Term
| Extracellular fluid volume is determined by: |
|
Definition
- RAAS
- ADH (vasopressin) |
|
|
Term
| RAAS: The juxtaglomerular apparatus secretes __ when __ __ and __ delivery to the distal nephron is ___. |
|
Definition
- renin
- GFR decreases
- sodium
- decreases |
|
|
Term
| Roles of Angiotension II: |
|
Definition
- impairs water excretion
- increases thirst
- stimulates aldosterone secretion (enhances sodium reabsorption) |
|
|
Term
|
Definition
saves sodium, gets rid of potassium
Water passively follows sodium |
|
|
Term
| Osmorecptors in the ___ respond to __ in plasma osmolarity, causing the release of ___ from the __ __. |
|
Definition
- hypothalamus
- increases
- ADH (vasopressin)
- posterior pituitary |
|
|
Term
| what determines if urine is concentrated or dilute? |
|
Definition
|
|
Term
| Volume depletion in general is due to a loss of __. |
|
Definition
|
|
Term
| Causes of volume depletion: |
|
Definition
- Bleeding
- Diarrhea/vomiting/nasogastric suction
- Burns
- Excessive Sweating
- 3rd Spacing
- Osmotic Diuresis in Diabetics
- Adrenal insufficiency (hypoaldosteronism) |
|
|
Term
| Volume overload is due to __ of __. |
|
Definition
retention of sodium
If sodium not getting to kidneys it can't be excreted, so it depends on blood to the kidneys |
|
|
Term
| Causes of Volume Overload (Sodium Retention): |
|
Definition
- Renal Failure
- Nephrotic Syndrome
- Heart Failure
- Cirrhosis |
|
|
Term
| Renal insufficiency (hypoaldosteronism) causes volume __, while renal failure causes volume __. |
|
Definition
|
|
Term
| Hyponatremia is sodium less than ___. Symptoms include: |
|
Definition
- 135 mEq/L
- HA
- Nausea
- Altered Mental Status
- Seizurse |
|
|
Term
| Hyponatremia is only alarming if the pt has: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Hyponatremia with normal serum osmolality is called ___. Explain what this is and why it happens. |
|
Definition
- Pseudohyponatremia
- occurs due to hyperlipidemia and hyperproteinemia
- lipids and protein take up lots of plasma room, so less room for water
- less water means less sodium even though concentration is normal |
|
|
Term
| High osmolality hyponatremia is aka ___ ___. Explain this and how it occurs. |
|
Definition
- Dilutional hyponatremia
- osmolality > 295 mmosm/kg
- osmotically active substances (glucose or mannitol) draw in more water causing dilution of sodium |
|
|
Term
| Low sodium> assess osmolality> low osmolality> assess volume |
|
Definition
|
|
Term
| Low osmolality hyponatremia: |
|
Definition
- serum osmolality < 280 mOsm/kg
- aka Hypotonic Hyponatremia
- must assess volume status next |
|
|
Term
| Hypotonic Hyponatremia can either me hypervolemic, euvolemic, or hypovolemic. |
|
Definition
|
|
Term
| Causes and tmt for Hypovolemic Hypotonic Hyponatremia: |
|
Definition
- Causes: Dehydration, Diarrhea/Vomiting, Diuretics
- Tmt: Normal Saline |
|
|
Term
| Causes and treatment of Hypervolemic Hypotonic Hyponatremia: |
|
Definition
- Causes: CHF, Cirrhosis, Nephrotic Syndrome (hypervolemic= edema)
- Treatment: water restriction (1-2 L/day), sometimes a diuretic |
|
|
Term
| Causes and tmt of Euvolemic Hypotonic Hyponatremia: |
|
Definition
- Causes: Hypothyroidism, Adrenal Insufficiency, SIADH, Psychogenic Polydipsia
- Tmt: restrict fluids |
|
|
Term
|
Definition
- serum sodium > 145
- serum osmolality > 295 |
|
|
Term
|
Definition
| - inadequate fluid intake or water loss in excess of sodium |
|
|
Term
| Normally with hypernatremia, you would make very __ urine. But with Diabetes Insipidus you cannot __ you're urine. May see __ in DI pts b/c losing so much free water. |
|
Definition
- concentrated
- cannot concentrate
- hypernatremia |
|
|
Term
| best way to dx hypernatremia: |
|
Definition
|
|
Term
| With hypernatremia, you lost too much water so you have excess sodium. |
|
Definition
|
|
Term
| Hypernatremia with urine osmol greater than 400: |
|
Definition
- kidneys are fine b/c can still concentrate urine
