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Electrolytes used for Replacement Therapy

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allelipraise's version from 2017-06-22 20:20

Section 1

Question Answer
Sodium Chloride, USP0.9% w/v (Isotonic);Used as wet dressings, irrigating body cavities or tissues, and as injections when fluid and electrolytes have been depleted.
Table saltContains silicates (prevent caking and adds to the product’s pouring qualities), KI (to prevent goiter)
Sodium Chloride“As effective as blood plasma in the emergency treatment of shock from serious burns and other injuries”
Hypotonic SolutionsAdministered for maintenance therapy when patients are unable to take fluid and nutrients orally for 1-3 days.
Dextrose (Glucose)Caloric source
Hypertonic SolutionsUsed when there is loss of sodium in an excess water.
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Section 2

Question Answer
Potassium Chloride, USPDOC for oral replacement of potassium (preferably as a solution) • Irritating to the GIT, therefore it must be well diluted.
KCl Tablets (Kalium Durules ®)USP requires it to be enteric-coated (can cause ulceration)
KClIV Serum potassium concentration, ECG and urinary output must be monitored!
Potassium ChlorideIndicated in the treatment of familial periodic paralysis
Potassium Chloride• Meniere’s syndrome • Antidote in digitalis intoxication • Adjunct drug for Myasthenia Gravis • Effective as diuretic
Potassium ChlorideContraindications: – Patients with impaired renal function with oliguria – Acute dehydration – Hyperpotassemic conditions – Patients receiving potassium-sparing drugs.
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Section 3

Question Answer
Calcium ChlorideCaCl2.2H2O
Calcium Chloride• Irritating to the veins, therefore, should be injected slowly. • Contraindicated in hypocalcemia associated with renal insufficiency
Calcium ChlorideCalcium source in many commercially available electrolyte replacement and maintenance solutions.
Calcium Chloride • Tachhydrite (CaCl2.2MgCl2.12H2O) • Deliquescent
Calcium GluconateTreatment of choice for hypocalcemia
Dibasic Calcium Phosphate– Calcium Monohydrogen Phosphate – Secondary Calcium Phosphate – Dicalcium Phosphate
Dibasic Calcium PhosphateGiven orally as a source of Ca and P (1:1); most frequently recommended for oral consumption as an electrolyte replenisher. • Insoluble in water, but soluble in acid
Tribasic Calcium PhosphateTricalcium phosphate; tertiary calcium phosphate; precipitated calcium phosphate
– Oral source of Ca and P – Antacid– Oral source of Ca and P – Antacid
Ca3(PO4)2Variable mixture of phosphates equivalent to nlt 90% Ca3(PO4)2
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Section 4

Question Answer
Magnesium SulfateUsed as a CNS depressant in the treatment of: – Eclampsia – Severe cases of hypomagnesemia (+ tremors and seizures) – Magnesium-deficient alcoholics
Magnesium SulfateOvertreatment can cause: – Respiratory paralysis and cardiac depression – Antidote: Calcium salts (gluconate)
Magnesium SulfateEpsom Salt
Magnesium SulfateAntidote for barium, barbiturate poisoning.
Magnesium Sulfate Injection– Depressant – Seasickness, hypertension, tetanus spasm, and convulsions. – Used in paroxysmal auricular and ventricular tachycardia by the IV route. – Cathartic (15 g) – Anticonvulsant (1g)
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Section 5

Question Answer
Normal Acid-Base Balance• The buffer system (body fluids and RBCs) • The pulmonary excretion of excess carbon dioxide • The renal excretion of either acid or base, whichever is excess.
Major Buffer System • Bicarbonate/CarbonicAcid • Monohydrogen Phosphate/Dihydrogen Phosphate
HemoglobinMost effective single system for buffering carbonic acid.
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Section 6

Question Answer
Respiratory Control – LungsHelp regulated acid-base balance by eliminating or retaining carbon dioxide
Respiratory Control – LungspH may be regulated by altering the rate and depth of respirations
Respiratory Control – Lungs• Changes in pH are rapid, occurring within minutes • Normal CO2 level: 35-45 mmHg
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Section 7

Question Answer
Renal Control – Kidney• Long-term regulator of acid-base balance • Slower to respond; may take hours or days to correct pH
Renal Control – Kidney• Kidneys maintain balance by excreting or conserving bicarbonate and hydrogen ions • Normal bicarbonate level: 22-26 mEq/L
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Section 8

Question Answer
Acid-Base ImbalancesAcidosis/Alkalosis
Acidosis– High blood [H+] – Low blood pH, <7.35
Alkalosis– Low blood [H+] – High blood pH, >7.45
Electrolytes Used in Acid-Base Therapy:MetabolicAcidosis– Sodium Bicarbonate – Sodium Lactate – Sodium Acetate – Sodium Citrate (occasional)
Electrolytes Used in Acid-Base Therapy:MetabolicAlkalosis– Ammonium Salts
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Section 9

