypotonic
b)provides primarily ECF volume
c)may cause ECF overload

Front 20

3% NaCl
a)tonicity
b)indications
c)cautions

Back 20

a)HYPERTONIC
b)hyponatremia
c)demyelinzation syndrome and hypernatremia

Front 21

Very general hyponatremia characteristics (3)

Back 21

1)most common electrolyte abnormality
2)serum Na value may have no correlation to ECF volume and Na content
3)result of an alteration in the normal ratio b/w total Na and water content of the ECF

Front 22

Hyponatremia is categorized by...(2)

Back 22

1)tonicity
2)volume status

Front 23

Hyponatremia = a Na value below

Back 23

Na < 135

Front 24

Hyponatremia symptoms depend on...and symptoms to follow (5)

Back 24

1)rapidity and degree of fall in Na levels

1)acute mental status changes
2)cerebral edema
3)confusion
4)stupor
5)coma

Front 25

Hypertonic Hyponatremia symptoms (4)

Back 25

1)serum osmolality elevated (over 280mOsm)
2)low sodium
3)excessive effective osmoles (like glucose and mannitol)
4)leads to diffusion of water from cells into ECF (DILUTING Na)

Front 26

Corrected Na =

Back 26

Measured Na + [1.6 x [(Serum Glc/100)-1]

Front 27

Hypotonic Hyponatremia symptoms (4)

Back 27

1)decreased osmolality (less than 280mOsm)
2)low sodium
3)must assess ECF volume status (euvolemic, hypervolemic, hypovolemic)
4)must also look @ kidney handling of Na and water

Front 28

Euvolemic Hypotonic Hyponatremia (WHEN KIDNEY'S ARE not @ FAULT) (2 and 3 causes)

Back 28

1)Uosm < 100
2)Una < 20
3)caused by primary polydipsia
4)caused by low solute intake
5)caused by drinking more water than you can get rid of

Front 29

Euvolemic Hypotonic Hyponatremia (WHEN KIDNEY'S ARE @ FAULT) (2 and 2 causes)

Back 29

1)Uosm > 100
2)Una > 20
3)caused by renal failure
4)caused by SIADH (incr ADH)

Front 30

Hypervolemic Hypotonic Hyponatremia (3 and 4 causes)

Back 30

1)decr EABV
2)Uosm > 100
3)Una < 20
4)caused by CHF
5)caused by cirrhosis
6)caused by nephrosis
7)caused by incr aldosterone state

Front 31

Hypovolemic Hypotonic hyponatremia (WHEN KIDNEY IS @ FAULT) (2 and 3 causes)

Back 31

1)Uosm > 450
2)Una > 20
3)caused by renal losses
4)caused by diuretics
5)caused by adrenal insufficiency

Front 32

Hypovolemic Hypotonic hyponatremia (WHEN KIDNEY IS not @ FAULT) (2 and 2 causes)

Back 32

1)Uosm > 450
2)Una < 20
3)caused by EXTRARENAL LOSSES
4)caused by GI, skin, lung losses

Front 33

Causes of SIADH (4) and what does SIADH cause

Back 33

1)tumors
2)CNS disorders
3)pulmonary disease/pneumonia
4)Drugs (BANCS)

CAUSES euvolemic hypotonic hyponatremia

Front 34

ALL hypotonic hyponatremia have what in common

Back 34

less than 280mOsm

Front 35

BANCS drugs than can cause SIADH

Back 35

1)Butyrophenones (haloperidol)
2)Amitriptylline (and TCAs)
3)NSAIDS
4)Carbamazepine
5)SSRI's

Front 36

Treating chronic SIADH (2)

Back 36

1)demeclocylcine 600mg bid
2)NaCl or urea tablets

Front 37

Treating refractory/acute SIADH (2)

Back 37

1)Vaprisol (and ADH antagonist)
2)but can correct Na too quickly

Front 38

Clinical presentation of hypotonic hyponatremia (2)

Back 38

1)most are asymptomatic
2)if Na drops rapidly pts may get cerebral edema

Front 39

Clinical presentation of hypovolemic hypotonic hyponatremia (3)

Back 39

1)dehydration/dry mucus membranes
2)hypotension
3)tachycardia

Front 40

Clinical presentation of hypervolemic hypotonic hyponatremia (2)

Back 40

1)peripheral edema
2)pulmonary edema

Front 41

Treatment of ANY hypotonic hyponatremia of pts w/ symptoms (4)