- didn't drink enough fluid |
|
|
Term
| Hypernatremia with urine osmol < 250: |
|
Definition
| - central or nephrogenic Diabetes Inspidius resulting in excess fluid loss |
|
|
Term
| Tmt of Hypovolemic Hypernatremia: |
|
Definition
| - normal saline until fluid is replaced and then switch to half normal saline |
|
|
Term
| Tmt of Euvolemic Hypernatremia: |
|
Definition
- PO water
- IV 5% dextrose in water (dextrose encourages your kidneys to get rid of sodium) |
|
|
Term
| Tmt of Hypervolemic Hypernatremia: |
|
Definition
| - IV 5% dextrose in water + furosemide (to get rid of sodium and water) |
|
|
Term
|
Definition
- K < 3.5
- weakness
- cramps
- constipation
- ileus
- paresthesias |
|
|
Term
|
Definition
- Decreased intake
- GI losses
- Hyperaldosteronism
- Cushing's
- Loop Diuretics |
|
|
Term
| ANYTIME YOU SEE CONSTIPATION OR ILEUS, THINK __ AND CHECK __. |
|
Definition
| HYPOKALEMIA, CHECK POTASSIUM |
|
|
Term
| EKG findings with hypokalemia: |
|
Definition
- flat T waves
- ST depression
- PVCs
- prominent U waves |
|
|
Term
|
Definition
| K replacement (oral pills or IV) |
|
|
Term
|
Definition
- Renal Failure
- Shift out of cells with DKA
- Aldosterone deficiency
- Psedo (RBCs lysed in the tube) |
|
|
Term
| What happens with potassium in DKA: |
|
Definition
- potassium shifts out cells and into extracellular fluid- hyperkalemia
KNOW THIS |
|
|
Term
| Drugs that may cause hyperkalemia: |
|
Definition
- K+sparing diuretics
- ACE-I |
|
|
Term
| Signs and Symptoms of Hyperkalemia: |
|
Definition
- weakness
- diarrhea
- nausea
- muscle cramps
- parethesias
- decreased reflexes |
|
|
Term
| Decreased reflexes are associated with hypo/hyperkalemia? |
|
Definition
| HYPERKALEMIA> DECREASED REFLEXES |
|
|
Term
| Hypokalemia causes __, while hyperkalemia causes __. |
|
Definition
|
|
Term
| EKG findings of Hyperkalemia: |
|
Definition
- peaked T waves
- wide QRS
- prolonged PR interval |
|
|
Term
|
Definition
- Calcium gluconate- only stabilizes cardiac muscle
- Bicarb/glucose/insulin- brings potassium back into cells in DKA
- Kayexelate- binds up K in gut
- Diuretics
- Dialysis |
|
|
Term
| If serum calcium is low, what is always tne next step? |
|
Definition
|
|
Term
| Define hypocalcemia and true hypocalcemia: |
|
Definition
- Hypocalcemia: serum Ca < 9 mg/dL
- True Hypocalcemia: low IONIZED Ca < 4.7 mg/dL |
|
|
Term
| Serum calcium may be artificially low if __ is low. |
|
Definition
albumin
if both serum calcium and albumin are low, then check ionized calcium |
|
|
Term
| Symptoms of Hypocalcemia: |
|
Definition
| - muscle cramps/spasms, paresthesisas, convulsions, arrhythmias |
|
|
Term
| what two signs are associated with HYPOCALCEMIA: |
|
Definition
- Chvostek's sign: facial muscle contraction with tapping of facial nerve anterior to ear
- Trousseau's sign: carpal spams after occlusion of brachial artery with cuff for 3 minutes |
|
|
Term
| EKG findings with hypocalcemia: |
|
Definition
|
|
Term
|
Definition
- Hypoparathyroidism
- Chronic renal failure
- Hypomagnesia
- Vitamin D deficiency |
|
|
Term
|
Definition
- oral calcium and vitamin D if asymptomatic
- Calcium gluconate IV if symptomatic
- Correct associated hypomagnesia |
|
|
Term
| Hypokalemia and Hypercalcemia both cause ___. |
|
Definition
|
|
Term
| Hypercalcemia (>11mg/dL) signs and symptoms: |
|
Definition
- constipation
- nausea
- vomiting
- anorexia
- polyuria
- decreased DTRs
- drowsiness
- weakness
- coma |
|
|
Term
| EKG findings of hypercalcemia: |
|
Definition
|
|
Term
|
Definition
- Hyperparathyroidism
- Sarcoidosis
- Malignancies
- Vitamin D intoxication |
|
|
Term
| Hypomagnesemia symptoms and signs: |
|
Definition
- weakness
- muscle cramps
- tremors
- seizures
- Hypertension
- Tachycardia
- confusion |
|
|
Term
| what two electrolyte abnormalities prolong the QT interval on EKG: |
|
Definition
- Hypercalcemia
- Hypomagnesemia |
|
|
Term
|
Definition
- PO Mg or IV if severe
- treat hypokalemia/hypocalcemia |
|
|
