Fluid and Electrolyte Balance Overview

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Questions and Answers

What is a common consequence of hypercalcemia? select 2

  • Increased phosphate levels
  • Increased muscle contraction efficiency
  • Weakness (correct)
  • Shortened ST and QT on EKG (correct)

Which of the following conditions can lead to hypocalcemia?

  • Hyperparathyroidism
  • Hypoparathyroidism (correct)
  • Malignancies
  • Rhabdomyolysis

What role does vitamin D play in phosphorus metabolism?

  • Inhibits phosphorus absorption
  • Has no effect on phosphorus levels
  • Promotes phosphorus absorption (correct)
  • Increases phosphorus excretion

What treatment is indicated for hypercalcemia? select all that apply

<p>Fluid resuscitation and diuretics (C), Biphosphonates (A), Calcitonin (B), Hemodialysis (D)</p> Signup and view all the answers

Which of the following best describes the relationship between calcium and phosphate levels?

<p>Calcium levels are indirectly proportional to phosphate (A)</p> Signup and view all the answers

What is the primary reason that males have a higher total body water (TBW) content compared to females?

<p>Males generally have more muscle mass. (B)</p> Signup and view all the answers

Which statement best describes the impact of age on total body water (TBW) content?

<p>Infants typically have a higher TBW than the elderly. (C)</p> Signup and view all the answers

How do colloids increase extracellular fluid (ECF) volume?

<p>By providing osmotic pressure to pull water. (B)</p> Signup and view all the answers

What is the primary effect of sodium on extracellular volume regulation?

<p>Maintaining absolute sodium and water content. (B)</p> Signup and view all the answers

What condition is characterized by a loss of water exceeding the loss of sodium resulting in increased plasma concentration of sodium?

<p>Hypernatremia (D)</p> Signup and view all the answers

What is the primary clinical manifestation of hyponatremia due to improper sodium excretion?

<p>Neurological disturbances (B)</p> Signup and view all the answers

Which of the following is NOT a common cause of hyperkalemia?

<p>Dehydration (B)</p> Signup and view all the answers

At what level of potassium concentration is skeletal muscle weakness expected to occur?

<p>K+ &gt; 8 (B)</p> Signup and view all the answers

What is the primary physiological roles of calcium in the body? select 3

<p>Muscle contraction (D), Membrane stability (A), Blood clotting (B)</p> Signup and view all the answers

Which of the following factors does NOT directly regulate calcium levels in the body?

<p>Cortisol (B)</p> Signup and view all the answers

What characterizes hyponatremia related to pseudohyponatremia?

<p>Normal total body sodium with a non-sodium solute trapping water (C)</p> Signup and view all the answers

Which condition is associated with hypophosphatemia? select all that apply

<p>Diabetic ketoacidosis (DKA) (A), Severe burns (B), Alcohol withdrawal (C), Hypercalcemia (D)</p> Signup and view all the answers

What condition is associated with hypovolemic hypernatremia? select 3

<p>Diarrhea (B), Dehydration (A), Osmotic diuresis (D)</p> Signup and view all the answers

What is the primary treatment for hypermagnesemia?

<p>IV calcium (D)</p> Signup and view all the answers

Which type of diabetes insipidus results from a decreased secretion of ADH leading to large amounts of dilute urine?

<p>Central DI (B)</p> Signup and view all the answers

What is the safest recommended rate for changing sodium balance in hypernatremia treatment?

<p>0.5 mEq/L/hr (A)</p> Signup and view all the answers

Which treatment approach should be applied if there is increased total body sodium?

<p>Administer D5W and a loop diuretic (C)</p> Signup and view all the answers

Hypomagnesemia may result from which of the following conditions? select all that apply

<p>Chronic alcoholism (C), Malabsorption syndromes (A), Diuretics (B), Long-term PPI therapy (D)</p> Signup and view all the answers

In what condition would postponement of elective surgeries be warranted due to sodium levels? select 2

<p>Hypernatremia greater than 150 mEq/L (C), Hyponatremia less than 130 mEq/L (B)</p> Signup and view all the answers

Which factor does NOT typically increase magnesium excretion?

<p>Hypoparathyroidism (C)</p> Signup and view all the answers

What is a common renal cause of hypoosmolality with decreased total body sodium? select 3

<p>Diuretics (A), Mineral corticoid deficiency (B), Nephropathy (D)</p> Signup and view all the answers

What is a key characteristic of nephrogenic diabetes insipidus?

<p>Normal ADH but kidney failing to respond (B)</p> Signup and view all the answers

Which compartment holds the greatest amount of total body water (TBW)?

