Term
| crystalloid isotonic solution |
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Definition
| initial fluid of choice for volume resuscitation |
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Term
| crystalloid hypotonic solution |
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Definition
| fluid of choice for maintenance fluids |
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Term
|
Definition
| fluid of choice for intravascular volume resuscitation |
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Term
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Definition
| normal lab value range for K |
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Term
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Definition
| normal lab value range for Mg |
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Term
PO route not preferred for replacement due to:
amount of replacement needed usually not tolerated PO due to ADRs (diarrhea)
saburable GI absorption -> limits amount that can be given in one PO dose
slow onset of action |
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Definition
| identify dose limiting ADRs of oral Mg therapy |
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Term
1 g/hr or slower
the slower the rate of Mg administration the more that is absorbed by the kidneys
the kidneys respond to changes in serum concentrations - if rapid increase in [Mg] the kidneys will excrete more Mg in response |
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Definition
| specify the ideal rate for administering IV Mg |
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Term
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Definition
| specify normal lab value range for phosphorus |
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Term
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Definition
| specify normal lab value range for Ca (unionized) |
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Term
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Definition
| hallmark sign of hypocalcemia |
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Term
| corrected calcium = serum Ca + 0.8(4-albumin) |
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Definition
| corrected calcium equation |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| normal range for bicarbonate |
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|
Term
anion gap = Na - (Cl + HCO3)
anion gap > 12 = anion gap acidosis |
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Definition
| equation to calculate anion gap |
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Term
| total body water = 0.6 x actual body weight |
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Definition
| equation for total body water |
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|
Term
| crystalloid isotonic solution |
|
Definition
initial fluid of choice for volume resuscitation
expands the extracellular fluid |
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|
Term
| crystalloid hypotonic solution |
|
Definition
good for maintenance fluids
good for IV medication admixtures
distributes into extracellular and intracellular compartments
not useful for rapid intracellular volume expansion due to greater distribution into intracellular fluid compartments more than isotonic fluids |
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|
Term
| crystalloid hypertonic solution |
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Definition
limited use due to risk of excessive increase in plasma sodium concentration leading to osmotic demyelination
stays in ECF and pulls water from the ICF
used for - symptomatic hyponatremia and a treatment to decrease intracranial pressure |
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Term
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Definition
most rapid intravascular volume expansion
remains primarily in the intravascular fluid compartment and pulls additional fluid into the intravascular space by oncotic pressure |
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Term
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Definition
indication -> intravascular volume resuscitation
ADRs: pulmonary edema, hypocalcemia, anaphylaxis |
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|
Term
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Definition
indication -> shift fluid from intracellular and interstitial compartments to the intravascular space
used in patients with hypovolemia with interstitial edema (hypotention during hemodyalysis, CHF) |
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|
Term
|
Definition
indication -> volume resuscitation
least used colloid due to ADRs: dose related bleeding tendencies, acute renal failure |
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Term
mild-moderate hypovolemia: 1-3 x basal fluid requirements
severe or hemodynamic instability: 500-1000 ml boluses until the patient is stable, then 2-3 x maintenance rate |
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Definition
| fluid replacement rates for mild-moderate hypovolemia and severe or hemodynamic instability |
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Term
general: N/V, constipation, muscular weakness, myalgias, cramps
cardiac: EKG changes, life-threatening arrhythmias, heart block, ventricular fibrillation, lowered threshold for digoxin toxicity
paralysis, respiratory depression, rhabdomyolysis |
|
Definition
| signs/symptoms of hypokalemia |
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|
Term
general: N/V, constipation, muscular weakness, myalgias, cramps, muscle twitching
cardiac: EKG changes, life-threatening arrhythmias
ascending paralysis |
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Definition
| signs/symptoms of hyperkalemia |
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Term
increased GI elimination: vomiting, NG emptying
enhanced fecal elimination: diarrhea, oral sorbitol, sodium polystyrene sulfate
enhanced renal elimination: diuretics (loops>thiazides), hypomagnesemia, aminoglycosides, high dose penicillins, amphotericin B (damages renal tubules), corticosteroids, platinum based chemotherapy
intracellular shift of K: insulin, metabolic alkalosis, beta-agonists, theophylline |
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Definition
| etiologies of hypokalemia |
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|
Term
increased GI intake: dietary, K supplements, IV fluids with K, TPN
extracellular shift: metabolic acidosis, beta-blockers, digoxin overdose, succinyl choline, muscle injury, hemolysis
decreased urinary excretion: RENAL FAILURE, K sparing diuretics, NSAIDs, hypoaldosteronism, ACEi/ARBs, trimethoprim |
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Definition
| etiologies of hyperkalemia |
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Term
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Definition
| 10 mEq of K = how much increase in serum K? |
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|
Term
10 mEq/hr / 10 mEq/hr
10 mEq/hr / 40 mEq/hr |
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Definition
max rate for peripheral/central IV K, not on EKG = ?
