P3 Therapeutics Test 1 Electrolytes

Front 1

what is the normal range of plasma osm

Back 1

275-290 mOsm/kg

Front 2

what kind of fluid is loss in dehydration

Back 2

hypotonic

Front 3

what happens to plasma osmolality in dehydration

Back 3

increases

Front 4

what happens to plasma osmolality in vol depletion

Back 4

nothing

Front 5

TBW depletion is seen in what

Back 5

dehydration

Front 6

Vol depletion involves depletion of what part of the TBW

Back 6

ECF

Front 7

hypotonic fluids distribute where and what are some examples what happens to cell volume

Back 7

ECF and ICF
INCREASE CELL VOLUME

ex: D5W, 0.45% NaCl

Front 8

isotonic fluids distribute where and what are some examples of what happens to cell volume

Back 8

ECF
NO CHANGE IN CELL VOLUME

0.9% NaCl, lactated ringers, plasmalyte

Front 9

hypertonic fluids distribute where and what are some examples what happens to cell volume

Back 9

ECF but due to the hyperosmolarity pull water from ICF therefore DECREASE CELL VOLUME

ex 3% NaCl, Albumin

Front 10

what are the Na values normally

Back 10

135-145 mEq

Front 11

what is third spacing

Back 11

build up in fluids in body compartments not in equilibrium with ECF

Front 12

how is 3rd spacing treated

Back 12

Na restriction +/- diuretics

Front 13

what is hyponatremia usually due to

Back 13

excess extracellular H2O to Na due to impaired water excretion

Front 14

what is the serum Na in hyponatremia

Back 14

<135

Front 15

what is the max you can correct someone's Na in a day

Back 15

12 mEq/24hr (0.5mEq/L/hr in 24hrs)

Front 16

what happens if you correct someone's Na past the max limit

Back 16

osmotic demyelination onset takes 5-7 days therefore to avoid slowly correct pt initially to get rid of symptoms then slowly correct over the next days

Front 17

what is the Na level in severe hyponatremia and what is the initial correction, initial goal,

Back 17

<110-115
initial correction is 5% in NaCl to get them symptom free

initial goal is 1-2 mEq/L/hr over 1st 24hrs

Front 18

what is Hypertonic hyponatremia

Back 18

increase serum Osm resulting in decrease serum Na

usually seen in hyperglycemic pts

Front 19

what kind of electrolyte disorder would be seen in hyperglycemic patients

Back 19

hypertonic hyponatremia

the elevated glucose increases the plasma osmolality and will pull H2O out of the cells (ICF > ECF) causing dilutional hyponatremia

Front 20

how do you correct hypertonic hyponatremia

Back 20

if due to glucose use the equation for corrected serum Na

corrected serum Na = serum Na + 0.016(serum glucose - 100)

Front 21

what is seen in isotonic hyponatremia

Back 21

decrease serum Na and normal plasma osmolality

Front 22

what is seen in hypotonic hyponatremia

Back 22

decrease serum Na and decrease serum osmolality

Front 23

what is seen in hypovolemic hypotonic hyponatremia

Back 23

decrease serum Na and decrease ECF volume (Na loss > water loss)

Front 24

what are signs of ECF depletion

Back 24

orthostatic hypotension, thirst, dry mucous membranes, decrease or low urine output

Front 25

what are some causes of hypovolemic hypotonic hyponatremia

Back 25

TZD, adrenal insufficiencies, 3rd spacing, V/D

Front 26

how do you treat hypovolemic hypotonic hyponatremia

Back 26

calculate ECF deficit
restore ECF w/ isotonic fluids (initial infusion rate 200-400 ml/min)

Front 27

what is seen in euvolemic hypotonic hyponatremia

Back 27

no change in Na slight increase in ECF

Front 28

what are the two groups of euvolemic hypotonic hyponatremia

Back 28

urine osm < 100 urine Na <20
-water intoxication, low solute intake, rapid H2O intake

urine osm >100 urin Na >20 (holding onto H2O and excreting Na)
-SIADH

Front 29

what is SIADH and what type of electrolyte disorder stems from it

Back 29

inappropriate ADH secretion/levels regardless of stimuli that normally inhibits it

seen in euvolemic hypotonic hyponatremia

Front 30

how do you treat SIADH

Back 30

if symptomatic: 3% NaCl (b/c pt losing more Na then .9% NaCl can replace) + furosemide (to prevent pt from becoming vol OD)

nonsymptomatic:
NaCl tabs (9g/day) + furosemide, demeclocycline, and vasoppression Rc antagonist (conivaptan, tolvaptan) can also be used

Front 31

what are some causes of SIADH

Back 31

diuretics, SSRI, NSAID, lung disorders (pneumonia, TB), malignancies (small cell lung cancer), desmopressin

Front 32

what is seen in hypervolemic hypotonic hyponatremia

Back 32

increase serum Na and increase in ECF volume

Front 33

what is seen in hypovolemic hypotonic hyponatremia

Back 33

decrease serum Na and decrease ECF volume (Na loss > water loss)

Front 34

what are signs of ECF depletion

Back 34

orthostatic hypotension, thirst, dry mucous membranes, decrease or low urine output

