Term
| Total body water is about __ - __ % of total body weight |
|
Definition
|
|
Term
| Body water for children and men |
|
Definition
|
|
Term
| Body water for women over 70 y/o |
|
Definition
|
|
Term
| Body water for women and old men (>70 y/o) |
|
Definition
|
|
Term
| intracellular versus extracellular fluid |
|
Definition
| 2/3 intercellular and 1/3 body water is extracellular |
|
|
Term
| Extracellular fluid: how much is interstitial vs. intravascular |
|
Definition
3/4 interstitial fluid
1/4 intravascular fluid |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Cl (HCO3, PO4, SO4, organic acids, proteins-albumin) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| PO4 (SO4, HCO3, organic acids) |
|
|
Term
| Osmolarity vs. Osmolality |
|
Definition
Osmolarity: (osmoles/L of soln)
Osmolality: osmoles/kg of solvent
**For water 1 kg = 1 L so osmolarity and osmolality are used interchangably for WATER ONLY |
|
|
Term
|
Definition
| colloid osmotic pressure caused by plasma proteins |
|
|
Term
|
Definition
Crystalloid-fluid made up of water and dissolved SALTS or SMALL SUGARS
Colloid- a homogeneous 'solution' of LARGE MOLECULES such as albumin or dextran |
|
|
Term
| Ions that make up 90% of ECF osmolality |
|
Definition
|
|
Term
| Ions that make up most of ICF osmolality |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
8.5-10.5 mg/dL
***Ionized Ca: 4.4-5.4 mg/dL |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
1.7-2.3 mg/dL
NOTE: poor indicator of true Mg in body |
|
|
Term
| Normal Serum Osmolality Equation and what it tells us |
|
Definition
(2 x SNa) + (BG/18) + (BUN/2.8) = 275-290 mOsm/kg
1. serum sodium is major contributor
2. even though glucose (and BUN) count for less in terms of osmolality, if they get significantly high (ex: BG=1200) then will start to play a more significant role and will become a concern |
|
|
Term
| Clinical Presentation of Dehydration |
|
Definition
Increased heart rate (body senses lower Volume and tries to compensate)
Decreased BP
Lower PCWP (pulmonary capillary weight pressure) or CVP (central venous pressure)
Low urine output
Hypernatremia
Increased serum osmolality
Shock |
|
|
Term
|
Definition
|
|
Term
|
Definition
| pulmonary capillary weight pressure |
|
|
Term
| Assessment tools for dehydration |
|
Definition
weight changes
thirst
mucous membranes
tear production
jugular vein visibility when supine
capillary refill time
urine specific gravity (measures concentration of urine)
skin turgor
physical symptoms (ex: BP, HR)
orthostasis (loss of 10-15% ECF) |
|
|
Term
| Ideal rate of change of serum osmoles in dehydration treatment |
|
Definition
|
|
Term
|
Definition
| isotonic fluid that contains sodium (thus it will mainly stay in ECF) but also has other ions |
|
|
Term
| a BUN/Scr ratio >20 indicates _________ |
|
Definition
|
|
Term
| urine Na of __________ indicates renal etiology of hyponatremia |
|
Definition
| over 20 (the kidney is NOT compensating for losses) |
|
|
Term
Where will 1 liter of 1/2NS distribute?
-how much in ECF
-how much in ICF
-how much in intravascular vs. interstitial |
|
Definition
500 ml NS and 500 ml plain water
500 ml NS only in ECF (375 interstitial/125 IV)
500 ml pure water distributes evenly (~333 mL ICF/~167 ml ECF [~40 ml IV/127 ml interstitial)
TOTAL:
333 mL ICF
667 mL ECF
500 mL interstitial
167 mL IV |
|
|
Term
| How does D20W distribute? |
|
Definition
| distributes evenly (the amount of dextrose doesnt matter because will eventually get metabolized and distribute evenly), however it is hypertonic so must just be careful where it can be infused |
|
|
Term
| Is D5NS hypo-, iso-, or hypertonic? |
|
Definition
| Hyper (D5W gets metabolized, left with NS but initially dextrose too) |
|
|
Term
| Why is tonicity important? |
|
Definition
| it indicates where it is safe to infuse something--ex: peripheral versus central line (once it is in the body, the body water will adjust to create an isotonic environment) |
|
|
Term
| General treatment of dehydration. |
|
Definition
1. immediate vascular expansion--500 ml IV for adults if symptomatic
2. Correction of fluid and electrolyte deficits
-restore balance over 24 hours+ if possible
3. Maintenance of fluids and electrolytes |
|
|
Term
| If patient in shock with massive blood loss--what should you give them? |
|
Definition
1. blood
2. other replacement fluids |
|
|
Term
|
Definition
|
|
Term
| Examples of Hypertonic Solutions |
|
Definition
|
|
Term
| Examples of Isotonic Solutions |
|
Definition
NS
Lactated Ringer's
5% Dextrose 0.225% NaCl |
|
|
Term
| Examples of Hypotonic Solutions |
|
Definition
|
|
Term
|
Definition
| NO! Even though D5W is sodium free, it is isotonic for infusion and thus doesnt cause cell swelling |
|
|
Term
| What would happen if you infused sterile water? |
|
Definition
|
|
Term
| What are the end products of dextrose metabolism |
|
Definition
|
|
Term
| Maintenance Volume Fluid Calculations for Adults/Adolescents |
|
Definition
for weight >20 kg
1500 mL + 20 ml(weight-20kg) |
|
|
Term
| Maintenance Volume Fluid Calculations for Peds |
|
Definition
for weight 10-20 kg
1000 mL + 50 mL(weight-10kg) |
|
|
Term
| Maintenance Volume Fluid Calculations for Neonates |
|
Definition
for weight <10 kg
100 mL/kg |
|
|
Term
| Drugs that can affect fluid dosing in dehydration |
|
Definition
diuretics
steroids
ACE inhibitors
Lithium (kidney sees it the same as Na+)
Vasoactive agents |
|
|
Term
|
Definition
Albumin 5% or 25%
Dextran 40 (10% soln)
Dextran 70 (6% soln)
Hetastarch |
|
|
Term
| Theory that colloids should be given if have low blood volume (in dehydration)--is this seen to be true? |
|
Definition
| NO, studies show there is no real success--about the same effectiveness as crystalloids |
|
|
Term
|
Definition
12-14g/day produced
contributes to oncotic pressure
normal concentration: 3.5-5 g/dL