max rate for peripheral/central IV K, on EKG = ? |
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|
Term
MOA: stabilizes myocardium by antagonizing cardiac conduction abnormalities
onset: 1-2 minutes |
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Definition
| MOA and onset of action of IV calcium used for cardioprotection when hyperkalemic |
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Term
MOA: increases pH (metabolic alkalosis) and causes K to shift intracellularly
onset: 30 minutes
good for patients who also have metabolic acidosis |
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Definition
| MOA and onset of sodium bicarbonate used for intracellular shift of K when hyperkalemic. |
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Term
MOA: insulin shifts K into cells and dextrose prevents hypoglycemia and increases natural insulin release
onset: 15-45 minutes
should be given by IV route |
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Definition
| MOA and onset of insulin +/- dextrose used for intracellular shift of K when hyperkalemic |
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Term
MOA: stimulates Na/K/ATPase pump to pump K into cell
onset: 30 minutes |
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Definition
| MOA and onset of albuterol used for intracellular shift of K when hyperkalemic |
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Term
MOA: increase K excretion in urine
onset: 5-15 minutes |
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Definition
| MOA and onset of loop diuretics used for increase K excretion when hyperkalemic |
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|
Term
MOA: binds to K in the GI tract and removes it in the feces
onset: 1 hour |
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Definition
| MOA and onset of sodium polystyrene sulfonate (Kayexalate) used for increased K excretion when hyperkalemic |
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Term
reduced intake: alcoholism (Mg is a cofactor in alcohol metabolism, malnutrition), malnutrition
decreased GI absorption: pancreatic insufficiency, short bowel syndrome, malabsorption syndrome
increased GI losses: vomiting, excessive laxative use, NG suctioning, prolonged diarrhea
enhanced renal elimination: loop diuretics, amphotericin b (damage tubules), cisplatin (damage tubules), nephrotic syndrome, renal tubule acidosis, hyperthyroidism, aldosteronism
intracellular shift: diabetic ketoacidosis, glucose, insulin |
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Definition
| etiologies of hypomagnesemia |
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|
Term
renal insufficiency
excess Mg intake - PO, IV, medications, TPN |
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Definition
| etiologies of hypermagnesemia |
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|
Term
neuromuscular: muscle weakness, muscle twitching, paresthesias, tetany, depression, hyperreflexia, psychosis, seizures
cardiovascular: EKG changes, TORSADES DE POINTS, sensitivity to digoxin |
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Definition
| signs/symptoms of hypomagnesemia |
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|
Term
weak, lethargic, tired, body slows down
Mg 4-6 mg/dL: hypotension, lethargy, bradycardia, drowsiness, EKG abnormalities
Mg 6-10 mg/dL: hyporeflexia, coma, drowsiness, hypocalcemia
Mg > 10 mg/dL: respiratory depression, heart block, asystole |
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Definition
| signs/symptoms of hypermagnesemia |
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|
Term
amount of replacement needed usually not tolerated PO due to ADRs -> diarrhea
saturable GI absorption -> limits amount that can be given in one PO dose
slow onset of action |
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Definition
| dose limiting ADRs of oral Mg |
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|
Term
1 g/hr or slower
the slower the rate, the more that is absorbed by the kidneys
the kidneys respond to rapid changes in serum [Mg] (kidneys will excrete Mg in response to elevated serum levels) |
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Definition
| ideal rate for IV administration of Mg |
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Term
| MOA: used to stabilize cardiac and neuro membranes; temporary treatment, does not decrease Mg levels |
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Definition
| MOA of IV calcium gluconate used for cardioprotection when hypermagnesemic |
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Term
| MOA: dilutes serum Mg and may stimulate renal elimination if ARF due to hypovolemia |
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Definition
| MOA of volume expansion with 0.9% NaCl used for cardioprotection and increased Mg excretion when hypermagnesemic |
