Renal: Electrolytes & Fluids

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Author:
jcbarbery
ID:
215303
Filename:
Renal: Electrolytes & Fluids
Updated:
2013-04-23 10:49:55
Tags:
renal kidney fluids electrolytes
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Description:
Overview of fluid and electrolyte repletion and management strategies
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  1. Maintenance Fluids
    1500 mL + 20/kg > 20
  2. Hypovolemia
    • Acute weight loss
    • Tachycardia
    • Orthostasis
    • Dry membranes
    • Dec. skin turgor
    • BUN:SCR >20:1
  3. Hypervolemia
    Acute Weight Gain

    Edema
  4. Assessment
    Fluids 1st -> Na
  5. Hyponatremia Stages
    Normal 135-145

    • Mild 125-130
    • Moderate 115-125
    • Severe 110-115
  6. Hyponatremia Presentation
    Usu. asymptomatic

    Nausea, malaise, HA, lethargy, restlessness, disorientation, seizures, coma, depressed reflexes
  7. Hypovolemic Hyponatremia Causes
    • External losses (GI, Skin, Lungs)
    • Renal losses
    • Diuretics
    • Adrenal insufficiency
  8. Hypovolemic Hyponatremia Tx
    • Asymptomatic / Na > 120 -> NS
    • Symptomatic / Na < 120 -> 3% NaCl

    Goal: Na inc. <12mEq/L in 24h

    Avoids risk of pontine demyelination (paralysis)
  9. Hyponatremic Hypervolemic Causes
    • CHF
    • Cirrhosis
    • Nephrosis
  10. Hyponatremic Hypervolemia Tx
    Treat underlying cause

    Fluid ; Na restriction (<1L/d ; 1-2g/day)
  11. Hyponatremic Euvolemic Causes
    • Hypothyroidism
    • Hypocortisolism
    • Renal failure
    • SIADH
    • 1o polydipsia
    • Low solute intake
  12. Hyponatremic Euvolemic Tx
    Remove underlying cause

    <1L/day fluids

    Conivaptan 20 mg IV bolus then 20 mg IV cont. infusion QD x 4d

    OR

    Tolvaptan 15 mg PO x 1d -> 30 mg QD

    OR

    Demeclocycline 300 mg PO TID
  13. Hypernatremic Presentation
    • Lethargy
    • Weakness
    • Confusion
    • Restlessness
    • Irritability
  14. Hypovolemic Hypernatemia Etiology
    • Renal
    • Adrenal
    • GI
    • Lungs
    • Skin
  15. Hypovolemic Hypernatremia Tx
    0.45% NaCl or D5W

    NS if hypotensive (<90)

    Goal Na dec <12/24h

    (Avoids cerebral edema)
  16. Hypervolemic Hypernatemia Etiology
    • Na Overload
    • Mineralocorticoid excess
  17. Hypervolemic Hypernatemia Tx
    • Loops (Furosemide 20-40 mg q6-12h)
    • dec. Na <12/24h
  18. Euvolemic Hypernatemia Etiology
    • Diabetes insipidus
    • Skin loss
    • Iatrogenic
    • Osmotic diuresis
    • Primary polydipsia
  19. Euvolemic Hypernatemia Tx w/Central DI
    Desmopressin 10 mcg QD intranasal
  20. Euvolemic Hypernatemia Tx w/Nephrogenic DI
    • remove/treat cause
    • <2g Na QD
    • Thiazides (HCTZ 25-50 mg PO QD)

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