Back 41

1)0.9% saline
2)3% saline (but be careful)
3)incr Na to 120mEq
4)correcting sodium too quickly causes osmotic demyelination

Front 42

Asymptomatic HYPOvolemic hypotonic hyponatremia treatment (3)

Back 42

1)primary concern is to correct hypovolemia
2)use isotonic solutions (0.9% NaCl) should be infused
3)administer @ 200-400mL/hr until hemodynamically stable, then decr to 100-150mL/hr

Front 43

Asymptomatic EUvolemic hypotonic hyponatremia treatment (3)

Back 43

1)ID and reverse cause (usually drugs, BANCS)
2)For SIADH and polydipsia, restrict fluids to cause a negative water balance (1000-1200mL/day)
3)Treat SIADH as previously mentioned

Front 44

Asymptomatic HYPERvolemic hypotonic hyponatremia treatment (5)

Back 44

1)HARD to treat
2)treat underlying cause
3)fluid and Na restriction (less than 2g Na and 1000-1200mL/day water)
4)use 3% Na for symptomatic cases
5)can use conivaptan

Front 45

Hyponatremia diagnosis summary (4)

Back 45

1)determine tonicity
2)determine ECF volume w/ hypotonic
3)REMOVE CAUSE OR TREAT UNDERLYING DISORDER
4)administer or restrict fluids

Front 46

Hypernatremia general characteristics (6)

Back 46

1)Na > 145
2)result of water deficit relative to ECF Na content
3)RARELY due to excess Na intake
4)ALWAYS hypertonic
5)ECF volume may be incr, decr, unchanged
6)must assess UOsm and urine output

Front 47

Hypernatremia caused by DIABETES INSIPIDUS & RENAL LOSS (2)

Back 47

1)UOsm < 450
2)UOP > 3000mL/day

Front 48

Hypernatremia OTHER WAY (2 and 2 causes)

Back 48

1)UOsm > 450
2)UOP < 3000mL/day
3)caused by insensible fluid loss (usually lung or skin)
4)caused by excess Na intake

Front 49

Insensible fluid loss (5)

Back 49

1)loss of free water or Na poor water
2)skin (fever, burns)
3)lungs (ventilated pts)
4)GI tract (suction)
5)causes hypernatremia

Front 50

Diabetes Insipidus (4)

Back 50

1)do not confuse w/ DM
2)opposite of SIADH (so decr in ADH)
3)can be central or nephrogenic
4)causes hypernatremia

Front 51

Central DI (3)

Back 51

1)marked reduced release of ADH
2)usually occurs in head trauma or neurosurgery pts
3)results in profuse diuresis of free water

Front 52

Nephrogenic DI (5)

Back 52

1)decr ADH receptor sensitivity
2)can be inherited
3)can be drug induced (by Li)
4)induced by hypokalemia
5)RARELY seen in pregnancy

Front 53

Hypernatremia goals (2)

Back 53

1)correct sodium
2)correct ECF volume

Front 54

Hypovolemic Hypernatremia treatment (2)

Back 54

1)0.9% NaCl until hemodynamically stable
2)0.45% NaCl or D5W to replenish water deficit

Front 55

SODIUM CORRECTION IS NEVER TO EXCEED... (2)

Back 55

1)0.5-1 mEq Na per hour
2)12mEq/day

Front 56

Treatment of Central DI (hypernatremia) (5)

Back 56

1)intranasal desmopressin (DDAVP) (ADH analog)- 10mcg daily
2)goal is to achieve daily urine volume of 2L w/ normal serum Na
3)chlorpropamide
4)tegretol
5)HCTZ

Front 57

Treatment of Nephrogenic DI (hypernatremia) (4)

Back 57

1)correct underlying cause (drugs or electrolytes)
2)common approach is thiazides w/ Na restriction
3)Li induced DI treated w/ amiloride
4)NSAIDs (indomethacin) may potentiate ADH activity

Front 58

Treatment of excess Na (hypernatremia) (2)

Back 58

1)loop diuretics (furosemide) enhance Na excretion
2)D5W to correct water deficit

Front 59

Basics on K+ (6)

Back 59

1)most abundant cation
2)98% intracellular (ICF) so serum K+ does NOT represent total body K+
3)for cardiac and neuromuscular fxn
4)get it from diet
5)renally eliminated
6)abnormal []s lead to cardiac & neuromuscular problems