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Term
| MOA: increased renal elimination of Mg and may stimulate urine output in oliguric renal failure |
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Definition
| MOA of loop diuretics used for increased Mg excretion when hypermagnesemic |
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Term
oral: MgCl, magnesium oxide (more elemental Mg), MgOH (milk of magnesia); considerations - diarrhea, divided doses
IV: magnesium sulfate; give IV slowly to avoid spike in concentration |
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Definition
| oral and IV products for hypomagnesemia |
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Term
decreased GI absorption: phosphate-binding medications, chronic diarrhea, sucralfate (phos binder), steaorrhea (fatty diarrhea), vitamin D deficiency, calcium carbonate
increased urinary excretion: hyperparathyroidism, metabolic acidosis, sodium bicarbonate, diuretics, volume expansion, renal transplant, burn recovery, malignant neoplasms, glucocorticoids
internal redistribution: refeeding syndrome, chronic alcoholism, respiratory alkalosis, insulin, recovery from diabetic ketoacidosis, sepsis |
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Definition
| etiologies for hypophosphatemia |
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|
Term
patients with renal insufficiency, especially CKD are at high risk
increased GI intake: dietary including TPN, vitamin D intoxication, phosphate-containing enemas
extracellular shift: tumor lysis syndrome, rhabdomyolysis, bowel infarction, hemolysis, diabetic ketoacidosis (prior to treatment)
decreased urinary excretion: RENAL FAILURE, hypoparathyroid, bisphosphonates, hypomagnesemia |
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Definition
| etiologies of hyperphosphatemia |
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|
Term
general: muscle weakness, irritability, dysphagia, ileus, confusion, numbness
severe: impaired diaphragm contractility and acute respiratory failure, paralysis, cardiac arrhythmias and decreased cardiac contractility, seizures and neurological dysfunction, tissue hypoxia and rhabdomyolysis, hemolytic anemia |
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Definition
| signs/symptoms of hypophosphatemia |
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|
Term
most patients are asymptomatic unless rapid onset
soft tissue calcifications when Ca x Phos > 55 chronically
moderate-severe: N/V/D, lethargy, seizures, renal failure due to ca-phos precipitations in kidney |
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Definition
| signs/symptoms of hyperphosphatemia |
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|
Term
dairy products are high in phos
many products contain K, must also assess patients K levels
common ADR = diarrhea
divided daily doses TID or QID
choose products based on restriction of K or Na
common initial dose = 30-60 mmol phos po divided doses |
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Definition
| oral phosphate products considerations |
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Term
| 3 mmol phos and 4.4 mEq K per mL |
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Definition
| ratio of K to phos in potassium phosphate IV (used for hypophosphatemia when patient has hypokalemia) |
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Term
| 3 mmol phos and 4 mmol Na per mL |
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Definition
| ratio of Na and phos in sodium phosphate IV (used for hypophosphatemia if patient is at risk for developming hyperkalemia) |
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Term
treat/reverse underlying cause
IV Ca to resolve symptoms of hypocalcemia
if Ca not resolving symptoms then hemodialysis is required |
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Definition
| treatment of acute hyperphosphatemia with symptoms of hypocalemia |
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Term
disease states: hypoparathyroidism, malignancies, rhabdomyolysis, chronic renal insufficiency, hyperphosphatemia, hypomagnesemia, acute pancreatitis, sepsis, vitamin D deficiency
medications: phenytoin, phenobarbital, cholestyramine, laxatives
others: blood products - due to citrate anticoagulant binding Ca |
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Definition
| etiologies of hypocalcemia |
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|
Term
disease states: hyperparathyroidism, malignancies, immobilization, thyroxoicosis, vitamin D intoxication, renal failure, renal transplant, adrenal insufficiency
medications: thiazide diuretics, calcium supplements, lithium, Al/Mg antacids, theophylline, tamoxifene, estrogens |
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Definition
