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Fluid/Electrolytes, Renal, Acid-Base

Terms in this set (22)

What is fluid balance? This occurs when what two things are present in the proper proportion? What % of body weight is water? What are the two major fluid compartments and what are their percentages? 2 components of the second? is ECF higher or lower in infants? More or less likely for fluid loss?

What is body fluid made of? 1 L of water is how many pounds? If women have more fat, is their TBW higher or lower? More susceptible to what?
Amount of fluid consumed equals fluid lost (pee, poo, sweat, exhaled)
Solvents and solutes
60%
ICF-40% of bw, 2/3 of TBW
ECF-20% of bw, 1/3 of TBW
Intravascular and interstitial
Higher
More

Water, electrolytes, solutes
1 kg or 2.2 lbs
Lower (water and fat don't mix)
Dehydration
For infants, what % of their body weight is water? Do they have higher or lower BMR? Is their BSA higher or lower, and what does this mean is greater? Related to size, are intake and output greater or lower? True or false: urine is more concentrated? At risk for?

For the elderly, is their TBW decreased or increased? Kidney efficiency? Thirst regulation better or worse? Risk for?
80%
Higher
Higher, more water loss
Greater
False
Dehydration

Decreased
Low
Worse
Dehydration and hypernatremia
What 2 ways does fluid move? Fluid movement depends on what? Where does water move through between blood and tissues? What are the pressures? What two things contribute to osmotic pressure? Difference between the two pressures?

Define tonicity, osmolality/osmolarity, and osmotic activity. Osmolar gap?
Filtration and reabsorption
Permeabiity of membranes
Semipermeable capillary membranes-osmotic and hydrostatic pressure
Proteins and electrolytes
Hydrostatic-push Osmotic-pull

Compares osmolality of a solution to the normal osmolality of body fluids
Units of measure to calculate osmotic activity
One solution passes through a semipermeable membrane to dilute the concentration of solution on the other side
Difference between calculated and actual osmolality
Explain capillary and interstitial oncotic pressure. Explain capillary and interstitial hydrostatic pressure. What things does osmotic pressure pull and hydrostatic push? What is net filtration/starling forces?

Define diffusion. Facilitated diffusion? Membrane channels vs membrane carriers?

Define osmosis. Which way does water move with regard to concetration? What creates osmotic pressure? True or false, the greater the difference in solutes the greater the pressure?
Capillary-attract water from interstitial space into capillary via osmosis
Interstitial-attract water from capillary into interstitial space vi osmosis
Capillary (blood pressure)-pushed water from capillaries into interstitial space
Interstitial-pushes water from interstitial space to capillaries
Osmotic-na, glucose, proteins
Hydrostatic-fluid and pressure
Difference between the oncotic and hydrostatic pressures at the vascular bed

Movement of solutes from greater to lesser concentration
Movement of solutes from greater to lesser concentration via transport proteins
Channels-tunnels that allow ions and small, water soluble things to pass thru (sodium potassium chloride)
Carrier-binding sites for specific molecules like glucose and amino acids

Diffusion of water across a selectively permeable membrane
Lower to higher
The difference in solute concentrations
True
What are aquapores? What do they allow/what does pore size control? How do lipid soluble substances pass and where? What is permeability influenced by?

At the arteriolar end of the capillary bed, which force exceeds and where does fluid move from/to? Venous end? What system carries excess fluid and proteins in the tissues back to circulation?

What is the normal osmolarity of plasma, tissue fluid, and ICF? What happens with isotonic, hypotonic, and hypertonic fluids?

What are crystalloids? What are they used for and what can they be? Colloids, their use, what they can be, and examples?
water-filled gaps in the junctions between capillary cells
Allow passage of water-soluble substances
Size controls what moves out of the blood
Pass through endothelial cells by dissolving in the lipid bilayer (such as gas)
Histamine

plasma hydrostatic pressure, capillary into the interstitium
plasma osmotic pressure, interstitium to capillary
lymphatic system

300 mOsm/L
Hypotonic-into the cells and swell-from the blood
Isotonic-nothing
Hypertonic-out of the cells and shrink-to the blood

Iv solutions with electrolytes and other things that mimic the body's ECF
Replace fluid + promote urination
Iso, hypo, or hyper

Proteins, starches, and other large molecules
Draws water from cells into plasma
Hypertonic
Serum albumin, blood products
What hormone regulates sodium and how/where?