<p>Intracellular fluid (ICF) = 55% (A)</p> Signup and view all the answers

By what mechanism do crystalloids increase extracellular fluid (ECF) volume?

<p>Hydrostatic effect (B)</p> Signup and view all the answers

How does sodium enable osmoregulation?

<p>By controlling extracellular osmolality (B)</p> Signup and view all the answers

What are the predominant ions found in the extracellular fluid (ECF)?

<p>Sodium (Na+) and Chloride (Cl-) and bicarb (A)</p> Signup and view all the answers

Changes to ___ volume are directly related to total body sodium content

<p>extracellular fluid (B)</p> Signup and view all the answers

What is the most common cause of hypernatremia?

<p>Decrease in circulating blood volume/free water loss (B)</p> Signup and view all the answers

Match the following conditions with their associated implications:

<p>Hypovolemic hypernatremia = Dehydration Euvolemic hypernatremia = Diabetes insipidus Hypervolemic hypernatremia = Cushing syndrome, primary aldosteronism Diabetes insipidus = Normal total body sodium in conscious patient</p> Signup and view all the answers

How do steroids, such as glucocorticoids, contribute to hypervolemic hypernatremia?

<p>By mimicking aldosterone to promote sodium retention and water reabsorption. (C)</p> Signup and view all the answers

What causes nephrogenic diabetes insipidus? (Select all that apply)

<p>Congenital (A), Kidney disease (B), Lithium use (C), Amphotericin B use (D)</p> Signup and view all the answers

Which of the following solutions are used to treat hypernatremia? select 2

<p>Enteral free water (A), D5W (5% dextrose in water) (B)</p> Signup and view all the answers

What can result from rapid correction of sodium imbalance?

<p>Both A and B (C)</p> Signup and view all the answers

If a patient has hypernatremia and decreased total body Na+, it is due to which of the following? (Select the correct answer)

<p>Fluid loss from dehydration or diuretics (B)</p> Signup and view all the answers

What is the appropriate intervention for a patient with hypernatremia and decreased total body Na+?

<p>Restoring plasma loss with isotonic solution before administering hypotonic solution (B)</p> Signup and view all the answers

If a patient has hypernatremia and increased total body sodium, what is the appropriate intervention?

<p>Administer loop diuretic to promote excretion of sodium and give D5W. (A)</p> Signup and view all the answers

What range of sodium levels would indicate postponement of elective surgeries? select 2

<p>Sodium greater than 150 (A), Sodium less than 130 (B)</p> Signup and view all the answers

What is the most common electrolyte abnormality?

<p>Hyponatremia (A)</p> Signup and view all the answers

When does hyponatremia occur?

<p>When sodium loss exceeds water loss (A)</p> Signup and view all the answers

What condition is nearly always associated with hyponatremia?

<p>Hypoosmolality (A)</p> Signup and view all the answers

Which surgical procedure is associated with pseudohyponatremia due to irrigation fluid being absorbed by vasculature?

<p>TURP (C)</p> Signup and view all the answers

Match the following conditions with their causes related to hypoosmolality/hyponatremia:

<p>Decreased total body sodium = Diuretics, mineral corticoid deficiency, vomiting Normal total body sodium = SIADH, hypothyroidism Increased total body sodium = Edematous disorders Edematous disorders (CHF, cirrhosis, CKD) = Kidneys can't excrete sodium and can't produce urine</p> Signup and view all the answers

What causes the neurological manifestations of hyponatremia?

<p>Increase in intracellular water causing edema (C)</p> Signup and view all the answers

At what serum sodium level are critical manifestations typically seen?

<p>&lt;120 mEq/L (A)</p> Signup and view all the answers

What is the appropriate treatment for SIADH?

<p>Free water restriction and demeclocycline (A)</p> Signup and view all the answers

What is the mechanism of action of demeclocycline?

<p>Antagonizes ADH at the renal tubules to cause diuresis (B)</p> Signup and view all the answers

What is a potential cause of cerebral salt wasting?

<p>Both intracranial disease and tumor (C)</p> Signup and view all the answers

What characterizes cerebral salt wasting?

<p>Elevated urine concentration of sodium with low serum osmolality (A)</p> Signup and view all the answers

What causes hyponatremia in cerebral salt wasting?

<p>Excess secretion of natriuretic peptides and altered sympathetic stimulation of the kidneys (C)</p> Signup and view all the answers

What is used to treat hyponatremia with decreased total body sodium?

