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58 Cards in this Set
- Front
- Back
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What would cause a decrease/dehydration in TBW?
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insufficient oral intake
excessive insensible losses diabetes insipidus excessive osmotic diuresis impaired renal concentrating mechanism |
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What are potential symptoms of TBW dehydration?
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excessive thirst
dry mucous membranes decreased skin tugor elevated sodium increased plasma osmolality concentrated urine acute weight loss |
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What is a good treatment strategy for dehydration due depletion of TBW?
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Fluid replacement
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What is a potential cause of depleted ECF?
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External fluid losses (burn, hemorrhage, diuresis, GI losses, adrenal insufficiency)
Third spacing (septic shock, anaphylactic shock, abdominal ascites) |
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What are potential symptoms of depleated ECF?
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Decreased tissue perfusion
dizziness orthostatic hypotension tachycardia decreased urine output increased hematocrit decreased central venous pressure hypovolemic shock |
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What are treatment strategies for depleated ECF?
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Rapid, aggressive fluid replacement
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What are crystalloids?
What are there Types? |
Water
Electrolytes Hypotonic: 0.45% NaCl Isotonic: 0.9% NaCl Lactated Ringers D5W Hypertonic: 3-5% NaCl |
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What are colloids used for?
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shift fluid into ECF
volume expansion |
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What are a few types of colloids?
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Dextrans
Hetastarch Albumin Fresh Frozen Plasma |
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What are hypotonic solutions good for?
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Tonicity 77mEq/L
good for treating hypertonic w decreased ECF, water replacement |
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What are isotonic solutions good for? (normal saline)
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ECF replacement
hyponatremia resuscitation metabolid alalosis hypercalcemia fluid replacement DKA |
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What are hypertonic saline solutions good for?
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treading hyponatremia only
RISK: potential to shift Na water balance |
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What is D5W solution good for?
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its isotonic with hypotonic action
has calories; treat severe hypernatremia |
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What is Lactated Ringers solution good for?
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volume expander
lactate mimics composition of fluids/electrolytes in blood ECF replacement: dehydration, acute blood loss, peri-op, burns, GI losses RISK: with large volumes watch out for metabolic alkalosis |
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What is fresh frozen plama good for?
Risks? |
good as volume expander due to excessive blood loss
RISK: anaphylaxis, viral transmission, increased nosicomal infections |
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What are the sodium concentrations of the different severities of hyponatremia?
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Serum Na < 135
Severe: Serum Na < 120 (usually symptomatic |
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What is hypertonic hyponatremia?
What are some potential causes? Potential treatment strategies? |
increase of TBW with little change in sodium concentration
Hyperglycemia administration of hyperosmolar glycerin or mannitol Treat underlying pathology: normalize blood sugars |
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What is are possible causes of hyptononic hyponatremia: Isovolemic?
What are potential symptoms? What are some treatment strategies? |
Carcinomas, meningitis
trauma, SIADH, medications, water intoxicantion, Pneumonia, Stroke headache, dysguesia, attention/memory impaired, confusion, coma, hallucinations, cramps, weakness, seizures, decrebrate posture, respiratory arrest Treatments: fluid restriction < 500mL/day over 3-5 days. If Na < 110 mEq/L, hypertonic saline |
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What is hypotonic hyponatremia? (Hypovolemic)
What are some causes of Hypovolemia? |
Decrease in ECF and TBW with reduced Na concentration
Causes: Diuretics, profuse sweating, burns, GI losses, hypoadrenalism, renal tubular acidosis Potential symptoms: thirst, decrease in weight, dry mucous membranes, tachycardia, orthostatic hypotension, decreased skin turgor, decreased urine output Treatment: replace Na deficiency and fluid deficiency with isotonic NaCl over 6-12 hours. |
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What is hypotonic hyponatremia, HYPERVOLEMIC?
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increase TBW increase in sodium but increase ofTBW outweighs increase of sodium concentration
Causes: CHF, liver cirrhosis, nephrotic syndrome Symptoms: Weight gain, dyspnea, rales, edema Treatment: Salt and water restriction and loop diuretics |
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What are some symptoms of hypotnatremia < 120 mEq/L? < 110?
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agitation, fatigue, headache, muscle cramps, nausea
<110 confusion, seizures coma |
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What are the levels for hypernatremia?
what are symptoms? |
Serum Na > 145 mEq/L > 165 mEq/L symptoms
thirst, decreased mentation, dry mucous membranes |
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What is hypertonic hypernatremia? (hypovolemic)
potential causes? potential symptoms? treatment strategies? |
low TBW and normal sodium concentration
Causes: diuretic use, adernal insufficiency, GI/Respiratory/Skin water losses, Profound diarrhea, Profuse sweating Symptoms: thirst, weight loss, dry mucous membranes, orthostatic hypotension, flate veins, tachycardia, skin: poor turgor Treatment: isotonic sodium over 30-45 minutes then D5W or hypotonic sodium; Decreased by 2mOsm/hr or 1 mEq/L/hr |
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Hypertonic Hypernatremia, Isovolemic?
