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105 Cards in this Set
- Front
- Back
Which IV fluid is the most similar to ECF?
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Lactated Ringer's
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Which IV fluid is the safest to give to pts?
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1/2 Normal Saline
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Two isotonic solutions
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NS and LR
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Name the three hypotonic solutions
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D5W, 1/2 NS, D5 1/2
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Name the two hypertonic solutions
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Na Lactate, 3%
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What does "isotonic" mean?
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the same concentration inside and outside of the cell
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Osmolarity/tonicity are measured in what?
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mEq
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ECF and ICF have what type of tonicity?
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Isotonic - normal osmolarity ranges =
ECF=280-310, ICF=350-400 |
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Major intracellular cation
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Potassium (K+)
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This is defined as fluid/Na lost ineven amounts in ECF with no ICF shift.
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Isotonic dehydration
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A BUN/Creatinine >30 suggests what?
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Dehydration (isotonic dehydration)
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A BUN/Creatinine of 20-30 suggests what?
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a renal problem
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Causes of isotonic dehydration
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Anything that can cause you to lose fluid - third spacing, vomiting, diarrhea, polyuria, gastric suction, hemorrhage, fever
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What is "third space shifting"?
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fluid located within organ spaces where fluid is not normally located (ascites, peritonitis, burns)
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Which fluid should a pt with an electrolyte imbalance NOT receive? Why?
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LR. It contains many electrolytes that can further exacerbate a pt's imbalance.
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S/Sx of isotonic dehydration
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Altered mental status, weight loss, dry mucous membranes, increasd BUN/CR, decreased BP, decreased skin turgor
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Treatment of isotonic dehydration
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underlying cause, isotonic fluid replacement, monitor I/O, LOC, VS, BUN, CBC, electrolytes
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Why monitor CBCs in pt w/isotonic dehydration?
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To see if pt is bleeding and establish if that is the cause of dehydration
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This is defined as fluid/Na+ gain in even amounts in ECF with no ICF shift (excessive fluid accumulation)
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Isotonic Overhydration
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Causes of isotonic overhydration
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-CHF, CRF, Liver Dz.
-Too much Na+ -Too much hypertonic soln. -Too many saline enemas, corticosteroids (solumed, pred) |
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S/Sx Isotonic Overhydration
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Peripheral edema, polyuria, acute weight gain, JVD, ascites, increased BP, decreased HCT
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Why would a pt's HCT be decreased in isotonic overhydration
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it becomes diluted with the excess fluid accumulation
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Treatment of isotonic overhydration
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-underlying cause
-less fluids -diuretics -I/O, VS, CXR, HEMATOCRIT!!!, BUN |
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Why do you want to do a CXR on a pt w/ isotonic overhydration?
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assess for pleural effusion or pulmonary edema
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What is the urine excretion goal in a pt w/isotonic overhydration?
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1 ml/kg/hr (max)
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Serum levels of hypokalemia
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mild = 3 - 3.5
Moderate = 2.5 - 3 Severe = < 2.5 meq/L |
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What is the transcellular shift seen in hypokalemia?
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ECF ---> ICF
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How is Lithium associated with hypokalemia?
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Lithium is a salt. It competes with K+ for excretion.
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Causes of hypokalemia
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-Loop diuretics
-Laxative abuse -Lithium -Liquor (alcohol) - |
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What other electrolyte deficiency will hinder the increase of potassium?
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Magnesium - if K+ will not increase, check Mg+ levels and fix those first
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S/Sx of isotonic dehydration
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Altered mental status, weight loss, dry mucous membranes, increasd BUN/CR, decreased BP, decreased skin turgor
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Treatment of isotonic dehydration
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underlying cause, isotonic fluid replacement, monitor I/O, LOC, VS, BUN, CBC, electrolytes
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Why monitor CBCs in pt w/isotonic dehydration?
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To see if pt is bleeding and establish if that is the cause of dehydration
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This is defined as fluid/Na+ gain in even amounts in ECF with no ICF shift (excessive fluid accumulation)
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Isotonic Overhydration
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Causes of isotonic overhydration
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-CHF, CRF, Liver Dz.