<p>Isotonic saline (A)</p> Signup and view all the answers

What is used to treat hyponatremia with normal or increased total body sodium?

<p>Water restriction (A)</p> Signup and view all the answers

What metabolic derangement increases MAC?

<p>Hypernatremia (A)</p> Signup and view all the answers

Which ions are predominantly found in the intracellular fluid (ICF)?

<p>Potassium and Magnesium (B)</p> Signup and view all the answers

How are potassium levels maintained in the body?

<p>Renal excretion and RAAS (A)</p> Signup and view all the answers

What factors cause K+ to shift into cells, leading to hypokalemia? (Select all that apply)

<p>Hypothermia (A), Insulin (B), Beta-agonists (C), Folate or B12 treatments (D)</p> Signup and view all the answers

Which of the following are symptoms of hypokalemia? (Select all that apply)

<p>Muscle weakness (A), Decreased cardiac contractility (B), Polyuria (C)</p> Signup and view all the answers

What type of fluids should be administered if your patient has hypokalemia? select 2

<p>Glucose-free IV fluids (A), Potassium-containing IV fluids (C)</p> Signup and view all the answers

What medication-related toxicity can occur with hypokalemia, requiring potassium levels higher than 4 mEq/L?

<p>Digoxin toxicity (A)</p> Signup and view all the answers

What is the most life-threatening electrolyte abnormality?

<p>Hyperkalemia (A)</p> Signup and view all the answers

What are the causes of hyperkalemia? (Select all that apply)

<p>Acidosis (A), Periodic paralysis (B), Beta-blockers (C), Conditions that cause cell lysis (D), ACE inhibitors (E), Blood transfusions (F)</p> Signup and view all the answers

When should potassium levels be treated?

<p>If levels are less than 3 mEq/L or greater than 6 mEq/L, or if symptomatic (C)</p> Signup and view all the answers

When do EKG changes occur with hyperkalemia?

<p>Levels greater than 7.0 mEq/L (C)</p> Signup and view all the answers

What are appropriate treatments for hyperkalemia? (Select all that apply)

<p>Diuretics (A), Glucose and Insulin (B), Calcium Salts to Stabilize Membrane (C), Bicarbonate (D), Avoid Lactated Ringer's (LR) (E)</p> Signup and view all the answers

What is calcium absorption dependent on?

<p>Vitamin D (A)</p> Signup and view all the answers

Which of the following hormones are involved in regulating calcium levels in the body? (Select all that apply)

<p>Parathyroid Hormone (PTH) - increases levels (A), Vitamin D - aids in absorption (B), Calcitonin - decreases levels (C)</p> Signup and view all the answers

What is the effect of acidosis on calcium levels?

<p>Increases ionized calcium levels due to decreased binding to albumin (ph-dependent) (A)</p> Signup and view all the answers

In what form is the majority of calcium found in the plasma?

<p>In free ionized form 50% (C)</p> Signup and view all the answers

What are the predominant causes of hypercalcemia? select 2

<p>Hyperparathyroidism (A), Malignancies (B)</p> Signup and view all the answers

What is calcium indirectly proportional to?

<p>Phosphate (C)</p> Signup and view all the answers

What is the antagonist to calcium?

<p>Magnesium (C)</p> Signup and view all the answers

What are the treatment options for hypercalcemia? (Select all that apply)

<p>Loop diuretics (A), Bisphosphonates (B), Calcitonin (C), Hemodialysis (D)</p> Signup and view all the answers

Which of the following are causes of hypocalcemia? (Select all that apply)

<p>Pancreatitis (A), Rhabdomyolysis (B), Chelation of calcium due to blood transfusions or albumin (D), Tumor lysis syndrome (E), Fat embolism (C)</p> Signup and view all the answers

What electrolyte disturbance is commonly associated with mass transfusions?

<p>Hypocalcemia (B)</p> Signup and view all the answers

Administer calcium with massive transfusions

<p>True (A)</p> Signup and view all the answers

Which electrolyte imbalance is associated with calcification in the blood, contributing to left ventricular hypertrophy (LVH), declined renal function, and atherosclerosis?

<p>Hyperphosphatemia (C)</p> Signup and view all the answers

What is the appropriate treatment for hyperphosphatemia?

<p>Phosphate binding antacids (A)</p> Signup and view all the answers

What are the causes of hypophosphatemia? (Select all that apply)

<p>Severe burns (A), Diabetic ketoacidosis (DKA) (B), Alcohol withdrawal (C), Insulin administration (D)</p> Signup and view all the answers

What two IV electrolyte solutions should NOT be administered together due to precipitation?