Causes? |
Causes:
fever, poor PO intake, diabetes insipidus symptoms: hypotonic urine, polydipsia Treatment Strategies: replace water w D5W or hypotonic NaCl over 48-72 hrs max 12 mEq/L/day |
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Hypertonic Hypernatremia, Hypervolemic?
Causes? Symptoms? Treatment Strategies? |
Causes:
aldosteronism, cushings, adrenal hyperplasia, latrogenic, Symptoms: weight gain, edema, dyspnea, rales Treatment: replace water with D5W and use diuretics to decrease Na |
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What is considered hypokalema?
Moderate? Severe? |
Serum K < 3.5 mEq/L
Moderate: Serum K 2.5 - 3.5 Severe: Serum K < 2.5 |
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What are potential causes of hypokalemia?
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Low PO intake of K
Increased ICF K due to: alkalosis, insulin, hypertonic solutions, paralysis, beta2agonist, megaloblastic anemia, leukemia (leukocyte elevation), decreased serum magnesium, hyperaldosteronism Renal Loss: diuretics, amphotericin B Non-renal loss: GI, skin, severe diarrhea and vomiting, severe sweating |
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What are some symptoms for hypokalemia?
Mild? Moderate? Severe? |
Mild:
asymptomatic Moderate: cramps, muscle weakness, polyuria, ECG changes, cardiac arrhythmias |
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What are treatment strategies for hypokalemia?
Mild? Moderate? Severe? |
Mild:
none Moderate: Po replacement - 20-120mEq/day in divided doses Severe: rate: 40mEq/L/hour MAX:400 mEq/day |
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What is are the serum concentration values for Hyperkalemia?
Mild? Moderate? Severe? |
Mild:
Serum K > 5.0mEq/L Moderate: Serum K > 6.5 - 8mEq/L Severe: Serum K > 8mEq/L |
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What are some potential causes for hyperkalemia?
Increase K+ intake? Decreased K+ excretion? Intracellular release? |
Increase K+ intake:
Use of Salt substitutes IV fluids with K Medications Decreased K excretion: ARF CRF Addison's Intracellular release: Tissue breakdown blood transfusion metabolic acidosis medications |
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What are some potential symptoms of hyperkalemia?
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decreased pH
Muscle weakness Paresthesias Hypostension ECG changes Cardiac arrhythmias |
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What are some treatment strategies for hyperkalemia?
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Agents that antagonize pro-arrhythmic effects of K such as CaCl or Ca Gluconate
Agents that decrease total body K: sodium polystyrene sulfonate loop diuretics hemodialysis Agents that drive K intracellularly: 10% dextrose 20 units of insulin |
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What is the serum concentration of hypocalcemia?
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Serum Ca < 6.5mg/dL
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What are some potential causes of hypocalcemia?
Acute? Chronic? |
Acute:
Most common cause is low serum proteins. Medications: phosphate replacement, loop diuretics, phenytoin, phenobarbital, coricosteroids, aminoglycosides, antibiotics, acetazolamide Chronic: Inadequate PO intake, Alcoholism, CRF, Metabolic Alkalosis, Hypoparathyroidism, Hyperphosphatemia, Vit D deficiency, hypoalbuminemia, Hypomagnesemia, Blood product infusion, Acute pancreatitis, Medications |
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What are some potential symptoms of Hypocalcemia?
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Trousseaus Chvosteks, tetany, muscle spasms, decreased reflexes, anxiety, hallucinations, seizures, lethargy, stupor, numbness/tingling in extremities, MI, brittle skin, grooved nails, hair loss, dermatitis, eczema
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What are some treatment strategies for hypocalcemia?
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Acute?
200-300 elemental calcium IV untill controlled; no faster than 30-60 mg/minute Chronic: PO supplements 2-4grams/day and if no response add Vit D to therapy |
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What are the serum ranges for hypercalcemia?
Mild? Moderate? Severe? |
Mild:
10-12 mg/dL Moderate: 12-13 mg/dL Severe: Serum Ca > 13 |
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What are some potential causes for hypercalcemia?
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Hyperparathyroidism, Histoplasmosis
Milk-alkali syndrome Malignancy Hyperthyroidism Medications (thiazides) Bony fractures Tuberculosis Acidosis |
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What are some potential symptoms for hypercalcemia?
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MEDICAL EMERGENCY if Ca > 14mg/dL
neuromuscular lethargy psychosis ataxia coma anorexia confusion cardiac changes ARF sudden death |
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What are some treatment options?
