What does FVE

(extracelluar fluid volume excess)

do to the body?

RESP: ORTHOPNEA, DYSPNEA, CRACKLES

cARDIO: BOUNDING PULSE,NVD,INCREASE IN CENTRAL VENOUS PRESSURE, HTN, PERIPHEAL EDEMA, ANASCARA(GENERALIZED EDEMA ALL OVER)

GASTRO:BLOATING R/T RT SIDED HEART FAILURE

URINARY:LOW OUTPUT

GENERAL:WEIGHT GAIN(MOST SENS.INDICATOR OF ECF EXCESS)

DIURECTICS(LASIX, HYDRODIUREL,ALDACTONE)

deCREASE FLUID INTAKE

MONITOR THROUGH CENTRAL VENOUS PRESSURE LINE

LOW SODIUM DIET

THIRST NOT AFFECTED, NEURO:DIMINISHED LOC

CV:DECREASED BP,POS TILT TEST,DECREASE CVP

URINARY:<30Ml/HR(RED FLAG)

GENERAL:WEIGHT LOSS

LAB:> H&H

TOO MUCH SODIUM AND NOT ENOUGH WATER INTAKE PULLS WATER OUT OF CELLS AND SHRINKS CELLS

(MOST COMMON PROBLEM IN PEDS)

DECREASEDE TEARS, MOIST MUCOUS MEMBRANES, URINE, LOC. CAN CAUSE COMA.

INCREASE IN BUN/CREATINE.

CHILDREN: SUNKEN FONTANELS,SUNKEN EYES

D51/4 NS B/C IT PULLS FLUID INTO CELLS.TREAT UNDERLYING CAUSE

IF PT HEMODYNAMICALLY UNSTABLE THEN TREAT INITIALLY WITH 0.9%NS

OFFER 50ML/KG OVER 4HRS(GIVE 5-15ML, FREQUENTLY) FOR MILD DEHYDRATION :      

100ML/KG OVER 6HR FOR MOD DEHYDRATION

IV FLIUDS FOR SEVERE DEHYDRATION

HOW DO YOU CALCULATE DAILY FLUID REQUIREMENTS FOR CHILDREN?

WT IN KG

100ML/KG FOR FIRST 10 KG

50ML/KG FOR SECOND 10 KG

20 ML/KG FOR REMAINDER OF WT IN KG

DIVIDE TOTAL AMOUNT BY 24 TO OBTAIN RATE IN ML/HR

WHAT WILL HAPPEN IF YOU GIVE NACL 3% TOO QUICKLY?

MAY CAUSE OSMOTIC DEMYELINATION SYNDROME

(DETERIORATION OF THE PONS)

SYNDROME MAY DEVELOP 1 TO SEV DAYS AFTER NA CORRECTED

K+ <3.0

(RED FLAG)

INADEQUATE INTAKE, PROLONGED VOMITING, GI SUCTIONING,DIARRHEA,DIURETICS,ACUTE RENAL FAILURE

(IN ALKALOSIS ,H+IONS MOVE INTO THE CELL IN EXCHANGE FOR K+ WHICH MOVE INTO THE CELL CREATING A HYPOKALEMIA STATE)

IV K+ 10-20MEQ/DL OEVR 1HR(NOMORE THAN 10MEQ/HR RECOMMENDED)

DECREASED K+ WILL CAUSE DIGOXIN TOXICITY

MAJOR CATION IN THE BODY, MOST ABUNDANT ION IN THE BODY

PLAYS ROLE IN MAINTAINING ACID-BASE BALANCE

PARTICIPATES IN CHO METABOLISM

RENAL FAILURE,RENAL TUBULAR DYSFUNCTION,MINERALCORTICOID DEFICIENCY

ACIDOSIS(CAUSES H+TO GO INTO THE CELL WHICH MAKES K+COME OUT,DRUGS THAT INHIBIT ALDOSTERONE PRODUCTION(ACE INHIBITORS,NSAIDS)

B-BLOCKERS(PREVENT EXTRARENAL K+FROM BEING DISPOSED)

STABILIZE OAND PROTECT HEART(CALCIUM GLUCONATE)

TREAT ACIDOSIS(BICARB)

IV GLUCOSE AND 10 UNITS INSULIN

ALBUTEROL(BETA ADRENERGIC)

KAYEXALATE

TREAT CAUSES

PARATHYROID HORMONE-

CALCITONIN AND VIT D

(CALCIUM IS ABSORBED FROM GUT UNDER INFLUENCE OF VIT D

HYPOALBUNEMIA,HYPOPARATHYROIDISM,

HYPOMAGNESIUM(CAUSES DECREASE IN SECRETION OF PTH AND INHIBITS THE BONES RESPONSE TO NORM PTH LEVELS),HYPERMAGNES,VIT D DEF.,RESP ALKALOSIS