Front 60

Hypokalemia etiology (5)

Back 60

1)K < 3.5
2)caused by poor dietary intake
3)caused by excess renal or GI loss
4)intracellular shifting of serum K+
5)potentiated by hypomagnesemia

Front 61

Excess renal/GI loss of K+ via... (4) (HYPOKALEMIA)

Back 61

1)diuretics
2)fludricortisone
4)cisplatin
5)vomiting/diarrhea

Front 62

Intracellular shifting of serum K+ via...(2) (HYPOKALEMIA)

Back 62

1)albuterol
2)insulin

Front 63

MOST COMMON SYMPTOM OF HYPOKALEMIA

Back 63

muscle cramps

Front 64

Clinical Presentation of HYPOKALEMIA (5)

Back 64

1)nonspecific
2)severity related to degree of hypokalemia and length of onset
3)CV, EKG abnormalities multiple arrhythmias possible
4)potentiates digoxin toxicity
5)neuromuscular- weakness, cramping, myalgias

Front 65

Treatment of HYPOKALEMIA (3)

Back 65

1)K+ containing foods
2)oral K+ supplements (40mEq in 3-4 doses)
3)IV replacement (max 10mEq/h thru peripheral line, 40mEq/h thru central line)

Front 66

Determining replacement K+ requirement for HYPOKALEMIA(2)

Back 66

1)If 3.0-3.5, 10mEq will raise K+ by 0.1mEq
2)If < 3.0, 20mEq will raise K+ by 0.1mEq

Front 67

How much K+ do you need if K+ is at 2.8?

Back 67

you need 40mEq to get it from 2.8 to 3.0, then 50mEq to get it from 3.0 to 3.5....so 90mEq

Front 68

Hyperkalemia etiology (4)

Back 68

1)K > 5.0
2)incr intake (diet or salt substitutes or excessive replacement)
3)decr renal exrection
4)extracellular shifting

Front 69

Decr renal excretion of K+ causing HYPERkalemia via... (3)

Back 69

1)renal failure
2)adrenal insufficiency
3)drugs

Front 70

Drugs that cause decr renal excretion of K+ resulting in HYPERkalemia (4)

Back 70

1)ACE inhibitors
2)ARBs
3)NSAIDs
4)K+ sparing diuretics

Front 71

Extracellular shifting that results in HYPERkalemia (2)

Back 71

1)acidosis
2)hemolysis

Front 72

Clinical presentation of HYPERkalemia (5)

Back 72

1)all muscles types fxns impaired
2)myalgia
3)nausea
4)ARRHYTHMIAS are most immediate concern
5)initial EKG abnormality is peaked T waves

Front 73

Treating EKG abnormalities from HYPERkalemia (4)

Back 73

1)IV calcium gluconante
2)stabilizes myocardium
3)decr arrhythmia risk
4)1-2grams IV push over 5-10 minutes, can repeat q10minutes

Front 74

Treatment of potassium shift that causes HYPERkalemia (4)

Back 74

1)insulin 10U w/ 10% dextrose
2)beta agonists like albuterol
3)sodium bicarb ONLY if pH < 7.0
4)THESE ARE ALL TEMPORARY MEASURES

Front 75

Treatment of HYPERkalemia to INCREASE K+ elimination (aleviate the decr K+ elimination) (3)

Back 75

1)Kayexalate (oral 15g or rectal 30g q6h)
2)loop diuretics (furosemide) only if NOT hypovolemic w/ GOOD RENAL FXN
3)dialysis (used in renal failure pts)

Front 76

Calcium fxns in body (3)

Back 76

1)preserve cell membrane
2)neuromuscular activity
3)coagulation cascade

Front 77

Labroatory hypocalcemia? (3)

Back 77

1)hypoalbuminemic states cause this
2)free fraction of Ca is increased but total Ca lab measurement appears low
3)MUST adjust for albumin

Front 78

How to correct Ca for albumin**********

Back 78

Corrected Ca = Measured Ca + [(4-albumin) x 0.8]

Front 79

Calcium regulation is via...(2)

Back 79

1)parathyroid hormone (PTH)
2)calcitonin

Front 80

PTH Ca regulation (3)

Back 80

1)incr serum Ca levels
2)incr osteoclast activity in bone causing incr Ca resorption from bone
3)reduces renal excretion of Ca

Front 81

Calcitonin Ca Regulation (3)

