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105 Cards in this Set

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Which IV fluid is the most similar to ECF?
Lactated Ringer's
Which IV fluid is the safest to give to pts?
1/2 Normal Saline
Two isotonic solutions
NS and LR
Name the three hypotonic solutions
D5W, 1/2 NS, D5 1/2
Name the two hypertonic solutions
Na Lactate, 3%
What does "isotonic" mean?
the same concentration inside and outside of the cell
Osmolarity/tonicity are measured in what?
mEq
ECF and ICF have what type of tonicity?
Isotonic - normal osmolarity ranges =
ECF=280-310, ICF=350-400
Major intracellular cation
Potassium (K+)
This is defined as fluid/Na lost ineven amounts in ECF with no ICF shift.
Isotonic dehydration
A BUN/Creatinine >30 suggests what?
Dehydration (isotonic dehydration)
A BUN/Creatinine of 20-30 suggests what?
a renal problem
Causes of isotonic dehydration
Anything that can cause you to lose fluid - third spacing, vomiting, diarrhea, polyuria, gastric suction, hemorrhage, fever
What is "third space shifting"?
fluid located within organ spaces where fluid is not normally located (ascites, peritonitis, burns)
Which fluid should a pt with an electrolyte imbalance NOT receive? Why?
LR. It contains many electrolytes that can further exacerbate a pt's imbalance.
S/Sx of isotonic dehydration
Altered mental status, weight loss, dry mucous membranes, increasd BUN/CR, decreased BP, decreased skin turgor
Treatment of isotonic dehydration
underlying cause, isotonic fluid replacement, monitor I/O, LOC, VS, BUN, CBC, electrolytes
Why monitor CBCs in pt w/isotonic dehydration?
To see if pt is bleeding and establish if that is the cause of dehydration
This is defined as fluid/Na+ gain in even amounts in ECF with no ICF shift (excessive fluid accumulation)
Isotonic Overhydration
Causes of isotonic overhydration
-CHF, CRF, Liver Dz.
-Too much Na+
-Too much hypertonic soln.
-Too many saline enemas, corticosteroids (solumed, pred)
S/Sx Isotonic Overhydration
Peripheral edema, polyuria, acute weight gain, JVD, ascites, increased BP, decreased HCT
Why would a pt's HCT be decreased in isotonic overhydration
it becomes diluted with the excess fluid accumulation
Treatment of isotonic overhydration
-underlying cause
-less fluids
-diuretics
-I/O, VS, CXR, HEMATOCRIT!!!, BUN
Why do you want to do a CXR on a pt w/ isotonic overhydration?
assess for pleural effusion or pulmonary edema
What is the urine excretion goal in a pt w/isotonic overhydration?
1 ml/kg/hr (max)
Serum levels of hypokalemia
mild = 3 - 3.5
Moderate = 2.5 - 3
Severe = < 2.5

meq/L
What is the transcellular shift seen in hypokalemia?
ECF ---> ICF
How is Lithium associated with hypokalemia?
Lithium is a salt. It competes with K+ for excretion.
Causes of hypokalemia
-Loop diuretics
-Laxative abuse
-Lithium
-Liquor (alcohol)
-
What other electrolyte deficiency will hinder the increase of potassium?
Magnesium - if K+ will not increase, check Mg+ levels and fix those first
S/Sx of isotonic dehydration
Altered mental status, weight loss, dry mucous membranes, increasd BUN/CR, decreased BP, decreased skin turgor
Treatment of isotonic dehydration
underlying cause, isotonic fluid replacement, monitor I/O, LOC, VS, BUN, CBC, electrolytes
Why monitor CBCs in pt w/isotonic dehydration?
To see if pt is bleeding and establish if that is the cause of dehydration
This is defined as fluid/Na+ gain in even amounts in ECF with no ICF shift (excessive fluid accumulation)
Isotonic Overhydration
Causes of isotonic overhydration
-CHF, CRF, Liver Dz.
-Too much Na+
-Too much hypertonic soln.
-Too many saline enemas, corticosteroids (solumed, pred)
S/Sx Isotonic Overhydration
Peripheral edema, polyuria, acute weight gain, JVD, ascites, increased BP, decreased HCT
Why would a pt's HCT be decreased in isotonic overhydration
it becomes diluted with the excess fluid accumulation
Treatment of isotonic overhydration
-underlying cause
-less fluids
-diuretics
-I/O, VS, CXR, HEMATOCRIT!!!, BUN
Why do you want to do a CXR on a pt w/ isotonic overhydration?
assess for pleural effusion or pulmonary edema
What is the urine excretion goal in a pt w/isotonic overhydration?
1 ml/kg/hr (max)
Serum levels of hypokalemia
mild = 3 - 3.5
Moderate = 2.5 - 3
Severe = < 2.5