Front 35

what are some causes of hypovolemic hypotonic hyponatremia

Back 35

TZD, adrenal insufficiencies, 3rd spacing, V/D

Front 36

how do you treat hypovolemic hypotonic hyponatremia

Back 36

calculate ECF deficit
restore ECF w/ isotonic fluids (initial infusion rate 200-400 ml/min)

calculate change in serum Na after infusing 1L of 0.9% NaCl

Front 37

what is seen in euvolemic hypotonic hyponatremia

Back 37

no change in Na slight increase in ECF

Front 38

what are the two groups of euvolemic hypotonic hyponatremia

Back 38

urine osm < 100 urine Na <20
-water intoxication, low solute intake, rapid H2O intake

urine osm >100 urin Na >20 (holding onto H2O and excreting Na)
-SIADH

Front 39

what is SIADH and what type of electrolyte disorder stems from it

Back 39

inappropriate ADH secretion/levels regardless of stimuli that normally inhibits it

seen in euvolemic hypotonic hyponatremia

Front 40

how do you treat SIADH

Back 40

if symptomatic: 3% NaCl (b/c pt losing more Na then .9% NaCl can replace) + furosemide (to prevent pt from becoming vol OD)

nonsymptomatic:
NaCl tabs (9g/day) + furosemide, demeclocycline, and vasoppression Rc antagonist (vonivaptan, tolvaptan) can also be used

Front 41

what are some causes of SIADH

Back 41

diuretics, SSRI, NSAID, lung disorders (pneumonia, TB), malignancies (small cell lung cancer), desmopressin

Front 42

what is seen in hypervolemic hypotonic hyponatremia

Back 42

increase serum Na and increase in ECF volume (impaired Na and H2O excretion)

Front 43

what are some causes of hypervolemic hypotonic hyponatremia

Back 43

CHF, nephrotic syndrome, cirrhosis, malnutrition (decrease albumin) ascites

urine osm > 100 urine Na <20 (holding water and Na)

Front 44

how do you treat hypervolemic hypotonic hyponatremia

Back 44

if symptomatic: 3% NaCl but only enough to get rid of symptoms +/- furosemide then H2O/Na restriction

nonsymptomatic: Na/H2O restriction, loops, vasopressing Rc antagonist (not conivaptan if pt has CHF)

Front 45

what are the serum levels in hypernatremia

Back 45

>145 mEq

Front 46

why is hypernatremia commonly seen in infants, elderly/disables, comatose

Back 46

the increase in serum osmolality will stimulate the thirst center normally causing someone to seek water therefore hypernatremia is commonly seen in pts w/o access to water

Front 47

what is the daily correction for hypernatremia

Back 47

decrease serum Na <= 8-10 mEq/L a day

Front 48

what is seen in hypovolemic hypernatremia

Back 48

decrease Na and total body water (water loss > Na loss)

Front 49

what are some causes of hypovolemic hypernatremia

Back 49

profound diarrhea (laxative induced)
sweating
osmotic diuresis
overuse of diuretics

Front 50

how do you treat hypovolemic hypernatremia

Back 50

calculate and replace free water deficit
fix underlying cause

Front 51

what is seen in isovolumic hypernatremia

Back 51

pure water loss and normal total body sodium

Front 52

what is the main cause of isovolumic hypernatremia

Back 52

diabetes insipidus

Front 53

what are the two forms of diabetes insipidus that can cause an electrolyte disorder

Back 53

central - decrease AVP secretion

nephrogenic - decrease renal response to AVP

Front 54

how do you treat central and nephrogenic diabetes insipidus

Back 54

central - give pt free water, desmopressin is 1st line med

nephrogenic - give pt free water, TZD and restrict dietary Na

Front 55

what is the urine output in central vs nephrogenic DI

Back 55

central 3-15 L/24hrs
nephrogenic: 3-5 L/24hrs

polyuria onset more rapid in central

Front 56

what is seen in hypervolemic hypernatremia

Back 56

increase total body Na and water (Na gain > water gain)

Front 57

what are some causes of hypervolemic hypernatremia

Back 57

intake of dietary Na
too much admin of hypertonic solutions (NaHCO3)
hyperaldosteronism

basically Na overload or mineral corticoid excess

Front 58

how do you treat hypervolemic hypernatremia

Back 58

loops + D5W
spironolactone/adrenalectomy if due to hyperaldosteronism

Front 59

what are symptoms of hypernatremia due to

Back 59

movement of water from ICF to ECF resulting in decrease cell volume

Front 60

what are the correction rates for acute and chronic hypernatremia

Back 60

acute: 1mEq Na/L/hr
chronic: 0.5 mEq Na/L/hr

Front 61

what is the fluid administration for hypernatremia

Back 61

give hypotnonic fluid
if hemo-unstable use 200-300ml/hr .9% NaCl until BP/HR stable

if hemo stable calculate water deficit (replace 50% of deficit w/ hypotonic solution over the 1st 24 hrs and the remainder over the next 24-72 hrs)

Front 62

at what glucose level do we correct for sodium

Back 62

>200

Front 63

what is the mEq for D5W, 0.22% NaCl, 0.45% NaCl, 0.9% NaCl, 3% NaCl

Back 63

D5W - 0
.22% NaCl - 38
.45% NaCl - 77
.9% NaCl - 154
3% NaCl 512