<p>Phosphate and Calcium (B)</p> Signup and view all the answers

Which of the following factors increases magnesium reabsorption? (Select all that apply)

<p>Hypocalcemia (A), Parathyroid Hormone (PTH) (B), Extracellular Fluid (ECF) depletion (C), Metabolic alkalosis (D)</p> Signup and view all the answers

Which of the following factors increases magnesium excretion? (Select all that apply)

<p>Hypercalcemia (A), Acute volume expansion (B), Aldosterone (C), Ketoacidosis (D), Diuretics (E), Alcohol ingestion (F), Phosphate depletion (G)</p> Signup and view all the answers

What condition is hypermagnesemia commonly associated with?

<p>Chronic Kidney Disease (CKD) (B)</p> Signup and view all the answers

Which electrolyte disturbances are associated with a widened QRS complex?

<p>Hyperkalemia and hypermagnesemia (B)</p> Signup and view all the answers

What cardiac condition is most commonly seen with hypomagnesemia?

<p>Atrial Fibrillation (A)</p> Signup and view all the answers

Which of the following electrolyte disturbances can result from hypomagnesemia? (Select all that apply)

<p>Hypocalcemia (A), Hypokalemia (B), Hypophosphatemia (C)</p> Signup and view all the answers

Excess of which electrolyte is associated with respiratory distress?

<p>Magnesium (D)</p> Signup and view all the answers

how does acid-base imbalance interact with calcium levels

<p>True (A)</p> Signup and view all the answers

Which two electrolyte antagonists follow each other to maintain homeostasis?

<p>Magnesium and Calcium (B)</p> Signup and view all the answers

Flashcards

Total Body Water (TBW)

The total amount of water in the body

Sodium's role in ECF

Sodium primarily controls ECF volume and osmolality, critical for maintaining action potentials.

ECF volume regulation

Regulation of extracellular fluid volume, mainly determined by sodium levels.

Hypernatremia cause

Hypernatremia is often due to loss of more water than sodium in the body, sometimes from decreased blood flow

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Crystalloid IV effect

IV fluids containing crystalloids increase ECF volume by hydrostatic pressure, but this effect isn't long lasting.

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Hypercalcemia causes

Hypercalcemia is high blood calcium and is often caused by hyperparathyroidism, malignancies, adrenal insufficiency, thiazide diuretics, or lithium.

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Hypercalcemia symptoms

Hypercalcemia symptoms include weakness, changes in heart rhythm (shortened ST & QT intervals on EKG).

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Hypocalcemia causes

Hypocalcemia (low blood calcium) can be caused by issues like hypoparathyroidism, pseudohypoparathyroidism, pancreatitis, rhabdomyolysis, or issues with vitamin D.

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Hypocalcemia symptoms

Hypocalcemia symptoms include muscle spasms (tetany), tingling, and changes in heart rhythm (prolonged ST&QT intervals on EKG).

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Phosphorus role

Phosphorus is important for cell function, nerve signals, and muscle actions. It is needed for tissue health, important for the body.

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Calcium's role

Calcium plays a crucial role in muscle contraction and is absorbed from diet, regulated by hormones (PTH, vitamin D, calcitonin).

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Calcium in the blood

Most blood calcium is free, some is bound to albumin, or absorbed in diet and is dependent on vitamin d, and the rest is bound to other molecules.

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Hypophosphatemia

Low phosphate levels in the blood, associated with increased risk of death from any cause. It can be triggered by various conditions like severe burns, diabetic ketoacidosis, and alcohol withdrawal.

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Hypophosphatemia treatment

Treatment involves replacing phosphate levels. Careful monitoring of glucose and respiratory alkalosis is essential. Avoid using intravenous phosphate with calcium, as they can precipitate.

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Hypermagnesemia

Elevated magnesium levels in the blood, often occurring in people with kidney disease. It can also be caused by excessive intake of magnesium-rich products like laxatives or antacids.

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Hypermagnesemia symptoms

Symptoms include muscle weakness, vasodilation, bradycardia, heart problems, and decreased reflexes. Severe hypermagnesemia can even lead to respiratory and cardiac arrest.

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Hypomagnesemia causes

Low magnesium levels are often caused by insufficient intake or malabsorption, but can also result from conditions like diuretic use, hypothyroidism, alcoholism, or certain medications.

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Diabetes Insipidus (DI)

A condition causing excessive urination due to a defect in the body's ability to regulate water balance. Characterized by increased diluted urine production because the kidneys do not respond to antidiuretic hormone.