Explain the RAAS system process.

What is natriuresis? Where are natriuretic peptides made? What causes their release? Are they agonists or antagonists to the RAAS? What do they cause?

What does ADH/Vasopressin do? What stimulates the release of this? What do they detect? What does it signal and what happens as a result?
Aldosterone acts on the distal tubule to increase reabsorption of na and promote excretion of H and K


Low blood pressure triggers renal juxtaglomerular cells to release renin, angiotensinogen becomes ang1, ang1 converts to ang2 due to ACE, ang2 causes vasoconstriction and causes aldosterone release from renal cortex, sodium/water is retained, potassium is excreted, and bloodpressure is increased

Excretion of large amts of sodium via urine
Heart and vasculature
Increase in atrial pressure or arterial pressure
Antagonists
Vasodilation and increase sodium/water excretion to decrease BP

Acts on the collecting ducts to reabsorb water and slow urination
Posterior pituitary osmoreceptors
High sodium, decreased bp, decrease body fluid, and increased osmolality of body fluids
Thirst and reabsorption of water
Plasma osmolality decreases
What are symptoms of FVE? complications? Treatment?

What is one common manifestation of FVE/what is it? How does it occur? What are the factors that contribute to it? An increase in weight of 5-10% and an increase of more than 10% indicates mild/moderate or severe edema?

For FVE, what would happen to all the lab values: serum osmolality, sodium, hemoglobin, hematocrit, specific gravity?
High BP, HR, and RR
JVD, narrow pulse pressure, bulging fontanelles, ascites, confusion, seizures, SOB, crackles, weight gain
Impaired blood flow, slow wound healing, increased risk of infection, increased risk of pressure sores, and death from edema
Fluid restriction/diuretics

Edema
Fluid retention in tissues
Imbalance of filtration/rebasorption
Increase plasma hydrostatic pressure, decrease plasma oncotic pressure, increase cap permeability, decrease lymphatic drainage
5-10%, mild to moderate
More than 10%, severe

Decrease
Decrease
Decrease
Decrease
Decrease
What is FVD/dehydration and causes? What is isotonic dehydration, what is it most common with, and what occurs as a result? What are the symptoms of FVD? What are symptoms of hypovolemia? Treatment + should you give fast or slow dt cerebral edema? What would the lab values look like for this?

What is third-spacing? What can occur from this? Examples?

What is SIADH? What causes it? Manifestations? What happens to labs?

What is DI? Causes? Manifestations? What happens to labs?
Excessive loss of body water
Lack of intake, too much sweating, burns
When water and electrolytes are lost in equal proportions
Hypovolemia
Decreased blood volume and inadequate perfusion
Headache, thirst, dry skin, dry mm, fever, weight loss, decrease and concentrated urine, depressed fontanels
Decrease bp, increase hr, increase rr, weak pulse, postural hypotension, decrease vein filling, shock
Give fluid, stop loss
Slow
All increased

Fluid gets trapped in the interstitial/pleural/pericardial space which cannot be used/moved
Dehydration
Ascites, cardiac tamponade, and pleural effusion

Too much ADH
CNS, trauma, meningitis, tumors, stroke, plus medications like chemo, SSRIs, TCAS, and ADH
Retain water, hyponatremia, fluid into cells
All decrease except urine gravity

Too little ADH
Brain tumors, head trauma, kidney damage, idiopathic
Polyuria (5-12 L in 24 hrs), polydipsia, tachycardia, tachypnea, hypotension, dry skin, neurological symptoms
All increased except urine gravity
What is an electrolyte? What are the 4 processes they are involved in? Do fluids in all compartments contain these? When one electrolyte moves out of the cell, what happens?

What fluid compartment is sodium in and what does it account for? What does it regulate? What are its constituent anions? What are the 4 roles?

