Term
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Definition
oxygen desaturation when a pt stands.
seen specifically in hepatopulmonary syndrome |
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Term
| What antihypertensive is contraindicated in a pt with dec kidney fxn |
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Definition
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Term
| what antihypertensive is contraindicated in a pt with cocain abuse |
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Definition
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Term
| what antihypertensive is contraindicated in a pt with kidney stones |
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Definition
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Term
| what is the max dosage of tylenol a day |
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Definition
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Term
| what is the max dose of tyelenol a day in a pt with liver disease |
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Definition
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Term
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Definition
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Term
| What do liver failure and nephrotic syndrome do to volume status of a pt |
|
Definition
| hypoalbuminemia --> third space fluid out of vasculature --> total body hypervolemia but intravascularly depleted |
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Term
| are pt with end stage renal disease hyper or hypovolemic |
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Definition
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Term
| what fluid is NOT helpful in maintaining intravascular volume? why? |
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Definition
| D5W, because only 1/12 of the solution will stay in the intravascular compartment, the rest will diffuse into the total body water |
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Term
what fluid is best for maintenance?
what fluid is best for replacing intravascular volume |
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Definition
1. maintain with D5/.45NaCl
2. replace with LR or normal saline |
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Term
| what fluid do you NOT use if a pt has hyperkalemia? |
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Definition
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Term
| What fluid is used to correct hypernatremia |
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Definition
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Term
| are pts with sepsis hyper or hypovolemic |
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Definition
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Term
| are ptw with abdominal inflammation processes hyper or hypovolemic |
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Definition
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Term
| how do you calculate the amount of fluids to maintain a person on? |
|
Definition
4/2/1 rule
4ml/kg for first 10kg
2mL/kg for next 10kg
1ml/kg for every additional 1kg |
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Term
| most common adult maintenance fluid |
|
Definition
| D5/.45NaCl with 20meq of KCl per liter |
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|
Term
| what major organ system problems lead to hypervolemia |
|
Definition
nephrotic kidney
CHF
liver cirrhosis
ESRD |
|
|
Term
| 4 "laws" of Na concentration vs Na content |
|
Definition
1. Na concentration reflects water homeostasis
2. Na content reflects Na homeostasis
3. hypo and hyperNAtremia are caused by too much or too little water
4. hypo and hypervolemia are caused by too much or too little sodium |
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Term
| how does increased intake of sodium effect kidney function? |
|
Definition
increased intake of Na --> increase in ECF volume --> inc GFR and Na excretion
once the volume of circulating blood goes back down, the GFR declines and the exretion of Na declines as well |
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|
Term
| how do loop diuretics work |
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Definition
|
|
Term
| how do thiazide diuretics work |
|
Definition
| inhibit NaCl cotransporter |
|
|
Term
| what is the major fxn of adh |
|
Definition
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Term
| How is hyponatremia categorized? |
|
Definition
1. Hypotonic Hyponatremia
a. hypovolemic
i. low urine Na
ii. hi urine Na
b. euvolemic
c. hypervolemic
2. Isotonic Hyponatremia
3. Hypertonic Hyponatremia |
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|
Term
| How is hypotonic hypovolemic hyponatremia subdivided? |
|
Definition
It is separated based on urine sodium content. If the urine sodium content is less than 10 then that means the kidneys are trying to help you keep some volume by retaining Na.
If the urine Na is >20 then that means there is something wrong with the kidneys allowing them to waste Na and ultimately dehydrate the body. |
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Term
| What are the causes of hypotonic hypovolemic hyponatremia with a urine sodium < 10? |
|
Definition
diarrhea
NG tube
vomit
burns, sweating
3rd spacing
pancreatitis |
|
|
Term
| What are the causes of hypotonic hypovolemic hyponatremia with a urine sodium > 20? |
|
Definition
diuretic use
ACEI or low aldosterone
Acute tubular necrosis |
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|
Term
| What are the causes of hypotonic euvolemic hyponatremia |
|
Definition
1. SIADH
2. post-surgery
3. hypothyroidism
4. increased water intake (or overuse of D5W)
5. hypothyroidism
6. psychogenic polydipsia
7. haloperidol
8. cycloposphamide |
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|
Term
| What are the causes of hypotonic hypervolemic hyponatremia. |
|
Definition
congestive heart failure
nephrotic syndrome (ESRD)
liver cirrhosis |
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|
Term
| What are the causes of isotonic hyponatremia? |
|
Definition
| this is when there is an increase in plasma solids that makes it seem like Na is low, but really it is a pseuxohypnatremia. this would be seen in conditions that have high lipids or protein |
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Term
| What are the causes of hypertonic hyponatremia? |
|
Definition
this is when osmotic substances shift H20 out of cells causing a decrease in Na concentration.
seen in hyperglycemia, mannitol use, sorbitol, glycerol and radiocontrast dyes |
|
|
Term
| how much does an increase in blood glucose change Na |
|
Definition
| for every increase in 100mg/dL of glucose, Na decreases by 3mEq/L |
|
|
Term
| what are the symptoms of hyponatremia |
|
Definition
"water intoxication" and cerebral edema symptoms:
1. HA
2. delirium
3. irritability
4. mm twitch, weakness |
|
|
Term
| how does hyponatremia effect DTR |
|
Definition
|
|
Term
| how do you treat hypotonic hyponatremia? |
|
Definition
1. mild (na=120-130) withold free water
2. mod (Na=110-120) give loop diuretics with saline
3. severe (Na<110) give hypertonic saline |
|
|
Term
| how do you dose hypertonic saline when treating pt with severe hypotonic hyponatremia |
|
Definition
-increase serum osm by 1-2 per hour
-do not increase more than 9 during first 24 hrs |
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|
Term
| how is hypernatremia categorized? |
|
Definition
hypovolemic
isovolemic
hypervolemic |
|
|
Term
| what are the causes of hypovolemic hypernatremia |
|
Definition
1. renal losses (diuretics, osmotic diuresis like glycosuria, renal failure)
2. extrarenal losses like diarrhea, sweating, respiratory losses |
|
|
Term
| what are the causes of isovolemic hypernatremia? |
|
Definition
diabetes insipidus
tachypnea |
|
|
Term
| what are the causes of hypervolemic hypernatremia |
|
Definition
itratogenic (TPN or overuse of NaHCO3)
exogenous glucocorticoids
salt water drowning
primary hyperalodosteronism |
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Term
|
Definition
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