-Too much Na+ -Too much hypertonic soln. -Too many saline enemas, corticosteroids (solumed, pred) |
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S/Sx Isotonic Overhydration
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Peripheral edema, polyuria, acute weight gain, JVD, ascites, increased BP, decreased HCT
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Why would a pt's HCT be decreased in isotonic overhydration
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it becomes diluted with the excess fluid accumulation
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Treatment of isotonic overhydration
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-underlying cause
-less fluids -diuretics -I/O, VS, CXR, HEMATOCRIT!!!, BUN |
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Why do you want to do a CXR on a pt w/ isotonic overhydration?
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assess for pleural effusion or pulmonary edema
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What is the urine excretion goal in a pt w/isotonic overhydration?
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1 ml/kg/hr (max)
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Serum levels of hypokalemia
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mild = 3 - 3.5
Moderate = 2.5 - 3 Severe = < 2.5 meq/L |
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What is the transcellular shift seen in hypokalemia?
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ECF ---> ICF
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How is Lithium associated with hypokalemia?
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Lithium is a salt. It competes with K+ for excretion.
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Causes of hypokalemia
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-Loop diuretics -Stress
-Laxative abuse -Amphotericin -Lithium -hypothyroid -Liquor (alcohol) -Liver |
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What other electrolyte deficiency will hinder the increase of potassium?
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Magnesium - if K+ will not increase, check Mg+ levels and fix those first
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What is Amphotericin B and what is it's relationship to hypokalemia?
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anti-fungal used to treat infections that works on Mg+. May inhibit a rise in K+ levels due to decrease in Mg+ levels.
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The "biggest" cause of hypokalemia?
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diuretics
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S/Sx of hypokalemia
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-anorexia -EKG change
-drowsiness -leg cramps -paresthesia -lethargy -digoxin toxicity |
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Why is insulin/glucose therapy a cause of hypokalemia?
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insulin draws potassium into the cell
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What drug reverses Digoxin toxicity?
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Digibind
(0.8-1.2 = normal dig.) |
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Treatment of hypokalemia
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-underlying cause =
-hypomagnesemia -give K+ supplement -K+ sparing diuretic |
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Potassium level is low and your digoxin level is high...what is this called?
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Digoxin toxicity
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Digoxin is an antiarrhythmic that works on the ATPase pump. T/F?
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True
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Serum levels for hyperkalemia
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Mild = 5.5 - 6
Moderate = 6.1 - 6.9 Severe = >7 mEq/L |
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What is the trancellular shift seen in hyperkalemia?
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ICF ---> ECF
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Causes of hyperkalemia
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-CRF or ARF
-tumor lysis syndrome -burns/tissue trauma -metabolic/lactic acidosis |
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How do burns/tissue trauma cause hyperkalemia?
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the cellular breakdown involved releases excess K+
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What SE does dig. toxicity cause visually?
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halos around objects (think Van Gogh)
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What drugs cause the lactic acidosis involved in hyperkalemia?
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Metformin (glucophage)
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What is the fastest way to give a pt K+ supplements if IV is not available?
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Liquid form
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T/F = It is OK to give a pt IV form of K+ IVP.
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False. NEVER give K+ IVP. Always infuse = 10/mEq/30min (fastest) or 20mEq/hr
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What is added to IV K+ to reduce the "sting" involved in it's administration?
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"Nute" (added sodium bicarb)
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What is the best way to give K+ supplement?
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Always try to give it orally ("if your gut works, use it") - if any other funky changes (EKG, ALOC, etc.), then give IV INF
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What can happen if you give K+ INF too fast?
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it can cause an arrhythmia
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What are the weakest diuretics?
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Potassium Sparing (least amount of water loss)
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What is an example of a potassium-sparing diuretic?
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Spironalactone (Aldactone)
Triemetrine (Dyazide) |
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Why do you never give calcium to a pt that is Dig. Toxic?
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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
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What are some drug-induced causes of hyperkalemia?
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-K+-sparing diuretics
-NSAIDS -dig. toxicity -ACEI/ARB |
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Which is more critical - hyper or hypokalemia.
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Hyperkalemia
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S/Sx of hyperkalemia
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-N/V/D
-paresthesias -EKG -confusion |
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What is Addison's Dz.?
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A syndrome involving aldosterone secretion that causes an increase in potasiium levels.