non-tissue bound albumin from interstitial fluid will return to intravascular space via LYMPHATIC DRAINAGE
tissue bound albumin is metabolized |
|
|
Term
| typical albumin concentration |
|
Definition
|
|
Term
|
Definition
prevent thromboembolism
improve peripheral blood flow |
|
|
Term
| 1 gm of albumin will bind ____ mL water |
|
Definition
|
|
Term
| how long will albumin stay in the intravascular space? |
|
Definition
|
|
Term
| what will happen when 100 mL of albumin 25% is administered? |
|
Definition
| all stays in intravascular space and each gram (25 g total) is associated with 18 mL water. so 450 mL increase in water in intravascular space (100 mL from infusion + 350 mL from interstitial space) |
|
|
Term
| what will happen when 500 mL of albumin 5% is administered? |
|
Definition
5 g/100 ml = 25 g total which is associated with a volume of 450 mL (so increase of 450-500 ml in intravascular volume)
pretty much what gets infused with 5% albumin is the increase in volume in the IV space |
|
|
Term
| With edema, should you give albumin 5% or 25%? |
|
Definition
Albumin 25%
THEN give a diuretic to get rid of the fluid that has been pulled into IV space |
|
|
Term
| uses of exogenous albumin |
|
Definition
resuscitation
correction of edema |
|
|
Term
| ADRs of exogenous albumin |
|
Definition
pulmonary edema
decreased calcium (Ca binds to albumin)
anaphylaxis (because it is a protein)
$$$ |
|
|
Term
| What affects the "dwell time" and duration of expansion of the intravascular space with dextran? |
|
Definition
| particle size of the dextran |
|
|
Term
| how much water is associated with 1 gram of dextran? |
|
Definition
| 20-30 mL water is associated with 1 gram of dextran |
|
|
Term
| if add 500 ml D40 what will be the change in volume? |
|
Definition
| increase of 100-1500 mL (10% soln where 1 gram is associated with 20-30 mL water) at 2 hours |
|
|
Term
|
Definition
renal failure
anaphylaxis (b/c protein)
osmotic diuresis (stop i SpGr >1.03 and Urine Volume<0.5mL/kg/hr)
false increase in blood glucose, total protein, and bilirubin
interference with blood cross matching
bleeding (keep doses <1.5g/kg/d)
RES blockade-immune function effect (reticuloendotheial blockade)
**NOTE: dont occur with crystalloids |
|
|
Term
|
Definition
6% soln in NS
Dosed at 20 mL/kg/day |
|
|
Term
|
Definition
Coagulopathy-dose dependent
depressed platelet count
prolonged PT and PTT
Pulmonary edema
Anaphylaxis (rare)
Hyperamylasemia: no alteration in pancreatic function but levels 2x normal for up to 5 days |
|
|
Term
| What is the primary ion of the plasma |
|
Definition
|
|
Term
Normal plasma osmolarity
How is it derived? |
|
Definition
280-295 mOsm/kg water
(2 x [Na]) + ([glucose]/18) + (BUN/2.8) |
|
|
Term
|
Definition
1. maintain ECF volume
2. Blood pressure regulation
3. maintain osmotic equilibrium |
|
|
Term
| what constitutes Hyponatremia |
|
Definition
|
|
Term
| what level indicates hypernatremia |
|
Definition
|
|
Term
| what is the daily intake required for sodium |
|
Definition
| ~50-100 mEq/d (RDI<2.3g = <100mEq) |
|
|
Term
| What two systems regulate Na |
|
Definition
ADH (aka arginine vasopressin)
Renin-Angiotensin-aldosterone system (RAAS) |
|
|
Term
| What is the most common electrolyte problem in hospitalized patients |
|
Definition
| hyponatremia (15-30% of cases) |
|
|
Term
| Hyponatremia is an INDEPENDENT risk factor for _____ (more than 1) |
|
Definition
Death in...
1. geriatric
2. HF
3. Cirrhosis
4. ICU
...patients |
|
|
Term
| Is hyponatremia usually a water or sodium problem? |
|
Definition
|
|
Term
|
Definition
125-130 mEq/L
Sx: impaired posture, attention, gait with chronic/increased fall risk |
|
|
Term
| Severity of hyponatremia depends on ________ and _________ |
|
Definition
|
|
Term
| What is a BIG concern with hyponatremia (moderate/severe) |
|
Definition
Osmotic demyelination syndrome
decreased plasma omolarity causes water to move into brain cells (swell/burst)
Na/K try to move out, but compensation takes 48 hours |
|
|
Term
| Moderate and severe hyponatremia levels and symptoms |
|
Definition
Moderate: 115-125 mEq/L
Severe: 110-115 mEq/L
Hypo-osmolality induced volume expansion of brain cells-->altered MS, seizures, coma, permanent brain damage, death |
|
|
Term
| What causes hypertonic hyponatremia |
|
Definition
having another molecule in the blood that usually isnt there:
1. mannitol
2. hyperglycemia
3. propylene glycol
4. polyethylene glycol |
|
|
Term
| T of F: the body will automatically decrease sodium in the blood with hyperglycemia |
|
Definition
| T: for every 100 mg/dl increase in blood glucose, the serum sodium decreases by 1.7 mEq/L (causes a 2 mOsm/kg decrease in osmolality) |
|
|
Term
| What is the difference between hypertonic and isotonic hyponatremia |
|
Definition
| with isotonic, the body has been able to compensate for the osmolality change due to solutes other than Na in the plasma (same causes for both-ex: mannitol, hyperglycemia...) |
|
|
Term
| Which type of hyponatremia is most common? |
|
Definition
|
|
Term
|
Definition
volume depletion and Na loss
can be caused by loss of Na renally or extrarenally
Tx: remove the cause and give NS |
|
|
Term
| T or F: in hypovolemic hypotonic hyponatremia you first lose sodium. |
|
Definition
| F: first you lose fluid (via sweating, diarrhea, thiazide diuretics)-->increase osmolality-->increase ADH-->water retention-->concentrate urine |
|
|
Term
| How long does it take for thiazide-induced hyponatremia to develop? |
|
Definition
|
|
Term
| MOA of thiazide diuretics |
|
Definition
inhibit sodium-chloride carrier in DISTAL tubule
BLOCKS Na reabsorption-->which allows water and Na to be removed
Water then gets retained through ADH-->causes greater loss of Na than water |
|
|
Term
| Urine Na (< or >) 20 mEq/L when Na losses are extrarenal (ex: GI, skin) |
|
Definition
| LESS than because the kidney tries to reabsorb salt |
|
|
Term