meq/L
What is the transcellular shift seen in hypokalemia?
ECF ---> ICF
How is Lithium associated with hypokalemia?
Lithium is a salt. It competes with K+ for excretion.
Causes of hypokalemia
-Loop diuretics -Stress
-Laxative abuse -Amphotericin
-Lithium -hypothyroid
-Liquor (alcohol)
-Liver
What other electrolyte deficiency will hinder the increase of potassium?
Magnesium - if K+ will not increase, check Mg+ levels and fix those first
What is Amphotericin B and what is it's relationship to hypokalemia?
anti-fungal used to treat infections that works on Mg+. May inhibit a rise in K+ levels due to decrease in Mg+ levels.
The "biggest" cause of hypokalemia?
diuretics
S/Sx of hypokalemia
-anorexia -EKG change
-drowsiness -leg cramps
-paresthesia -lethargy
-digoxin toxicity
Why is insulin/glucose therapy a cause of hypokalemia?
insulin draws potassium into the cell
What drug reverses Digoxin toxicity?
Digibind
(0.8-1.2 = normal dig.)
Treatment of hypokalemia
-underlying cause =
-hypomagnesemia
-give K+ supplement
-K+ sparing diuretic
Potassium level is low and your digoxin level is high...what is this called?
Digoxin toxicity
Digoxin is an antiarrhythmic that works on the ATPase pump. T/F?
True
Serum levels for hyperkalemia
Mild = 5.5 - 6
Moderate = 6.1 - 6.9
Severe = >7