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What is the "biggest" cause of hyperkalemia?
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Acute renal failure/chronic renal failure
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How does Tumor Lysis Syndrome (TLS) cause hyperkalemia?
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Pt with tumor that is undergoing chemo - cells are rapidly broken down causing excess K+ to be released
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Acute hyperkalemia that is considered moderate or above (over 6)= what medication do you give the pt?
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Calcium gluconate 10%
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Why do you give calcium to a pt with acute hyperkalemia that is considered moderate or above?
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It is cardio-protective (assists is contractions/reduces arrhythmias)
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If your pt is hyperkalemic and is presenting with metabolic acidosis, what drug do you give?
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Sodium Bicarb (HCO3)
- 50mL IVP over 10 minutes - or add to bag and infuse over 1 hr. |
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If the potassium does not drop within an hour after your initial interventions for hyperkalemia, what do you do next?
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Start an insulin drip
-100 units/100mL (1U/mL) or D10W |
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T/F - Both insulin and dextrose draw potassium into the cell.
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True.
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**What is another name for Kayexelate and what is it?
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Sodium Polyesterene. A sorbitol or sugar-based product
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How is Kayexelate given?
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30 gm Orally or 50 gm by enema
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When is Kayexelate given?
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Given to moderate hyperkalemic pts. that do not have the severe symptoms (EKG changes, etc.) b/c it takes 1-2 hrs to work.
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How does Kayexelate work?
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The sorbitol binds to the K= and excretes it in the feces
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If the hyperkalemia does not go down despite all pharmacological efforts, what should you do for the pt?
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Dialysis - will probably give Kayexelate in conjunction with the dialysis.
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Serum level that marks hyponatremia.
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<135 mEq/L
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What is the fluid shift involved in hyponatremia?
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ECF ---> ICF (causes cellular swelling)
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S/Sx of hyponatremia
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-CEREBRAL EDEMA -resp. arrest
-orthostasis -confusion (key) -seizures at 118 -pitting edema |
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Three types of hyponatremia
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-Hypovolemic (low Na, low TBW)
-Euvolemic (normal Na, high TBW) -Hypervolemic (high Na, high TBW |
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What is SIADH
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Syndrome of inappropriate anti-diuretic hormone
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What drug is used to help pt's with SIADH?
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Desmopressin
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Drugs that can cause hyponatremia
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Vasopressin, NSAIDS, SSRIs, Clonidine (Alpha II agonist), TCAs
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Treatment for hypovolemic and euvolemic hyponatremia
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isotonic saline (NS) 1.5-2 mEq/L/hr until resolved
Goal = Na+ of 120 or better |
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If the Na+ level is below 118 (and you fear seizures), what soln. may you give?
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3% hypertonic soln
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What happens if you give 3% hypertonic saline too fast?
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may cause Central Potine Myelating Disorder - hurts cerebellum which impairs mov't and can cause paralysis
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Treatment of Hypervolemic Hyponatremia
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-3% hypertonic soln
-diuretics -fluid restriction |
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Serum level that distinguishes hypernatremia
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>145 mEq/L
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What is the fluid shift in hypernatremia?
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ICF ---> ECF (cell shrinks)
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S/Sx of hypernatremia
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-restlessness, weakness, tachycardia, flushed skin, delirium, decreased salivation & tears
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Three types of Hypernatremia
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-Hypovolemia (low Na, low TBW)
-Euvolemic (normal Na+, low TBW) -Hypervolemia (high Na, norm TBW |
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What types of pt's are on osmotic diuretics?
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Pt's with increased ICP or pts with increased cerebral edema (hyponatremia)
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What is the only extrarenal cause of hypernatremia?
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Skin. (sweating)
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T/F - NSAIDS decrease Na+ (so you can use them to treat hypernatremia) but you avoid them in pt's that are hyperkalemia
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True.
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What are some causes of hypervolemic hypernatremia?
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-improper formulas (feeding tubes)
-hyperaldosteronism |
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Treatment for hypernatremia?
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Loops, D5W, poss. dialysis
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Where is 60-70% of body fluid (water) exchanged in the kidney?
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Loop of Henle
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What are the strongest diuretics?
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loops
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