| Which type of diuretic infrequently causes hyponatremia? |
|
Definition
| Loop (because works further down) |
|
|
Term
| When Na > 20 mEq/L in hypovolemic hypotonic hyponatremia it can be caused by: |
|
Definition
Diuretics
Adrenal Insufficiency |
|
|
Term
| What is the most common type of hyponatremia? |
|
Definition
| Euvolemic hyponatremia (60%) |
|
|
Term
| What is the presentation of euvolemic hyponatremia? |
|
Definition
| No clinical signs of fluid overload/hypovolemia |
|
|
Term
| Causes of euvolemic hyponatremia |
|
Definition
SIADH (can be caused by tumors, CNS disorders, trauma, Drug induced, pulmonary disease, mechanical ventilation, idiopathic)
Drugs that cause SIADH: nicotine, antipsychotics, TCAs, DDAVP, oxytocin, 'ecstasy'
Hyperthyroidism, Adrenal insufficiency
Exercise associated hyponatremia |
|
|
Term
| Treatment of euvolemic hyponatremia |
|
Definition
1. If possible, correct underlying cause
2. treatment will vary depending on acute/chronic onset and if patient is symptomatic
3. IF SIADH:
a. Acute: Hypertonic Saline
b. Chronic: Fluid restriction (alternatives-demeclocycline, urea, lithium) |
|
|
Term
| Causes of hypervolemic hyponatremia |
|
Definition
**Increased ECF volume (+ edema) but decreased effective circulating volume
heart failure
cirrhosis
renal failure
nephrotic syndrome |
|
|
Term
| With hypervolemic hypotonic hyponatremia urine Na is (< or >) 20 mEq/L |
|
Definition
| Less than 20 (AVP release causes renal sodium and water retention but water>Na) |
|
|
Term
| When would you use a vasopressin antagonist in hyponatremia? |
|
Definition
| HYPERvolemic hyponatremia |
|
|
Term
| Vasopressin Antagonist Examples |
|
Definition
"vaptan" class
1. Tolvaptan
2. Conivaptan
$$$$$$ |
|
|
Term
| Vasopressin Antagonist MOA |
|
Definition
Inhibit aquaporin formation in kidneys
More free water is excreted
No hypotension |
|
|
Term
| In acute onset hyponatremia correction should be _______ while with chronic onset correction should be ______ |
|
Definition
Acute = rapid correction
Chronic = slow correction |
|
|
Term
| What should be monitored in hyponatremia treatment |
|
Definition
| urine osmolarity and sodium |
|
|
Term
| How quickly can hyponatremia be corrected? |
|
Definition
<10-12 mmol/L over 24 hours
**Aim for 8 mmol/L per day
<18 mmol/L over 48 hours
**IF acute or symptomatic chronic hyponatremia: 1-2 mmol/L/hr (once symptoms resolve, reduce rate)
DO NOT exceed because brain cells will swell-->exception to these rates is ONLY if head injury within the last 2 hours--then can correct at a faster rate |
|
|
Term
| 1 mL/kg of 3% saline increases Na by _____ mEq/L |
|
Definition
~1 mEq/L increase
***20-30 mL/hr will raise [Na] by 8 mEq/L/day |
|
|
Term
| for every 1 mL of 3% saline how much ICF water gets puled into the ECF? |
|
Definition
| ~7 ml from ICF (therefore, if infuse 50 mL 3% NaCl-->400 mL water added to ECF [50mL + 7(50mL)]) |
|
|
Term
| does hypertonic saline cause rapid or slow redistribution? |
|
Definition
|
|
Term
| Uses of hypertonic saline: |
|
Definition
1. Rapid onset hyponatremia (because quick redistribution) with symptoms of urine concentrations over 200 mOsm/kg water and clinical euvolemia or hypervolemia
2. Head injury |
|
|
Term
| ADRs of hypertonic saline |
|
Definition
1. electrolyte disturbances
2. pulmonary edema
3. coagulopathies |
|
|
Term
| T or F: hypernatremia is always hypertonic |
|
Definition
| True (But can be hypertonic and not hypernatremic) |
|
|
Term
| Signs and Symtoms of Hypernatremia |
|
Definition
Thirst
Tachycardia
Low CVP or PCWP
Decreased urine output (unless DI)
CNS (seizures)
The onset of hypernatremia will affect severity |
|
|
Term
| Causes of and treatments for hypovolemic hypernatremia |
|
Definition
Water loss > Na loss
Insensible Losses, vomiting, diarrhea
Tx:
1. Calculate free water deficit
2. Administer D5W, 1/4NS, 1/2NS, NS (may still be hypotonic in comparison to blood) |
|
|
Term
| causes of and treatments for Hypervolemic hypernatremia |
|
Definition
Sodium overload
Mineralocorticoid excess
Gain of Na greater than the gain of water
**Bodies ability to work is problematic
Tx:
1. Restrict Na
2. Give Diuretic |
|
|
Term
| Causes of and treatments for Euvolemic hypernatremia |
|
Definition
CHRONIC ONLY
DI
Osmotic diuresis
Tx:
1. D5W (will disperse evenly)
2. Treat DI if required |
|
|
Term
| How to calculate water deficit |
|
Definition
Water deficit = TBW x [(SNa/140)-1]
**If hyperglycemic, correct serum Na by adding 1.7 mEq/L for every 100 mg/dL increase in serum glucose |
|
|
Term
|
Definition
Treatment for Central DI
DDAVP
intranasal, PO, IV, SC, IM
Synthetic vasopressin analog: antidiuretic (V2):vasopressor (V1) ratio (2000-4000:1) vs. vasopressin ratio (1:1)
Other uses: nocturnal enuresis, acute uremic bleeding (increases plasma Factor VIII activity)
Dosing: 2-4 mcg IV or SQ BID or 0.1-0.8 mcg PO BID-TID
Duration of action: 8-12 hours |
|
|
Term
| Two types of diabetes insipidus |
|
Definition
|
|
Term
| Treatment for nephrogenic DI |
|
Definition
1. sodium restriction and a thiazide-->promotes proximal water reabsorption
2. NSAIDs may potentiate the activity of ADH (ex: indomethacin)
3. lithium-amiloride: inhibits lithium uptake into collecting duct |
|
|
Term
| How to treat sodium overload |
|
Definition
loop diuretics to facilitate sodium overload
D5W to replace water |
|
|
Term
| Loop Diuretics MOA and examples |
|
Definition
Furosemide
Bumetanide
Torsemide
Ethancrine Acid
MOA: inhibits Na-K-Cl carrier on Loop of Henle
20% of Na fraction gets excreted (most) |
|
|
Term
|
Definition
Inhibits Na-Cl carrier in DISTAL Tubule
3-5% of Na fraction gets excreted |
|
|
Term
| Potassium Sparing Examples and MOA |
|
Definition
MOA: inhibits Na channel in cortical either directly or by decreasing aldosterone activity
Direct: Amiloride, Triamterene
Indirect: Spirnolactone, Eplerenone
Only 1-2% of Na gets excreted |
|
|
Term