Question Answer
Sodium AcetateCH3COONa.3H2O
Sodium AcetateRestores blood pH and plasma bicarbonate in patients suffering from metabolic acidosis of acute cholera.
Sodium Acetate• For uremic acidosis • Used as a diuretic, urinary alkalizer, and systemic antacid or alkalizer.
Sodium AcetateGood catalyst for acetylation reactions in organic chemistry
Sodium AcetateWhen absorbed, it is easily oxidized in the tissues to sodium bicarbonate: CH3COONa + 4O  NaHCO3 + H2O + CO2
Sodium AcetateDiuretic (in the treatment of cystitis and diseases of the urinary tract associated with highly acid urine).
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Section 10

Question Answer
Potassium AcetateCH3COOK
Potassium Acetate• Diuretic and Urinary Alkalizer • Can also act as antacid • All precautions for KCl apply to potassium acetate
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Section 11

Question Answer
Sodium Bicarbonate (NaHCO3)Sodium acid carbonate; sodium hydrogen carbonate; baking soda; bicarbonate of soda
Sodium Bicarbonate (NaHCO3)When heated, the salt loses water and carbon dioxide into the normal carbonate
Sodium Bicarbonate (NaHCO3)When it reacts with acid, it always liberates gas. – Effervescent Tablets
Sodium Bicarbonate- PhenolphthaleinDistinguishing Test between HCO3- and CO32-? –
Sodium Bicarbonate (NaHCO3)Used principally for its acid-neutralizing properties – Combats gastric hyperacidity – Combats systemic acidosis
Sodium Bicarbonate (NaHCO3)Buffer System • Has been shown to interfere with tetracycline absorption.
Sodium BicarbonateTreatment of methyl alcohol poisoning
Sodium BicarbonateIncreases the alkali reserve of the blood and to replace sodium ion in case of clinical dehydration.
Sodium Bicarbonate Injectionacidotic condition
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Section 12

Question Answer
Sodium BiphosphateNaH2PO4.H2O
Sodium BiphosphateSodium dihydrogen phosphate,Sodium acid phosphate
Sodium Biphosphate• Urinary acidifier • Laxative and cholagogue • Marketed as Betaphos
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Section 13

Question Answer
Potassium BicarbonateKHCO3
Potassium Bicarbonate• Officially classified as electrolyte replenisher • Component of oral effervescent potassium replacement solutions (K-lyte®) • Used as an antacid for people who must restrict their sodium intake – AE: hyperpotassemia
Potassium Bicarbonate• Antacid and diuretic • Carbonating agent in the preparation of Magnesium Citrate Solution • Utilized in the preparation of Potassium Arsenite Solution.
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Section 14

Question Answer
Sodium CitrateNa3C6H5O7.2H2O
Sodium CitrateAnticoagulant/Has a diuretic effect/• Buffer effect • SystemicAlkalizer
Citraterapidly metabolized to CO2 and H2O
CitrateUsed in chronic acidosis to restore bicarbonate reserve
Sodium CitrateSequestering agent – Benedict’s Solution
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Section 15

Question Answer
Potassium CitrateK3C6H5O7.H2O
Potassium CitrateSystemicAlkalizer/• Diuretic, expectorant, and diaphoretic • Slightly laxative
Component of Potassium Triplex®Along with Potassium Acetate and Bicarbonate
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Section 16

Question Answer
Sodium LactateNaC3H5O3
Sodium Lactated-lactate vs l-lactate
Sodium Lactate• Antacid and anti-ketogenic • Systemic alkalizer
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Section 17

Question Answer
Ammonium ChlorideNH4Cl
Ammonium Chloride– Ammonium muriate – Sal Ammoniac – Salmiac
Ammonium Chloride– Acid-base equilibrium of the body – Diuretic – urinary and systemic acidifier – Expectorant
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Section 18

Question Answer
Fluid maintenance Therapy Supplies normal requirements for water and electrolytes who cannot take them orally – Should always contain at least 5% dextrose – Na, K, Cl, HCO3, Mg, P, lactate or acetate
Electrolyte replacementHeavy loss of water and electrolytes (prolonged fever, severe vomiting, and diarrhea)
Electrolyte Combination Therapy:Two Types – Solution for rapid initial replacement – Solution for subsequent replacement
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Section 19

Question Answer
Ringer’s Injection– NaCl (0.86%) – KCl – CaCl2 (as dihydrate) – 147 mEq/L Na, 4 mEq/L K, 4.5 mEq/L Ca, 155.5 mEq/L Cl).
Lactated Ringer’s Injection Contains: – 0.6% NaCl – Sodium Lactate – KCl – CaCl2 (as dihydrate) – 130 mEq/L Na, 4 mEq/L K, 2.7 mEq/L Ca, 109.7 mEq/L Cl, 27 mEq/L Lactate)
Oral Electrolytes SolutionsLytren ® • Pedialyte ® • Used to replace mild to moderate fluid and electrolyte losses due to diarrhea and other conditions.
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