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Hypernatremia Treatment

Hypernatremia correction should be gradual to avoid cerebral edema or demyelination syndromes. Free water is the preferred treatment, aiming to restore normal plasma osmolality and address the underlying cause.

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Hypernatremia and Surgery

Elective surgeries are often postponed for patients with hypernatremia levels above 150mEq/L to avoid adverse outcomes.

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Hyponatremia Causes (Renal)

Low sodium levels (hyponatremia) with a renal cause are usually due to diuretics, mineral corticoid issues, or nephropathy.

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Hyponatremia Causes (Extrarenal)

Low sodium levels (hyponatremia) with extrarenal causes are usually from factors like excessive vomiting, diarrhea, or sweating.

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Pseudohyponatremia

A non-sodium substance is holding extra water in the extracellular fluid, creating a diluted hyponatremia effect.

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Hyponatremia and Hypoosmolality

Low sodium levels often accompany low blood osmolality (the concentration of dissolved particles in the blood).

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Study Notes

Fluid and Electrolyte Balance

  • Males have slightly more total body water (TBW) than females due to muscle mass differences.
  • TBW decreases with age.
  • ICF (intracellular fluid) comprises 55% of TBW.
  • ECF (extracellular fluid) comprises 45% of TBW, further divided into interstitial and intravascular fluid.
  • Intravenous fluids, like crystalloids, increase ECF volume via hydrostatic pressure and colloids via oncotic pressure.

Osmolality and Sodium

  • Osmolality is the concentration of solute particles in a solution, crucial for cellular function and volume regulation.
  • Sodium is a key cation, essential for osmotic balance and nerve impulse transmission.
  • Body maintains extracellular fluid volume and osmolarity.
  • Sodium functions in the generation of action potentials, volume regulation, and osmoregulation.

Water Regulation and Electrolyte Imbalances

  • Regulation controlled by various systems (RAAS, SNS, ADH, BNP), which maintain water and electrolyte balance.
  • Hypernatremia: Excess sodium relative to water.
  • Causes: Water loss (dehydration), fluid loss via diarrhea or diuresis. Symptoms worsen with serum sodium above 150 mEq/L.
  • Hypovolemic hypernatremia seen in dehydration, diarrhea, and osmotic diuresis.
  • Euvolemic hypernatremia is seen in diabetes insipidus.
  • Hypervolemic hypernatremia is seen in Cushing syndrome and primary hyperaldosteronism.
  • Central DI: Impaired ADH secretion, resulting in excess urine production.
  • Nephrogenic DI: Impaired kidney response to ADH.

Hyponatremia Definitions

  • Hyponatremia: Low sodium relative to water. Symptoms emerge at serum sodium levels below 130 mEq/L.
  • Hypoosmolality is usually accompanied by hyponatremia.

Potassium (K+)

  • Essential for maintaining resting membrane potential, nerve transmission, muscle contraction, and acid-base balance.
  • Hypokalemia: Low potassium. Causes: Inadequate intake, excessive loss.
  • Symptoms: Polyuria, decreased cardiac contractility, skeletal muscle weakness.
  • Causes: Poor intake, excessive excretion, conditions (hypokalemic periodic paralysis, primary hyperaldosteronism, renal tubular acidosis, metabolic alkalosis). Symptoms of hypokalemia worsen as the serum potassium levels drop.
  • Hyperkalemia: High potassium. Causes: Kidney dysfunction (CHF, cirrhosis, nephrotic syndrome). Symptoms: Muscle weakness, peaked T waves, shortened QT interval, widened QRS complex.
  • Elective surgery recommendations for potassium: K+ >3. Goal of K+ of 4 if patient takes digoxin.

Calcium (Ca2+)

  • Crucial for muscle contraction, nerve function, and blood clotting.
  • Hypercalcemia: High blood calcium. Causes: Hyperparathyroidism, malignancies. Symptoms include weakness, EKG changes, shortened ST and QT intervals.
  • Hypocalcemia: Low blood calcium. Causes: Hypoparathyroidism, pseudohypoparathyroidism. Symptoms include tetany, paresthesia, cardiac arrhythmias.

Magnesium (Mg2+)

  • Important cofactor for many enzymes; crucial for nerve and muscle function.
  • Hypermagnesemia: High magnesium. Causes: Excess intake, kidney dysfunction. Symptoms: Muscle weakness, vasodilation, bradycardia.
  • Hypomagnesemia: Low magnesium. Causes: Inadequate intake, malabsorption syndromes. Symptoms include weakness, fasciculations, ataxia, and arrhythmias.

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