| Distal sodium reabsorption can occur with chronic loop diuretic use. What should you do if/when this occurs? |
|
Definition
|
|
Term
| What occurs with renal insufficiency with diuretics? |
|
Definition
Filtered Na load decreases with GFR
-larger and more frequent dosing may be required
-with continuous infusion-load first |
|
|
Term
|
Definition
**Only use if CrCl>50mL/min
Hypercalcemia
Hypokalemia |
|
|
Term
|
Definition
Hypokalemia
hypomagnesemia
metabolic aklalosis
highly protein bound |
|
|
Term
| ADRs of K+ sparing diuretics |
|
Definition
Hyperkalemia
Gynecomastia (esp. with spirnolactone) |
|
|
Term
| T or F: serum sodium concentrations typically have little variation. |
|
Definition
| T: normally vary by less than 2-3% in healthy individuals |
|
|
Term
| T or F: Potassium in almost completely reabsorbed by the kidney. |
|
Definition
| T: 80-90% of filtered K is reabsorbed |
|
|
Term
| Which endogenous protein most affects Ca levels? |
|
Definition
|
|
Term
| Where is the majority of Mg stored in the body? |
|
Definition
|
|
Term
| T or F: there is hormonal control of Mg. |
|
Definition
|
|
Term
| T or F: serum sodium concentrations typically have little variation. |
|
Definition
| T: normally vary by less than 2-3% in healthy individuals |
|
|
Term
| T or F: if there is a low measured Ca level, it always means you need to give more Ca. |
|
Definition
| F: must check albumin, if albumin is also low, then ionized Ca may be normal |
|
|
Term
| Regulation mechanisms of Ca |
|
Definition
1. PTH: stimulates release of Ca from bone, decreases Ca excretion, increases vitamin D (from kidney) to increase Ca absorption in GI
2. Calcitonin: inhibits Ca bone resorption (bone breakdown) |
|
|
Term
|
Definition
1. increased abosorption
2. decreased elimination
3. increased bone resorption (bone breakdown)
Neoplasms: MOST COMMON-esp carcinomas of lung, breast, multiple myeloma-->PTH-related protein released
Medications: increased renal reabsorption: [1] thiazides and [2] lithium
Endocrine diseases
Immobilization (osteoclasts work alot)
Paget's disease
rhabdomylolysis (breakdown of muscle cells) |
|
|
Term
|
Definition
RENAL: kidney stones, renal tubular dysfunction, polyuria, polydipsia
GI: anorexia, N/V, constipation
CV: QT shortening, ventricular arrhythmias
Musculoskeletal problems |
|
|
Term
| Clinical Presentation of hypercalcemia (levels) |
|
Definition
mild-moderate: 10.5-13 mg/dl
severe>13 mg/dl
crisis>15 mg/dl (Medical emergency) |
|
|
Term
| What is ALWAYS the first step in treating hypercalcemia? |
|
Definition
|
|
Term
| What should you avoid in the treatment of hypercalcemia? |
|
Definition
IV phosphate (because will precipitate)
However, bisphosphonates are ok to use (use IV not PO because need quick onset) |
|
|
Term
| What is the general treatment plan for hypercalcemia |
|
Definition
1. Expand Intravascular volume
then...
2. Promote Ca excretion |
|
|
Term
| Treatment options (drugs) for hypercalcemia |
|
Definition
1. Loop diuretics (block Ca reabsorption)-avoid in fluid restricted patients (CKD stages 4/5, heart failure)
2. Calcitonin (Miacalcin)
3. Bisphosphonates (IV b/c PO is slow)-first line for CA associated hypercalcemia/long-term control; caution in renal osteodystrophy secondary to chronic kidney disease
4. Gallium nitrate and mithramycin (no longer used b/c poorly tolerated)
5. Corticosteroids if caused by malignancy (not usually used) |
|
|
Term
|
Definition
Fast onset (1-2 hr)
For Tx of hypercalcemia
derived from salmon
SC or IM
Tachyphylaxis with chronic therapy (due to antibody formation) |
|
|
Term
| What is first line for cancer associated hypercalcemia? |
|
Definition
| IV bisphosphonates (etidronate, pamidronate, zoledronate, ibandronate) |
|
|
Term
|
Definition
1. hypoparathyroidism (post-op)
2. vitamin D deficiency (uncommmon)
3. hypomagnesemia-->impaires PTH secretion
4. Oral phosphorous therapy, sodium phosphate bowel preparations
5. Drugs (loops, phenytoin, calcitonin, barbiturates) |
|
|
Term
| Clinical presentation of hypocalcemia |
|
Definition
hallmark-tetany (facial, extremity muscle spasms, cramps)
Neuro: weakness, fatigue, seizures, confusion, depression, memory loss (chronic)
CV: hypotension, bradycardia, QT prolongation, unresponsive to vasopressors (b/c not enough calcium in smooth muscle to contract?) |
|
|
Term
| Which loop diuretic should you give if you have a sulfa allergy |
|
Definition
|
|
Term
| Treatment of hypocalcemia |
|
Definition
1. Correct the underlying cause
2. Check albumin-if Alb low then ionized Ca may be normal
If chronic: check vit D and PTH
If acute: give 100-300 mg elemental IV Ca (pref. gluconate salt-can do peripheral line) |
|
|
Term
| Which can be given IV peripherally: calcium chloride or calcium gluconate? |
|
Definition
Gluconate (9% elemental Ca= less chance of precipitating)
CaCl is only reserved for life threatening emergencies because 27% elemental Ca |
|
|
Term
| What is Calcium acetate most used for? |
|
Definition
| To decrease phosphorus (sequesterant) |
|
|
Term
| The lab values for which nutrients are not very indicative of their levels in the body? |
|
Definition
|
|
Term
| where is most of the body's phosphorus found? |
|
Definition
Skeleton 85%
ICF 14%
ECF 1% |
|
|
Term
| In what form is phosphate usually found? |
|
Definition
1. ATP,2,3-diphosglycerate (DGP), fructose 1,6-diphosphate
2. Inorganic phosphate (PO4) mostly in ECF and some in ICF |
|
|
Term
| T or F: phosphate is mostly renally eliminated by filtration. |
|
Definition
| T: ~80-90% reabsorbed in proximal tubule |
|
|
Term
| Causes of hyperphosphatemia |
|
Definition
| 1. endogenous release or renal failure (causes decreased vit D concentrations, decreased Ca concentrations, increased PTH) 2. Tumor lysis and rhabdomylosis (acute lymphatic leukemia, Burkitt's lymphoma-chemo->kills all cells which expel their PO4) 3. DKA 4. Increased intake (Acute phosphate nephropathy) |