NEURO:CAUSES EXCITABILITY IN CELLS OF CNS

PERIORAL PARESTHESIA

CARPOPEDAL SPASM

CHVOSTEK'S SIGN

SEIZURE,TETANY

LARYNGEAL SPASM

DYSRHYTHMIAS(PROLONGED ST AND QT INTERVALS)

CALCIUM GLUCONATE 10%

(1-2 AMPS OVER 4 MIN)

VIT D SUPPL(HELPS ABSORB CALCIUM)

CA SUPPL(CAL CITRATE BETTER ABSORBED THAN CARBONATE OR LACTATE)

PHOSPHATE BINDERS

DECREASE DIETARY PHOSPHATES

INCREASED CALCIUM INTAKE OR ABSORPTION

(MILK-ALKALI SYDROME:INGESTION OF LARGE AMOUNTS OF MILK OR ALKALI: OR VIT D OD)

SHIFT OF CAL FROM BONE TO ECF

(HYPERPARATHYROIDISM  10-20% CASES OF HYPERCALCEMIA)

DECREASE IN SECRETION

LETHARGY,COMA,CONFUSION

BONE PAIN/WEAKNESS

HTN,DYSRHYTHMIAS

N/V,DAIRRHEA,ANOREXIA,CONSTIPATION

PANCREATITIS

POLYURIA,NOCTURIA,POLYDIPSIA,RENAL INSUFF

KIDNEY STONES

3-4 L OF NS

LOOP DIURETIC

BIPHOSPHONATES(INHIBITS RELEASE CA FROM BONE)

CORTICOSTERIODS

CALCITONIN(INHIBITS BONE REABSORP AND INCREASES CA SECRETION)

HEMODIALYSIS

DECREASED GI ABSORP

DECREASED RENAL REABSORP

EXTRACELLUAR TO INTRACELLUAR SHIFT

HYPERTHYRIODISM

FANCONIS SYNDROME

NERVOUSNESS, IRRABILITY,SEIZURES,COMA

MUSCLE AND BONE PAIN

HEMOLYTIC ANEMIA(P PROMOTES O2 RELEASE O2 TO TISSUES)

TISSUE HYPOXIA,RESP MUSCLE PARALYSIS

CARDIOMYOPATHY

IMPORTANT WITH O2 IN CELLS

HELPS FIGHT INFECTION

INCREASED PHOS WITH RENAL PTS,KEEP ON LOW PHOS DIET

IV:KPO4 OR NAPO4

ORAL: NEUTRAPHOS 250MG TAB Q8-12HR

MUST CORRECT HYPERCALCEMIA FIRST OR MAY DEVELOP METASTIC CALCIFICATION

DIARRHEA,GI SUCTIONING,STARVATION

INTESTINAL BYPASS SX

RENAL DISORDERS

MEDICATIONS(DIURETICS,CYCLOSPORINES,INFUSIONS OF SODIUM AND CA INCREASE EXCRETION OF MAG)

INSULIN,GLUCOSE,LOOP AND THIAZIDE DIURETICS

CATECHOLAMINES,ENDOCRINE DISORDERS

DYSRHYTHMIAS,TORSADE DE POINTES

DIGOXIN INTOXICATION

DELIRIUM, CONFUSION,PERSONALITY CHANGES

TREMORS

TETANY

HYPEREFLEXIA

PARENTERAL REPLACEMENT

MGSO4(50%)Q4-6HR IM

MGSO4 IN D5W (IV)

ORAL: MG 250-500MG QID

TREAMENT OF VENT DYSRHYTHMIAS

CAUSES OF HYPERMAGNESIUM?

( NORMAL MG IS 1.5-2.5MG/DL)

RENAL INSUFF

ANTACID CONTAINING MG

LAXATIVE CONTAINING MG

EXCESS DOSE OF MG WHEN TREATING ECLAMPIA OR DELAYED LABOR

TREATMENT OF HYPOMAGNESIUM

PRIMARILY LOCATED ICF AND BONE

ACTIVATES ICF ENZYMES

ESSENTIAL FOR PROTEIN AND NUCLEIC SYNTHESIS

NEUROMUSC AND CV INTEGRITY

CAN HAVE CURARE-LIKE EFFECT ON NEUROMUSC JUNCTION THROUGH INHIBITION OF ACETYLCHOLINE

ASSESS OF HYPERMAGNESIUM?

DEPRESSED TENDON REFLEXES

DIFF TALKING AND SWALLOWING

DILATED PUPILS,LETHARGY

PARALYSIS OF RESP MUSCLES

HYPOTENSION,BRADYCARDIA,CARDIAC ARREST,DYSRHYTHMIAS,CONSTIPATION,N/V

DIFF URINATING

TREAT UNDERLYING CAUSES

CALCIUM IV REVERSES RESP DEPRESSION OR DYSRHYTHMIAS

CALCIUM GLUCONATE 10% OVER 4HR TO PROMOTE SECRETION OF MG

LASIX, DIALYSIS

GLUCOSE AND INSULIN TO PROMOTE TRANSFER OG MG INTO CELL