Back 81

1)inhibits osteoclastic activity in bone (INCR OSTEOBLAST activity)
2)calcitonin is incr when ionized Ca []s are high
3)Decr Ca resorption from the bone

Front 82

HYPOcalcemia etiology (3)

Back 82

1)corrected Ca < 8.5
2)primary cause is hypoparathyroidism
3)many times it is idiopathic

Front 83

HYPOcalcemia clinical presentation (2)

Back 83

1)neuromuscular myalgias or tetany
2)CV arrhythmias

Front 84

HYPOcalcemia treatment by IV (3)

Back 84

1)ONLY symptomatic HYPOcalcemia will require IV replacement
2)1g Ca CHLORIDE (must be given in a central line)
3)2-3g Ca GLUCONATE (must be given by peripheral line & can be given quicker than CaCl)

Front 85

HYPOcalcemia treatment by PO (5)

Back 85

1)can be done for asymptomatic HYPOcalcemia
2)1-3g elemental Ca in divided doses
3)Ca carbonate or Ca citrate
4)CARBONATE absorbs better in acidic environment and should be taken w/ food
5)CITRATE can be taken w/o food

Front 86

% elemental Ca and dosage form of each
a)CaCl
b)Ca gluconate
c)Ca citrate
d)Ca carbonate

Back 86

a)27% IV
b)9% IV
c)25% PO
d)40% PO

Front 87

HYPERcalcemia etiology (7)

Back 87

1)Ca > 10.5
2)incr bone resorption
3)incr GI absorption
4)decr elimination by kidneys
5)Malignant Cancer secreting PTH
6)Primary cause in general population is primary hyperparathyroidism
7)Li & HCTZ too

Front 88

Clinical presentation of HYPERcalcemia (3)

Back 88

1)pts are usually asymptomatic
2)untreated can lead to oliguric renal failure, coma, arrhythmias***
3)high Ca and P = calciphylaxis

Front 89

Treatment of HYPERcalcemia (7)

Back 89

1)0.9% NaCl is MAIN ONE******
2)loop diuretics
3)calcitonin
4)bisphosphonates
5)Gallium nitrate
6)Mithramycin
7)Glucocorticoids

Front 90

0.9% NaCl treatment of HYPERcalcemia mechanism

Back 90

utilized for volume expansion to incr urinary Ca excretion

Front 91

Loop diuretics treatment of HYPERcalcemia mechanism (2)

Back 91

1)incr urinary ca excretion
2)helps to avoid fluid overload

Front 92

Calcitonin treatment of HYPERcalcemia mechanism (3)

Back 92

1)good if pt can NOT tolerate saline hydration
2)primary mechanism is thru inhibition of bone resorption
3)admin test dose prior to treatment to assess allergy

Front 93

Bisphosphonates treatment of HYPERcalcemia mechanism (3)

Back 93

1)BLOCKS bone resorption
2)pamidronate is best bisphosphonate
3)good at controlling hypercalcemia associated w/ malignancy

Front 94

Phosphorous physiology/fxns (4)

Back 94

1)important to ppl on ventilator
2)required for proper mitochondrial fxn
3)utiltized in the formation of ATP
4)P []s are largely maintained by renal excretion and reabsorption

Front 95

HYPERphosphatemia etiology (3)

Back 95

1)PO4 > 5
2)decr urinary phosphorous excretion or incr phosphorous in the ECF
3)uncommon in pts w/ normal renal fxn

Front 96

Clinical presentation of HYPERphosphatemia (2)

Back 96

1)S&S result of Ca-P product
2)serum P multiplied by serum Ca should be less than 55, if over = calciphylaxis

Front 97

HYPERphosphatemia treatment (4)

Back 97

1)correct underlying cause
2)antacids
3)Renagel (more expensive than antacids)
4)for asymptomatic chronic HYPER use PO4 binders to decr GI absorption

Front 98

HYPOphosphatemia etiology (4)

Back 98

1)decr GI absorption
2)incr urinary excretion
3)transcellular redistribution
4)long term admin of PO4 binder can decr GI absorption of P

Front 99

HYPOphosphatemia treatment (3)

Back 99

1)KEY is prevent clinical situations which may lead to low P (like alcoholism and malnutrition)
2)oral P is used for mild-moderate case of HYPO and those who are asymptomatic
3)for oral P use K-Phos or Na-Phos

Front 100

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Back 100

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