|
|
Term
| Clinical presentation of hyperphosphatemia |
|
Definition
precipitation (of Ca and PO4) can cause obstructive nephropathy
likely when Ca x PO4 = 50-60 (about double the normal product)
(Goal is <55 in CKD) |
|
|
Term
| Treatment for hyperphosphatemia |
|
Definition
Phosphate binders to decrease GI absorption
**Ca is preferred (Ca acetate) except with elevated Ca x PO4 product then try non-calcium binders (lanthanum carbonate, sevelamer, carbonate, aluminum salt-->may be toxic so dont give with CKD)
**The only way to decrease PO4 is to not absorb it in the first place |
|
|
Term
| Who has a higher incidence of hypophosphatemia |
|
Definition
|
|
Term
| Causes of hypophosphatemia |
|
Definition
1. decreased absorption
2. enhanced excretion
3. acute volume expansion-->shifts PO4 out of serum
4. Extracellular to intracellular redistribution-->RAPID REFEEDING (if too quick then the body's phosphate will rush into cells to help breakdown glucose for energy (ATP)) |
|
|
Term
| Presentation of hypophatemia |
|
Definition
1. depleted intracellular ATP
-impaired respiratory function
-myalgias
-muscle weakness
-bone pain
-impaired cardiac muscle function
2. Decreased oxygen delivery (decreased 2,3-DPG concentrations in RBCs)
-Rigid RBCs become trapped in spleen-hemolysis
-impaired WBC functions-increase risk for infections |
|
|
Term
| Treatment for hypophosphatemia |
|
Definition
Severe:
IV, sodium or potassium phosphate (15 mmol will correct by 0.5 to 0.8 mg/dl)
Suggested max infusion rate = 9 mmol phos/hr (risk of symptomatic hypocalcemia, soft tissue calcification, rapid K+ could stop heart)
Mild to Moderate:
PO
50-60 mmol/d in divided doses
neutra-phos (8 mmol/packet)
*Dose limited by osmotic diarrhea
**Caution in CKD because could cause hypoerphosphatemia if correct too quick |
|
|
Term
| where is potassium found? |
|
Definition
75% skeletal muscle
25% in liver and RBCs |
|
|
Term
| potassium disturbances mainly affect ________. |
|
Definition
| neuromuscular activity (especially cardiac function |
|
|
Term
| T or F: Most people get the required amount of K+ daily. |
|
Definition
|
|
Term
| T or F: Potassium is mainly filtered and reabsorbed in the proximal tubule and loop of Henle. |
|
Definition
|
|
Term
| What 4 things regulate potassium? |
|
Definition
1. Insulin
2. Catecholaimes
3. Aldosterone-->promotes K excretion
4. Acid-base balance (hydrogen gets exchanged for K) |
|
|
Term
| Is hyperkalemia associated with acidosis or alkalosis? |
|
Definition
| acidosis (body is trying to compensate for the acidosis, so is exchanging H for K) |
|
|
Term
|
Definition
1. diuretics-loops and thiazides (inhibit reabsorption of Na and excretion of K and decreased volume stimulates aldosterone)
2. Diarrhea
3. Vomiting/NG suctioning-loss of HCl=alkalosis
4. Hypomagnesemia |
|
|
Term
| Drugs that cause hypokalemia |
|
Definition
| diuretics, high-dose penicillins, sorbitol, laxatives, beta-2-receptor agonists, tocolytics, theophylline, insulin |
|
|
Term
| Clinical presentation of hypokalemia |
|
Definition
Mild: asymptomatic usually; N/V,constipation, weakness
Moderate: cramping, weakness, myalgias, malaise
Severe: paralysis, rhabdomyolysis, respiratory distress, ECG chages (ST depression, T-wave inversion, U-wave elevation), arrhythmias, death |
|
|
Term
| What must you correct first before fixing hypokalemia? |
|
Definition
|
|
Term
| To fix hypokalemia would you prefer NS or dextrose containing solutions? |
|
Definition
| NS because dextrose can cause insulin release and worsen hypokalemia |
|
|
Term
| Potassium burns in peripheral veins. In order to help with that people often give ___________. What is the problem with that. |
|
Definition
Lidocaine can be infused to, but if do this then it cant be felt if it slipped out of the vein
alternative--slow the rate! no more than 10 mEq/100 mL |
|
|
Term
| 10 mEq of K will correct about _______ in serum |
|
Definition
0.1 mEq/L
**in sereve hypokalemia it only changes it by 0.05 mEq/L |
|
|
Term
|
Definition
1. Replace Mg first
2. IV or PO K replacement
3. for every 1 mEq/L decrease below 3.5 mEq/L there is a total body deficit of 100-400 mEq
4. K-sparing diuretics may be considered instead of chronic oral replacements |
|
|
Term
| T or F: Most potassium salts are control release. |
|
Definition
|
|
Term
| Is hyper or hypo kalemia more common? |
|
Definition
| Hypo-because of K-depleting diuretics |
|
|
Term
| Most common cause of hyperkalemia |
|
Definition
Over replacement with IV potassium
Other causes: overuse of K supp, dietary intake, decreased excretion esp with AKI (ACE-Is, ARBs), redistribution into ECF (acidosis, DM) |
|
|
Term
| Presentation of hyperkalemia |
|
Definition
Cardiac (heart palpitations), neuromuscular, smooth muscle cell function
usually asymptomatic
Severe: sine wave, ventricular fibrillation, lose p wave--melds with QRS complex |
|
|
Term
| Treatment of hyperkalemia |
|
Definition
Severe:
1. Ca for EKG abnormalities
2. Dextrose/insulin (IV)
3. Albuterol good short term with kids
4. Bicarb is acidemic
5. Hemodialysis PRN (if severe)
Mild/Moderate
1. Loop diuretics (K wasting)
2. Sodium polystyrene sulfonate (SPS, Kayexalate)-exchange resin (Na for K)-induces diarrhea
-oral preferred (over enema-must always use premade product if use enema)
-caution in patients with ileus (causes intestinal necrosis) |
|
|
Term
| primary intercellular cation |
|
Definition
|
|
Term
| What tightly regulates K? |
|
Definition
| Na/K/ATPase pump (insulin, catecholamines, acid/base balance) |
|
|
Term
|
Definition
| Primarily ICF (67% bone and 20% muscle) |
|
|
Term
| What is the second most abundant ICF cation |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What factors affect Mg reabsorption in the loop of Henle? |
|
Definition
1. Serum Mg levels: b/c no hormonal control movement is concentration dependent