mEq/L
What is the trancellular shift seen in hyperkalemia?
ICF ---> ECF
Causes of hyperkalemia
-CRF or ARF
-tumor lysis syndrome
-burns/tissue trauma
-metabolic/lactic acidosis
How do burns/tissue trauma cause hyperkalemia?
the cellular breakdown involved releases excess K+
What SE does dig. toxicity cause visually?
halos around objects (think Van Gogh)
What drugs cause the lactic acidosis involved in hyperkalemia?
Metformin (glucophage)
What is the fastest way to give a pt K+ supplements if IV is not available?
Liquid form
T/F = It is OK to give a pt IV form of K+ IVP.
False. NEVER give K+ IVP. Always infuse = 10/mEq/30min (fastest) or 20mEq/hr
What is added to IV K+ to reduce the "sting" involved in it's administration?
"Nute" (added sodium bicarb)
What is the best way to give K+ supplement?
Always try to give it orally ("if your gut works, use it") - if any other funky changes (EKG, ALOC, etc.), then give IV INF
What can happen if you give K+ INF too fast?
it can cause an arrhythmia
What are the weakest diuretics?
Potassium Sparing (least amount of water loss)
What is an example of a potassium-sparing diuretic?
Spironalactone (Aldactone)
Triemetrine (Dyazide)
Why do you never give calcium to a pt that is Dig. Toxic?
It can cause "Stone Heart" - a condition where the heart becomes calcified and does not pump. If dig level is too high, DO NOT give Calcium
What are some drug-induced causes of hyperkalemia?
-K+-sparing diuretics
-NSAIDS
-dig. toxicity
-ACEI/ARB
Which is more critical - hyper or hypokalemia.
Hyperkalemia
S/Sx of hyperkalemia
-N/V/D
-paresthesias
-EKG
-confusion
What is Addison's Dz.?
A syndrome involving aldosterone secretion that causes an increase in potasiium levels.
What is the "biggest" cause of hyperkalemia?
Acute renal failure/chronic renal failure
How does Tumor Lysis Syndrome (TLS) cause hyperkalemia?
Pt with tumor that is undergoing chemo - cells are rapidly broken down causing excess K+ to be released
Acute hyperkalemia that is considered moderate or above (over 6)= what medication do you give the pt?
Calcium gluconate 10%
Why do you give calcium to a pt with acute hyperkalemia that is considered moderate or above?
It is cardio-protective (assists is contractions/reduces arrhythmias)
If your pt is hyperkalemic and is presenting with metabolic acidosis, what drug do you give?
Sodium Bicarb (HCO3)
- 50mL IVP over 10 minutes
- or add to bag and infuse over 1 hr.
If the potassium does not drop within an hour after your initial interventions for hyperkalemia, what do you do next?
Start an insulin drip
-100 units/100mL (1U/mL) or D10W
T/F - Both insulin and dextrose draw potassium into the cell.
True.
**What is another name for Kayexelate and what is it?
Sodium Polyesterene. A sorbitol or sugar-based product
How is Kayexelate given?
30 gm Orally or 50 gm by enema
When is Kayexelate given?
Given to moderate hyperkalemic pts. that do not have the severe symptoms (EKG changes, etc.) b/c it takes 1-2 hrs to work.
How does Kayexelate work?
The sorbitol binds to the K= and excretes it in the feces
If the hyperkalemia does not go down despite all pharmacological efforts, what should you do for the pt?
Dialysis - will probably give Kayexelate in conjunction with the dialysis.
Serum level that marks hyponatremia.
<135 mEq/L
What is the fluid shift involved in hyponatremia?
ECF ---> ICF (causes cellular swelling)
S/Sx of hyponatremia
-CEREBRAL EDEMA -resp. arrest
-orthostasis
-confusion (key)
-seizures at 118
-pitting edema
Three types of hyponatremia
-Hypovolemic (low Na, low TBW)
-Euvolemic (normal Na, high TBW)
-Hypervolemic (high Na, high TBW
What is SIADH
Syndrome of inappropriate anti-diuretic hormone
What drug is used to help pt's with SIADH?
Desmopressin
Drugs that can cause hyponatremia
Vasopressin, NSAIDS, SSRIs, Clonidine (Alpha II agonist), TCAs
Treatment for hypovolemic and euvolemic hyponatremia
isotonic saline (NS) 1.5-2 mEq/L/hr until resolved

Goal = Na+ of 120 or better
If the Na+ level is below 118 (and you fear seizures), what soln. may you give?
3% hypertonic soln
What happens if you give 3% hypertonic saline too fast?
may cause Central Potine Myelating Disorder - hurts cerebellum which impairs mov't and can cause paralysis
Treatment of Hypervolemic Hyponatremia
-3% hypertonic soln
-diuretics
-fluid restriction
Serum level that distinguishes hypernatremia
>145 mEq/L
What is the fluid shift in hypernatremia?
ICF ---> ECF (cell shrinks)
S/Sx of hypernatremia
-restlessness, weakness, tachycardia, flushed skin, delirium, decreased salivation & tears
Three types of Hypernatremia
-Hypovolemia (low Na, low TBW)
-Euvolemic (normal Na+, low TBW)
-Hypervolemia (high Na, norm TBW
What types of pt's are on osmotic diuretics?
Pt's with increased ICP or pts with increased cerebral edema (hyponatremia)
What is the only extrarenal cause of hypernatremia?
Skin. (sweating)
T/F - NSAIDS decrease Na+ (so you can use them to treat hypernatremia) but you avoid them in pt's that are hyperkalemia
True.
What are some causes of hypervolemic hypernatremia?
-improper formulas (feeding tubes)
-hyperaldosteronism
Treatment for hypernatremia?
Loops, D5W, poss. dialysis
Where is 60-70% of body fluid (water) exchanged in the kidney?
Loop of Henle
What are the strongest diuretics?
loops