Na, K Mjm

Front 1

water distribution for a 70 kg male/female?

Back 1

70 x .6 = 42 liters
70 x .5 = 35 liters

Front 2

watre balance is dependent on?

Back 2

access to water/intact thrist mech
extrarenal water losses
appropriate renal excretion of solutes and water
intact ADH system

Front 3

75% of water is reabsorbed in?

Back 3

proximal tubule

Front 4

what happens at the collecting ducts?

Back 4

ADH is secreted and water is reabsorbed.

Front 5

measuring plasma osmolality/serum osm?

Back 5

2xNa+(glu/18)+(BUN/2.8)+X

Front 6

the serum sodium is a measure of?

Back 6

concentration

Front 7

changes in total body sodium content alter?

Back 7

ECV (BP)

Front 8

regulation of plasma osmolality?

Back 8

osmoreceptors in hypothalamus make changes in thirst and affect the release of ADH

Front 9

hyponatremia usually reflects hypo-osmolality except?

Back 9

pseudohyponatremia: increase in lipids and proteins
other solutes in high concentration like glucose

Front 10

acute hyponatremia can cause?

Back 10

cerebral edema and intercranial hypertension

Front 11

correcting glucose for hyponatremia?

Back 11

for every 100 units over 100 glucose increases, the sodium will drop 1.6 units.
Important to determine if it is hyponatremia due to water/salt or glucose

Front 12

hypovolumic with <20 SNa vs >SNa?

Back 12

Non-renal Na loss, GI los, Skin loss.
Renal loss, diuretics, bicarbonaturia

Front 13

Hypervolemic with <20 SNa vs >SNa?

Back 13

Edematous states, cirrohsis, CHF, nephrotic syndrome.
renal failure

Front 14

Euvolemic with <20 SNa vs >SNa?

Back 14

SIADH, hypothyroidism, adrenal insuff.
polydipsia

Front 15

lab work up for hyponatremia?

Back 15

FeNa, UNa, Uosm

Front 16

Fe: <1
UNa: <10

Back 16

increased PT function

Front 17

Fe: >2
UNa: >20

Back 17

good hydration, diuretics, Proximal tubule

Front 18

other lab work up with hyponatremia?

Back 18

renal, adrenal and thyroid function

Front 19

Tx for hypovolemic hyponat?

Back 19

isotonic IV fluids or colloids, reverse underlying process

Front 20

Euvolemic hyponatremia?

Back 20

est acute (<48 hrs) and chronic states.

Front 21

Tx for hypervolemic hyponat?

Back 21

fluid restriction, sodium restriction, loop diuretics

Front 22

What can happen if you correct acute hyponat too fast?

Back 22

cerebral demyelinating dz. more than 12 units in first 24 hrs. over correct more than 140 with first 2 days

Front 23

Tx of severe asymptomatic hyponat?

Back 23

fluid restrict 800/1000 ml/day
IV meds in isotonic fluids
may need Lasix

Front 24

tx of severe symptomatic hyponat?

Back 24

mild symptoms: correct Na bt 0.5 mEq/L/hr unitl 120
sever symptoms: 1-2 mEq/L/hr for first 5-10 but no more than 12

Front 25

Med tx for hyponat?

Back 25

VAsopressin receptor antagonist: conivaptan, tolvaptan

Front 26

If euvolemic/hypervolemic and stable than?

Back 26

Hep Lock IVF while eval in process

Front 27

why not aim for normal SNa?

Back 27

because overcorrection will occur. use 3% NaCl and monitor

Front 28

hypernat is usually a manifestation of?

Back 28

severe dehydration

Front 29

clinical manifestations of hypernat?

Back 29

confusion, neuro irritability, seizure, coma, CNS hemorrhage

Front 30

Hypovomic hypernat?

Back 30

renal losses: loops, post-obstruct, renal dz
extrarenal loss: excessive sweat, burns, diarrhea

Front 31

hypervolemic hypernat?

Back 31

hyperaldo, cushings, hypertonic solutions, too much Na

Front 32

euvolemic hypernat?

Back 32

extrarenal: insensible loss
renal loss: DI, osmo-diuresis

Front 33

calculate free water deficit?

Back 33

total body water (42 for 70kg) x (SNa/140) - TBW
replete half this amount in 24 hours and the remainder over the next

Front 34

management of hypernat?

Back 34

correct at tempo it happened (0.5 mEq/L/hr) if not acute
use diuretics as needed, watch glucose with D5W

Front 35

where is 98% of K+ located?

Back 35

inracellular

Front 36

what is K+ gradient maintained by?

Back 36

Na/K ATPase

Front 37

changes in K can effect?

Back 37

skeletal muscle, cardiac, neural cells

Front 38

Other fators that effect K+ distribution between intracellular ECF?

Back 38

catecholamines, insulin, exercise, metabolic acidosis

Front 39

where does excretion of K+ happen primarily?

Back 39

distal tubule of nephron. Aldo has major effect on this

Front 40

etiology of hypokalemia?

Back 40

alkalemia, increased insulin, B adrenergic activity, periodic paralysis, Tx of anemia, diarrhea, loop/thiazides, mineralocorticoids, hypomag

Front 41

clinical manifestations of hypokal?

Back 41

muscle weakness, cardiac arrythmias, rhabdo, hyperglycemia, renal dysfunction

Front 42

Hypokalemia oral tx?

Back 42

determine if it is K loss or cellular shift
give KCl; mild: 20 mEq 1-3/day
severe: 40 3-4/day

Front 43

Wen do switch to IV tx?

Back 43

paralysis, ECG abnormalities. Use non-dextrose containing fluids

Front 44

Labs for K+ problems?

Back 44

SK+, renin aldo, serum HCO3, TTKG

Front 45

TTKG levels?

Back 45

<2 = minimal urine K
>4 = increased urine K

Front 46

Etiology of hyperkalemia?

Back 46

increased intake, metabolic acidosis, insulin deficiency, B adrenergic blockade, severe exercise, dig overdose, succ, renal failure, vol depletion, hypoaldo, ACE/ARB therapy

Front 47

clinical manifestations of hyperkal?

Back 47

impaired neuromuscular function, decreased cardiac conduction and dysrhythmias (elongation of QRS until V-tach)

Front 48

cardiac toxicity can be potentiated by?

Back 48

hypocal, hypomag, hyponat

Front 49

pseudohyperkalemia

Back 49

seen in long venous blood draw and hemolysis. be sure to check serum and plasma K

Front 50

hyperkal tx?

Back 50

stop K intake, stabalize, temporize (redistribute), enhance excretion, calcium gluconate, sodium, B agonist, diuretics, keyexalate, HCO3

Front 51

what can calcium do for hyperkal pts?

Back 51

increase the threshold at which excitation will occur