2. Intraluminal Na and ECF volume status: decreased ECF volume causes increased Mg reabsorption (b/c decreased luminal flow and increased Na reabsorption) AND low Na diet causes increased Mg reabsorption
3. PTH increases Mg reabsorption |
|
|
Term
| What are the central roles of Mg |
|
Definition
cellular function and cofactor in numerous biological reactions (especially systems depending on ATP) and enzymes
Also:
1. mitochondrial and cell membrane function
2. protein synthesis
3. PTH secretion
4. nerve conduction, membrane stabilization
5. INHIBITS CALCIUM CHANNELS |
|
|
Term
| Hypomagnesemia is most common is what kind of patients? |
|
Definition
|
|
Term
|
Definition
1. GI losses: decreased absorption/intake (ex: alcoholism), increased loss
2. Renal losses: most common with loops and thiazides (also with foscarnet, aminoglycosides, amphotericin)
3. Commonly associated with hypocalcemia |
|
|
Term
| T or F: Serum Mg = total body Mg |
|
Definition
| False-most in cells so poor reflection |
|
|
Term
| Clinical Presentation of hypomagnesemia |
|
Definition
Mild to moderate: 1-1.5 mEq/L
Severe: <1 mEq/L
typically asymptomatic BUT other electrolyte abnormalities (low K, Ca) can be present and difficult to assess Mg deficit alone
MOST prominent symptom: HYPOCALCEMIA (possibly due to PTH secretion, decreased vit D, skeletal resistance to PTH) |
|
|
Term
| Signs and Symptoms of hypomagnesemia |
|
Definition
Neuromuscular: tetany, twitching, weakness, seizures, coma, ataxia, tremor
GI: N/V
CV: HEART PALPITATIONS and ARRHTYMIAS-torsades de pointes (digoxin induced, ventricular fibrillation)
Moderate to severe: prolonged PR interval, progressive widening of QRS complex, flattened T waves |
|
|
Term
| Treatment of hypomagnesemia |
|
Definition
Mild-moderate: Magnesium oxide 400-800 mg TID-QID (60% elemental)--Diarrhea is dose-limiting
Severe: IV MgSO4 (1 gram = 8.12 mEq)
may require 8-12 g in the first day then 4-6 g/day for 3-5 days
Decrease dose by 50% in kidney disease
*Must correct hypoMg before other electrolyte disturbances |
|
|
Term
| Hypermagnesemia occurs when _______. |
|
Definition
| when intake exceeds kidneys' ability to excrete (stage 4-5 CKD, elderly) |
|
|
Term
| T or F: hyperMg is very uncommon |
|
Definition
| T and symptoms are rare when Mg<3mg/dl |
|
|
Term
|
Definition
Rare unless Mg>3 mg/dl
Listed by increasing severity:
sedation
Hypotonia
Hporeflexia
Somnolence
Coma
Muscle paralysis
Respiratory depression
Complete heart block
Asystole |
|
|
Term
|
Definition
Decrease Mg intake
Loop diuretics to promote excretion
Antagonize Mg physiologic effects with Ca (use IV calcium chloride 10%--avoid PO Ca) |
|
|
Term
| What is first line therapy for hyperkalemia with ECG changes? |
|
Definition
|
|
Term
| You shouldnt exceed ____ mEq with potassium tablets |
|
Definition
| 60 mEq--better tolerated with food |
|
|
Term
| Sign of chromium deficiency |
|
Definition
|
|
Term
| sign of selenium deficiency |
|
Definition
|
|
Term
| sign of copper deficiency |
|
Definition
| anemia, hematological changes |
|
|
Term
|
Definition
alopecia
decreased wound healing
diarrhea |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how often should you check pre-albumin in high risk patients? |
|
Definition
|
|
Term
| what is the normal levels of prealbumin? |
|
Definition
18-38 in women
20-40 in men |
|
|
Term
| T or F: prealbumin is a precursour for albumin |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Normal serum level of albumin |
|
Definition
|
|
Term
|
Definition
| protein energy malnutrition (aka Marasmus) |
|
|
Term
| What type of malnutrition in protein deficient but not calorie deficient? |
|
Definition
|
|
Term
|
Definition
Quicker decline
hypermetabolic
hyperglycemic: increased insulin-->ressistance; high glucose prevents fat metabolism
Protein sparing effect (of burning fat) is minimal b/c of decreased fat metabolism
So patient who hasnt eaten in 4-5 days, is hyperglycemic (control with insulin drip), very protein deficient (give proteins), not burning fat but protein instead
Seen to result in death sooner than non-stressed starvation |
|
|
Term
|
Definition
| Nitrogen(IN)-[Nitrogen(OUT) + 4g] |
|
|
Term
| Who soon after hospitalization should nutritional screening take place (according to JACHO) |
|
Definition
|
|
Term
| Nutritional Screening vs Nutritional Assessment |
|
Definition
Screening: by a nurse within first 24 hours to determine risk of malnourishment
Assessment: done by a dietician for patients who are "at risk" + monitored throughout stay |
|
|
Term
| Low albumin can result in what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| KY ranks _____ in overweight people |
|
Definition
|
|
Term
| Modest weight loss SIGNIFICANTLY reduces mortality due to what? |
|
Definition
| diabetes related conditions |
|
|
Term
two low fat diet
what was the reason for such a high failure rate? |
|
Definition
1. Pritikan diet
2. Ornish Diet Plan
Severe fat restriction was too stringent |
|
|
Term
| What is the ideal ratio for omega-6:3 |
|
Definition
4:1 or 6:1
(currently 20:1 up to 50:1) |
|
|
Term
|
Definition
| goes to arachadonic acid-->inflammatory prostaglandins + TXA=vasoconstriction |
|
|
Term
| Omega-6 are ______ series and omega-3 are ______ series |
|
Definition
Omega-6 are even series-->TXA2, PGE2
Omega-3 are odd series-->TXA3 (much less clotting and inflammation) |
|
|
Term
| What are the two metabolites of omega-3 FA |
|
Definition
|
|
Term
| What is the key concept of the omega-3 FA diet? |
|
Definition
Minimize omega-6, not just add fat sources
(ex: eat fatty fish at least 2 times per week)
good for CV patients |
|
|
Term
Linoleic acid is omega-___
Linolenic acid is omega-___ |
|
Definition
Linoleic= omega-6
Linolenic= omega-3 |
|
|
Term
| Which type of fat is most dominant in the Mediterranean diet? |
|
Definition
|
|
Term
| what is the American equivalent to the Mediterranean diet |
|
