Fluid_Lyte_LectureFinal_2012

Diabetes insipidus gi causes vomiting ng suction

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Diabetes insipidus GI causes Vomiting NG suction Enterocutaneous fistula Diarrhea Osmotic laxatives (lactulose) Cutaneous causes Burns Excessive sweating
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Neurogenic (Central) Diabetes Insipidus Etiology Post-neurosurgery, idiopathic, other CNS injury Problem: ADH secretion is impaired Presentation Polyuria w/ slightly elevated Sosm Not hypernatremic unless no water access/thirst Relative euvolemia Diagnosis Low Uosm (50-400 mosm/kg) Water deprivation test + ADH administration Result uOsm > 600 mOsm/L
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Nephrogenic Diabetes Insipidus Etiology Reduced effect of ADH on distal kidney Lithium carbonate , tubulointerstitial kidney disease, congenital Problem: ADH secretion is appropriate but the kidneys are not responsive to it Presentation Polyuria w/ slightly elevated Sosm Not hypernatremic unless no water access/thirst Relative euvolemia Diagnosis Low Uosm (50-400 mosm/kg) Water deprivation test + ADH administration Result uOsm < 300 mOsm/L
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POTASSIUM
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Case # 6 A 67 y/o volunteer gardener arrives to her routine physician visit tired and weak. When asked she indicates that the weeds are out of control & she is just tired from to much work. Her PMH includes HTN, non-insulin dependent diabetes, & glaucoma. She takes furosemide 20 mg QD, diltiazem 90 mg QID, and metformin 500 mg BID. Her physical exam is unremarkable with the exception that her extremities & mucous membranes are dry. 154 / 98 / 15 87 Ca +2 8.7 Mg + 1.5 PO 4 2.9 3.1 / 22 / 1.6
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Case # 6 A 67 y/o volunteer gardener arrives to her routine physician visit tired and weak. When asked she indicates that the weeds are out of control & she is just tired from to much work. Her PMH includes HTN, non-insulin dependent diabetes, & glaucoma . She takes furosemide 20 mg QD, diltiazem 90 mg QID, and metformin 500 mg BID . Her physical exam is unremarkable with the exception that her extremeties & mucous membranes are dry . 154 / 98 / 15 87 Ca +2 8.7 Mg + 1.5 PO 4 2.9 3.1 / 22 / 1.6
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Causes of Hypokalemia <3.5 mEq/L Intake Diet Inability to eat K free PN Excess renal loss Diuretic therapy Phase of renal failure Primary hyperaldosteronism Corticosteroid tx Excess GI loss Vomiting Diarrhea GI suction Gi fistula drains Shifts β-adrenergic agent Insulin administration Alkalosis
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EmergMedClinNAm5;23:723 Etiologies of Hypokalemia
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Drug-Induced Hypokalemia MOA: Transcellular Shifts Β 2 -Receptor Agonists Epinephrine Albuterol Terbutaline Salmeterol Ephedrine Pseudoephedrine Tocolytic agents Ritrodrine Theophylline Caffeine Insulin overdose
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Drug-Induced Hypokalemia MOA: Enhanced Renal Excretion Diuretics Acetazolamide Thiazides Metolazone Furosemide Torsemide Bumetanide Ethacrynic acid High-dose PCN Nafcillin Ampicillin Penicillin Mineralocorticoids Aminoglycosides Amphotericin Cisplatin
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Drug-Induced Hypokalemia MOA: Enhanced Fecal Excretion Sorbitol Sodium polystyrene
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