| etiologies of hypercalcemia |
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|
Term
acute: muscle cramps and paresthesias, laryngeal spasms, bradycardia, hypotension, arrhythmias, seizures, TETANY = HALLMARK SIGN OF HYPOCALCEMIA
chronic: depression, anxiety, memory loss, confusion, hair loss, grooved/brittle nails, exzema, dermatitis |
|
Definition
| signs/symptoms of hypocalcemia |
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|
Term
acute: constipation, N/V, anorexia, PUD, oliguric renal failure, nephrolithiasis/obstruction, mild drowsiness, progressing weakness, depression, lethargy, stupor, coma, ventricular arrhythmias
chronic: metastatic calcifications, nephrolithiasis (kidney stone), chronic renal insufficiency |
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Definition
| signs/symptoms of hypercalcemia |
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|
Term
| corrected Ca = serum Ca + 0.8(4-albumin) |
|
Definition
|
|
Term
CaCl = central line only (extravasation risk)
Ca gluconate = safer than Cl, contains less elemental Ca than Cl, can be used in peripheral or central line |
|
Definition
| compare/contrast CaCl and Ca gluconate |
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|
Term
corticosteroids and IV bisphosphonates
not calcitonin |
|
Definition
| what treatments for hypercalcemia can be used in cases of malignancy? |
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Term
central stimulation of respiration (hyperventilation): pain, anxiety, fever, brain tumors, stroke/TIA, head trauma, pregnancy
peripheral stimulation of respiration: pulmonary embolism, CHF, altitude, asthma, pulmonary shunts, hypotension, pneumonia, poor lung compliance (stiff lungs)
medications: salicylates, nicotine, thyroid hormone, catecholamines
other: mechanical hyperventilation, hepatic cirrhosis, gram-negative sepsis |
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Definition
| etiologies of respiratory alkalosis |
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|
Term
acute:
impaired profusion - massive pulmonary embolism, cardiac arrest
impaired ventilation - severe pulmonary edema, severe pneumonia (muscles worn out)
CNS depression - medications (opioids, benzodiazepines, alcohol), trauma, stroke
chronic:
impaired ventilation - COPD, chest muscle wall problems
CNS - obstructive sleep apnea, tumors, stroke |
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Definition
| etiologies for respiratory acidosis |
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|
Term
sodium chloride sensitive (urine Cl < 10 mmol/L) - Cl is a base, if Cl gets low the body holds on to bicarbonate instead and leads to alkalosis: GI losses, diuretics (get rid of K and Na and Cl follows), cystic fibrosis, excessive bicarbonate therapy
sodium chloride resistant (urine Cl > 10 mmol/L): excessive mineralocorticoid activity (hyperaldosteronism, Cushing's), excessive black licorice intake
other: alkali administration, massive blood transfusion (due to citrate), carbohydrate refeeding after starvation, large doses or penicillin |
|
Definition
| etiologies of metabolic alkalosis |
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|
Term
non-anion gap: due to excessive loss of bicarbonate accompanied by an increase in renal reabsorption of Cl, diarrhea, GI fistula, ileostomy, carbonic anhydrase inhibitors, renal tubular acidosis
anion gap: due to excessive organic acid accumulation, MUDPILES, methanol, uremia, diabetic ketoacidosis, polyethylene glycol, ischemia, lactic acidosis, ethylene glycol, salicylate intoxication, 3 main causes - lactic acidosis, ketoacidosis, renal failure |
|
Definition
| etiologies of metabolic acidosis |
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|
Term
hypophosphatemia
hypocalcemia
hypokalemia |
|
Definition
| electrolyte disorders that accompany respiratory alkalosis |
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|
Term
|
Definition
| electrolyte disorders that accompany respiratory acidosis |
|
|
Term
hypophosphatemia
hypocalcemia
hypokalemia |
|
Definition
| electrolyte disorders that accompany metabolic alkalosis |
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|
Term
hyperkalemia
hyperglycemia |
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Definition
| electrolyte disorders that accompany metabolic acidosis |
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|
Term
anion gap: treat the underlying cause. DO NOT ADMINISTER SODIUM BICARBONATE
acute non anion gap: GOAL - to increase bicarbonate, not to normalize pH; calculate base deficit, start by replacing 50% of base deficit with IV sodium bicarbonate over > 30 minutes, 1 amp bicarb = 50 mEq NaHCO3 (3 amps in D5W = 150 mEq Na = isotonic) |
|
Definition
| how to treat anion gap and non anion gap metabolic acidosis |
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