Definition
| Sonoma Diet-low cal low sugar |
|
|
Term
| what diet is the same as the low GI index + high fiber |
|
Definition
|
|
Term
| What is a big problem with using meridia for weight loss? |
|
Definition
| people with CAD, CHF, arrhythmias, or stroke history should NOT take it...mainly seen in overweight people who are most interested in taking this drug |
|
|
Term
| T or F: dietary supplement labels can NOT claim that the product can diagnose, prevent, mitigate, treat, or cure a specific disease |
|
Definition
| T: that would be a drug if they could |
|
|
Term
|
Definition
1. inability to absorb adequate nutrients (massive small bowel resection, short gut syndrome)
2. Bone marrow transplant with GVHD (graft vs. host disease) of the gut or chronic malabsorption from RADIATION
3. Severe ACUTE pancreatitis requiring bowel rest for 7-10 days
4. Enterocutaneous fistulas
5. Enteral feeding access not possible due to upper GI obstruction
6. Low birth weight infants |
|
|
Term
|
Definition
1. NPO over 7-10 days
2. Malabsorption from radiation/chemo
3. major GI surgery with suspected bowel ischemia
4. post-op small bowel obstruction
5. severe brain injury with enteral access not acheived within 72 hr
6. ongoing GI hemorrhage
7. prolong use of vasopressors, unable to advance enteral nutrition toward goal (decreased blood supply to GI-ischemia) |
|
|
Term
| why dont we give TPN in the terminally ill? |
|
Definition
| TPN is a medical treatment (so not with Hospice patients) |
|
|
Term
|
Definition
|
|
Term
| IV Fat emulsions are what type of fat? |
|
Definition
|
|
Term
| what type of fat is only given PO? |
|
Definition
|
|
Term
| what vitamin must be added to TPN separately? |
|
Definition
|
|
Term
| what trace element should you not give to people in renal failure without dialysis |
|
Definition
|
|
Term
| what trace elements should you not give in cholestatic liver disease? |
|
Definition
|
|
Term
| what electrolyte should be added last to TPN? |
|
Definition
| Phos (add Ca first to interact with AA-becomes monobasic, less likely to react with Phos)--main thing is to make sure they are separated |
|
|
Term
| Things that help decrease the risk of Calcium-phos precipitation |
|
Definition
1. lower concentrations
2. acidic pH
3. higher AA concentrations
4. lower temps
5. separate when mixing
6. faster infusion rate
**use CaCl2 salt (not carbonate) |
|
|
Term
| Things to do to decrease chance of bacterial growth in TPN |
|
Definition
1. acetate (CAA) > 35 mEq/L-prevents bacterial growth (EXCEPT candida)
2. acidic and hypertonic not ideal for bacterial growth
3. Decrease Candida growth by cooling to 4 degrees C
4. Infuse within 36 hr of making***MVI have 36 hr BUD once added
5. Alb increases growth so try not to include in TPN |
|
|
Term
| Medications often added to TPN |
|
Definition
Insulin-can stick to bag (variable infusion levels)
H2RA-famotidine
Heparin
Do NOT ADD: Alb or Iron Dextran (would be ok, but nothing else in compatible to it) |
|
|
Term
| Even though peripheral TPN decreases infection rate what are 2 issues? |
|
Definition
1. large volume
2. phlebitis (>600 mOsm) |
|
|
Term
|
Definition
| peripherally inserted central catheter |
|
|
Term
| big issues with TNA vs. TPN |
|
Definition
TNA:
cant filter with 0.22 micron filter (standard with TPN)
cant visually detect particulate matter (ex: Ca-PO4 PPT)
Enhanced microbial growth potential-extended fat hang time |
|
|
Term
| How to begin TPN administration |
|
Definition
start at 25 mL/hr x 8 hr
increase by 25 ml/hr Q8H until goal
if blood sugar >250 do not increase rate
TO D/C TPN:
taper by 25 mL/hr Q6-8H OR
decrease by 1/2 rate for 3-6 hr
**Concern of hypoglycemia if stop too fast (b/c insulin has longer 1/2life than glucose)
NOTE: no need to taper if other food source (Ex: started PO or enteral) |
|
|
Term
|
Definition
| percutaneous endoscopic gastrostomy (sam as G-tube) |
|
|
Term
| What is the smallest enteral feeding tube? |
|
Definition
J-tube (4-10 French)
*easily clogged |
|
|
Term
| which enteral tube do you not usually put food down? |
|
Definition
| NG-tube, usually just meds |
|
|
Term
| How to begin Enteral Feeding: |
|
Definition
1. slow at first to determine tolerance (at 10 mL/hr)
2. increase by 10-25 mL/hr Q6-8H if feeding continuously
3. DO NOT dilute isotonic formulas--no benefit |
|
|
Term
| Which type of protein is easiest to absorb? Intact proteins, small peptides, or free amino acids? |
|
Definition
| Small peptides (usually absorbed as tri- and dipeptides) |
|
|
Term
| T or F: all enteral formulas contain fiber. |
|
Definition
|
|
Term
| T or F: all enteral formulas contain linoleic and linolenic acid fats. |
|
Definition
|
|
Term
| When is it good to give someone MCT? |
|
Definition
| Enteral-when patient cant produce lipase (ex: CF kids, pancreatic CA, some diabetics) |
|
|
Term
| When are hypertonic enteral formulas a concern and why? |
|
Definition
| when they are given into the lower GI tract because they can cause diarrhea (if given at top, can decrease tonicity by end) |
|
|
Term
| T or F: Metamucil can go down a tube feed? |
|
Definition
F-will 'concrete it'
soluble fiber is ok down tube |
|
|
Term
| if enteral tube gets clogged what should you do? |
|
Definition
|
|
Term
| What can cause diarrhea in enteric feeding? |
|
Definition
drugs! (ex: KCl if not enough water)
sorbitol
prolonged antibiotics
hyperosmotic feeding
laxatives
hypoalbuminemia-bowel edema
lactose intolerance/fat malabsorption
rapid GI transit
low-residue intolerance (lack of bulk)
bacterial contamination (change bag Q24H) |
|
|
Term
| issue with digoxin and enteral nutrition |
|
Definition
| Digoxin undergoes acid hydrolysis normally in stomach--if bypass stomach can get higher levels |
|
|
Term
| Cipro + other fluoroquinolones and EN |
|
Definition
with J-tube: decreased absorption of drug
binds to EN protein, chelation with cations (?)