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if its bad enough aggressive rehydration 200-300 mL/hour. Once ECF repleated fored diuresis with loop diuretics.
bisphosphonates, hydrocortisone, mithramycin, calcitonin, gallium |
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What are the ranges for Hypophosphatemia?
Mild? Moderate? Severe? |
Mild:
Serum PO2 Moderate: Serum PO2 1 - 2.5 Severe: Serum PO2 < 1 mg/dL |
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What are some potential causes of hypophosphatemia?
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Increased shift intracellularly: hyperglycemia, insulin, malnourishment
Decreased absorption: starvation, excessive use antacids, osteomalacia, diarrhea/laxative abuse Increased renal losses: diuretics, DKA, alcohol abuse, hyperparathyroidism, burns Medications: sucralfate, diuretics, corticosteroids, cisplatin, antacids, calcium carbonate, magnesium oxide, foscarnet, phenytoin |
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What are some potential symptoms of hypophosphatemia?
Mild? Moderate? Severe? |
Mild:
Largely asymptomatic Moderate: Neurological Irritability: parathesias, muscle weakness, myalgias, bone pain, anorexia, nausea, vomiting, RBC hemolysis, seizures, coma, platelet dysfunction Severe: Acute respiratory failure |
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What are some treatment strategies for hypophosphatemia?
Mild? Moderate? Severe? |
Mild:
Eat foods rich in phosphates Moderate: PO supplement with 1.5 - 2 grams/day in 3-4 divided doses (diarrhea dose limiting effect) Severe: Phosphate injections and sodium phosphate |
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What is the serum concentration for hyperphosphatemia?
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Serum PO2 > 4.5mg/dL
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What are some potential causes for hyperphasphatemia?
Impaired Secretion: Redistribution to ECF: Increased intake: |
Increased secretion:
hypoparathyroidism Renal failure (CrCl < 25) Redistribution to ECF: Acid-base imbalance (acidosis) Rhabdomyolysis Muscle necrosis Tumor lysis syndrome Increaded intake: Medications |
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What are some potential symptoms of hyperphosphatemia?
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hypocalcemia
paresthesias ECG changes Metastatic calcifications |
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What are sometreatment strategies for hyperphosphatemia?
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Dietary restriction
Phosphate binders: PhosLo - calcium acetate causes constipation/gas Fosrenal Renagel - N/V/D |
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What are the ranges for hypomagnesemia?
Mild? Moderate? Severe? |
Mild:
Serum Mg2 1-1.5 mg/dL Severe: Serum Mg < 1.0 mg/dL |
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What are some potential causes of hypomagnesemia?
Inadequate intake? Inadequate absorption? Excessive GI loss? Excessive urine loss? |
Inadequate intake of Mg: ALCOHOLISM (50% cases), dietary restriction, TPN w/out adequate Mg
Inadequate absorption: steatorrhea, cancer, malabsorption, excess calcium and phosphatein GI tract Excessive GI loss: diarrhea, laxative abuse, NG tube suctioning, acute pancreatitis Excessive Urine Loss: hyperaldosteronism, DKA, renal disorders, meds (aminoglycosides, amphotericin B, insuilin, cyclosporine, loop, thiazides |
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What is Hunry Bone Syndrome and what is its effect?
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Decreased PTH
Decreases Ca, Mg, and K |
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What are some potential symptoms of hypomagnesemia?
Mild? Moderate? Severe? |
Mild:
Asymptomatic Moderate: Hyperreflexia, muscle weakness, cramps, agitation, confusion, tremor, seizures, ECG changes, metabolic alkalosis, digoxin toxicity, HYPOCALCEMIA, HYPOKALEMIA Severe: personality changes, disorientation, convulsions, psychosis, stupor, coma |
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What are some treatment strategies for hypomagnesemia?
Mild? Moderate? Severe? |
Mild:
Increased PO intake with MagOx 400 mg (20 mEq) Moderate/Severe: IV Mg2SO4 10mL |
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What are the serum concentrations for hypermagnesemia?
Mild? Moderate? Severe? |
OVERALL:
Serum Mg > 2.4 mg/dL Mild: Serum Mg 2.5 - 4mg/dL Moderate: Serum Mg 4 - 12 mg/dL Severe: Serum Mg > 13 mg/dL |
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What are some potential causes of hypermagnesemia?
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Renal failure + lithium or antacids or magnesium suppelments
hepatitis Addisons |
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What are some potential symptoms of hypermagnesemia?
Mild? Moderate? Severe? |
Mild: asymptomatic
Moderate: Hyporeflexia, weakness, sonmolence, hypotension, ECG changes, nausea, vomiting, cutaneous vasodilation, bradycardia Severe: Muscle paralysis, complete heart block, asystole, respiratory failure, refracory hypertension, death |
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What are some treatment strategies for hypermagnesemia?
Mild? Moderate? Severe? |
Mild:
No heart changes: normal saline + furosemide Moderate/Severe: IV calcium gluconate |
