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45 Cards in this Set
- Front
- Back
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what happens to the water content of the body as you age
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as age INCREASES
total body water DECREASES |
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what is the subsets of TBW
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2/3 ICF
1/3 ECF -1/4 Intravascular -3/4 Interstitial space |
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where do each of the fluids go
Hypotonic Hypertonic Isotonic |
Hypotonic - ECF only
Isotonic - ECF and ICF Hypertonic - ECF then causes a shift of water from ICF to ECF |
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what do each of the fluids do to cell volume
Hypotonic Hypertonic Isotonic |
Hypotonic -
Hypertonic - decreases cell volume Isotonic - no change in cell volume |
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what is the equation for plasma osmolality
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Posm = 2[Na] + [Glucose/18] + [BUN/2.8]
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what are some tools to ID fluid alterations
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HnP:
N/V burns excessive sweating CHF/dyspnea low albumin -weight -ins and outs -decrease BP increase HR -edema and rales -Hgb:HCT should be 1:3 -UOP |
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what type of fluid is lost in dehydration
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hypotonic fluids
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what type of fluid is lost in volume depletion
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isotonic fluids
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3rd spacing causes what type of water loss: depletion or dehydration
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volume depletion
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how are colloids different from crystalloids
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colloids: contain large molecules, remain in the intravascular space longer and increase oncotoic pressure in intravascular space therefore increase intravascular volume
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name the crystalloid solutions in each class
hypotonic isotonic hypertonic |
hypotonic - D5W, 0.45% NaCl
isotonic - 0.9% NS, lactated ringers hypertonic - 3% NaCl |
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what is "3rd spacing"
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acute sequestration in a body compartment not in equilibrium with ECF
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what CrCl must a patient have in order to treat their sodium disorder with a thiazide diuretic
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CrCl > 30
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what are the normal levels of these lytes
Na K Mg Ca PO4 |
Na 135-145
K 3.5-5.5 Mg 1.7-2.3 (1.4-1.8) Ca 8.5-10.5 PO4 2.5-4.5 |
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what is the max correction of sodium
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12 mEq/L/24 hrs or 0.5mEq/L/hr
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what happens if you correct hyponatremia too fast
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osmotic demyelination (IRREVERSIBLE)
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WHAT ARE THE CLASSIFICATIONS AND SYMPTOMS SEEN AT THESE MEQ
>125-130 <115 - 125 <110-115 |
severe <110-115: seizure, coma, death
mild >125-130: asymptomatic moderate <115-125: bloating, HA, N/V, muscle cramps |
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what is the initial correction and initial goal for a patient with severe hyponatremia
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increase plasma tonicity enough to relieve symtpoms then increase in serum Na by 5%
initial goal: increase serum Na by 1-2 mEq/L/hr over first 2-4 hrs |
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what type of colloid do you use in patients with severe hyponatremia
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hypertonic solutions
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what type of hyponatremia is this
decrease serum Na and normal plasma osmolality |
isotonic hyponatremia
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what are causes of isotonic hyponatremia
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infusion of Na free solutions (lipids, proteins)
hyperlipidemia hyperprotenemia |
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what is the treatment of isotonic hyponatremia
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0.9 NaCl
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what type of hyponatremia is this
increase serum osmolality producing decrease serum Na |
hypertonic hyponatremia
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what are some causes of hypertonic hyponatremia
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excess of non Na effective osmoles in the ECF (glucose, glycerin or mannitol infusions)
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how does hypertonic hyponatremia cause dilutional hyponatremia
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hypertonic ECF pulls water out of ICF
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how do you treat hypertonic hyponatremia
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Na and water restriction
correct underlying cause |
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what is the equation for corrected sodium in hyperglycemia
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corrected serum Na = serum Na + 0.015(serum glucose - 100)
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what type of hyponatremia is this
decrease serum Na and decrease osmolality |
hypotonic hyponatremia
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what type of hypotonic hyponatremia is this
decrease total body Na and decrease ECF volume |
hypovolemic hypotonic hyponatremia
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what are SSx of ECF depletion
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orthostatic hypotension
thirst dry mucus membranes decreased/low UOP |
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what type of hypotonic hyponatremia is this
normal total body Na and small increase in ECF volume |
euvolemic hypotonic hyponatremia
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what are the 2 main groups of euvolemic hypotonic hyponatremia
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Uosm < 100 UNa < 20
Uosm > 100 UNa > 20 |
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what can cause
Uosm < 100 UNa < 20 |
rapid water administration
water intoxication low solute intake |
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what can cause
Uosm > 100 UNa > 20 other than SIADH |
glucocorticoid deficiency
hypokalemia renal disease adrenal insuficiency hypothyroidism |
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how do you treat
symptomatic SIADH |
fluid restriction 1-2 L/day
symptomatic -hypertonic saline -furosemide 40 mg IV q 6h asymptomatic -NaCl tabs +/- loops demeclocycline vasopressin Rc antagonist (tolvaptan, conivaptan) |
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what type of hyponatremia is this
increase total body Na and increase ECF volume |
hypervolemic hypotonic hyponatremia
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what is the cause of hypervolemic hypotonic hyponatremia
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CHF, cirrhosis, malnutrition (decreased albumin)
-impaired Na and water excretion |
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what is the treatment for hypervolemic hypotonic hyponatremia
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symptomatic: 3% NaCl +/- loops followed by Na/H2O restriction
asymptomatic: Na and H2O restriction, loops, vasopressin Rc antag |
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what is the main cause of isovolemic hypernatremia
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Diabetes insipidus
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tx for central and nephrogenic isovolemic hypernatremia
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central - acute polyuria
-replace free water deficit -correct underlying cause -desmopressin (DDAP) nephorgenic - gradual development of polyuria -replace free water defitic -correct underlying cause -TZD + restrict dietary Na |
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causes of hypokalemia
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ECF > ICF shift: insulin, beta agonist, dextrose, metabolic alkalosis, NaHCO3
mineralcorticoid excess (retain Na/excrete K) hypoMg (impairs fxn of Na/K ATPase pump promoting renal K wasting) |
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what meds cause hypokalemia
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cisplatin
amphotericin B aminoglycosides aldosterone diuretics |
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causes of hyperkalemia
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ICF > ECF shift
-metabolic acidosis -insulin deficiency -beta blockers, digoxin |
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what meds cause hyperkalemia
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ACE-I
ARB K sparing diuretics NSAIDs trimethoprim |
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why do you give IV Calcium to symptomatic hyperkalemia patients
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calcium stabilizes the heart
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