hold tube feed (cipro), adjust dose, or give in duodenum
Moxi:best F with EN |
|
|
Term
| Sevelamer issues with tube feeding |
|
Definition
| Clogs tube feed (same with other viscous/thick meds) |
|
|
Term
| What is the issue with acidic medications and enteral nutrition? (examples) |
|
Definition
Curdles intact protein (dont mix with enteral nutrition products)
Ex: KCl, guafenesin, in flavorings |
|
|
Term
| What is the issue with giving elixirs with enteral nutrition? |
|
Definition
| precipitates inorganic salts in enteral formula |
|
|
Term
| Can you give microencapsulated drugs via feeding tube? |
|
Definition
Sometimes-if the tube is large enough
Do NOT crush the microcapsules
How:
Mix pellets with water or acid and flush down feeding tub
Careful about potentially clogging tubes
Ex: Diltiazem, ferrous gluconate, nizatidine, pancreatic enzymes, verapamil |
|
|
Term
| Issues with phenytoin and EN |
|
Definition
phenytoin has decreased absorption with EN
hold tube feed for 1 hour before and after |
|
|
Term
| Issues with itraconazole and EN |
|
Definition
decreased absorption (improved in fasted state)
hold tube feed 1 hr before and after (or double dose) |
|
|
Term
| Issues with levothyroxine and EN |
|
Definition
decreased absorption, but better when fasted
hold tube feed before and after for 1 hr (or adjust dose) |
|
|
Term
| Issues with warfarin and EN |
|
Definition
with VITAMIN K Enteral formulas
+Warfarin can bind to proteins in EN formula
transitioning to PO may reduce dose (if increased it to compensate for vit K)
HOLD tube feed 1 hr before and after (or adjust dose based on INR if continuous EN) |
|
|
Term
| Issues with carbamazepine and EN |
|
Definition
decreased absorption because sticks to tubing
Dilute suspension and monitor efficacy
hold tube feeding if not Gastric (dont hold if in stomach) |
|
|
Term
|
Definition
Enteric coated
Cant crush and mix with water because will be less effective
For liquid preparation-need to dissolve in bicarb
Zegerid omeprazole and bicarb powder
Lansoprazole granule packets have xanthan gum--clogging |
|
|
Term
| How much water should be used to flush EN tube before and after each medication? |
|
Definition
|
|
Term
| Which tube is preferred for medications placement in EN? |
|
Definition
G-tube
1. larger tube
2. less irritation by meds
If cant give med via G-tube, must finely crush and mix with ~60 mL water for J-tube |
|
|
Term
|
Definition
AA + Dextrose -->browning
instability issue (seen with PN) |
|
|
Term
|
Definition
| cimetidine and famotidine greater stabilty than ranitidine |
|
|
Term
| what vitamin is added in greater amounts when at risk for refeeding syndrome? |
|
Definition
|
|
Term
| Ca/PO4 PPT safety factors |
|
Definition
(mEq of Ca + mM of Phos) x 100/ PN Volume
for AA concen over 2.5% factor should be less than 4
Easier Way: (if AA concen >4%)
for 2:1: Ca x P less than 300
for 3:1: Ca x P less than 150 |
|
|
Term
| T or F: positive charges can be disruptive to PN? |
|
Definition
| T, can be disruptive to emulsifier (fats) in TNA |
|
|
Term
| For extended dating on TNA bags--homecare stabilty guidelines |
|
Definition
| AA concen at least 4% Dextrose at least 10% Fats at least 2% sum of divalent cations less than 20-25 mEq/L sume of monovalent cations less than 150-200 mEq/L |
|
|
Term
| who should NOT get 3:1 PN? |
|
Definition
pediatrics--they require high Ca/Phos concentrations--too risky
L-cysteine is added which is good for Ca/Phos but disrupts fat emulsion |
|
|
Term
| Aluminum concentration is limited in PN |
|
Definition
limited to 25 mcg/L
renal function and CNS toxicity |
|
|
Term
| What is the filter size for a 2:1? 3:1? |
|
Definition
2:1: 0.22 micron
3:1: 1.2 micron
dont remove filters |
|
|
Term
| what is given to decrese catheter related occlusions? |
|
Definition
low dose warfarin
give alteplase for suspected thrombus |
|
|
Term
| PN and Ceftriaxone issues |
|
Definition
Ceftriaxone warning with IV Ca--precipitate
contraindicated in neonates
Flush line thoroughly in other patients
Can also try to hold Ca from PN for ~48 hrs after last rocephin dose
Consider ceftriaxone alternatives |
|
|
Term
|
Definition
| can cause dose dumping-dont take with food |
|
|
Term
| What is the hallmark sign of refeeding syndrome? |
|
Definition
hypophosphatemia (hypoMg and hypoK)
(edema, thiamine and folate deficiencies) |
|
|
Term
| T or F: for EN elixirs and susp are favored over syrups |
|
Definition
|
|
Term
| T or F: you can dilute hypertonic meds for EN |
|
Definition
|
|
Term
| What are some drugs that have acid-dependent absorptions? |
|
Definition
Fe
carbamazepine
ketoconazole
itraconazole
tetracyclines |
|
|
Term
| during stress your body runs out of which AA? |
|
Definition
| arginine (conditionally essential) |
|
|
Term
| what electrolyte is of great concern in kidney disease? |
|
Definition
| Phosphorus (even on dialysis have trouble eliminating) |
|
|
Term
| T or F: restricting Na in the diet is critical in liver disease |
|
Definition
|
|
Term
| Severe chronic protein restriction in liver disease will result in ________. |
|
Definition
| Protein Calorie Malnutrition |
|
|
Term
| patients with short bowel will most benefit from what type of enteral formula? |
|
Definition
semi-elemental (small di and tri peptides)
have MCT oil for easiest abosprtion
also used when transitioning from TPN to EN |
|
|
Term
| What are specific needs in surgery, trauma, and burn patients? |
|
Definition
HIGH:
Calories
Protein
K
Phos
Supp:
vit C
glutamine, arginine, omega-3->immune function
selenium
BCAA
Increased zinc for wound healing |
|
|
Term
| What is the greatest concern when feeding COPD patients |
|
Definition
Dont overfeed them
Increased CHO-->CO2 which they are already retaining
can give fats (least amount of CO2)--BIG DIARRHEA
still maintain high protein diet |
|
|
Term
| Issues with feeding ARDS patients |
|
Definition
Supplement omega 3 FA and decrease/eliminate omega 6
omega 6= inflammation
ARDS (Acute Respiratory Distress syndrome) associated with severe inflammation |
|
|
Term
| What drug stimulates lipoprotein lipase activity and possibly improves IVFE associated hyper-triglyceridemia? |
|
Definition
|
|