What are the values for hyponatremia? If there's decreased sodium in the plasma, what happens to cells? What group is this common in? What does it alter the ability to do and what signs occur as a result?

What are the two categories of causes and what are the examples in each? What anion is decreased also and what level? What should we cautiously use? What 4 things should we enact?
An element dissolved in solutions which separate into ions and carries electrical current
Neuromuscular impulses, body fluid osmolality, distribution of body fluids and electrolytes between compartments, and acid-base balance
Yes
Another takes its place

ECF-90% of ecf cations
Osmotic forces
NaCl and NaHCO3
Neuromuscular irritability, acid-base balance, chemical reactions, membrane transport

less than 136 mEq/L
Water goes in and they swell
Elderly

Depolarize/repolarize
Lethargy, confusion, depressed reflexes, coma, seizures

Actual loss-gi, renal, skin, and low-sodium diet
Dilution-iv fluids, intake, siadh, and edema
Chloride-less than 97
Gradually
Hypertonic iv solutions
Fluid restriction, monitor serum sodium, i/o, and weight
What are the values for hypernatremia? This causes what? Symptoms? Causes? What anion is increased also and what level? At what speed do we restore balance? What 5 things should we enact?

What fluid compartment is potassium in and what does it account for? What is the normal range? What mechanism helps maintain balance? Along with hydrogen and sodium, what does it help maintain? It is required for the deposition of what two substances in what two places? It plays a role in what two things in what two places? What is it regulated by? At what speed do we restore balance? What is the most efficient regulator of potassium and where is it reabsorbed? True or false, H+ impact K+.
Greater than 145 mEq/L
Water from ICF-ECF, intracellular dehydration
Dehydration, thirst, convulsions, tachycardia, muscle twitch
Too much aldosterone, iv na+ intake, oral na+ intake, water loss, decrease water intake, DI, renal failure, vomiting/diarrhea, and age
Chloride-Greater than 105 mEq/L
Gradually
Oral fluid intake, oral sodium restriction, isotonic IV like D5W, io, daily weight

ICF-98% or intracelllular cations
3.5-5.0 mEq/L
Na-K atpase
Electrical neutrality
Glucose and glycogen in skeletal muscle and liver
Cardiac conduction and nerve impulses to skeletal+smooth muscle
Diet, kidney, aldosterone, insulin secretion, pH
Gradually
Kidney, proximal tubule and loop of henle
True
What are the values for hypokalemia? Causes? Is it usually symptomatic or asymptomatic? Symptoms occur in relation to the rate of what? What are symptoms? Management, including the numbers for two of them?

What class is potassium chloride in? MOA/where it is excreted? Route?For the first route, what should you give it with? For the second, can you give iv push and what is the recommended rate? Is it a high alert med? Are there concentrated KCls allowed in nursng? Adverse effects? Contraindications? What do we monitor?
Less than 3.5 mEq
Diuretics, too much aldosterone, increased entry into cells, loss, decrease intake, insulin, sweating, drainage, excess IV infusion with no electrolytes, ICF shift (burn, trauma, starvation), GI
Asymptomatic
Depletion
Decreased neuromusclar excitability, smooth muscle atony causing constipation, hyperglycemia from glucose intolerance, cardiac dysrhythmias from delayed repolarization, and digoxin toxicity (they compete for same receptors on na k pump)
Correct acid-base imbalance, eat potassium-rich food (40-80 mEq/day), IV if necessary (10 mEq/hr), monitor cardiac function and digoxin therapy

Electrolyte supplement
Essential functions, excreted in urine
PO powder and gels, IV
Food and water
NO, 10 mEq/100 mL/hour of central infusion of 40 mEq/1000 mL MAX
Yes
No
Arrhythmia, bleeding, NV, diarrhea, hyperkalemia, rash
Hyperkalemia, kidney issues, hypersensitivity
Dig toxicity, kidney status, diuretics
What is the value for hyperkalemia? Causes? Symptoms? What can heart issues progress to? Treatment?
Greater than 5 mEq/L
K+ sparing diuretics and ace/arbs/aldosterone antagonists, po intake, iv intake, cell trauma, renal failure, adrenal insufficiency, acidosis, insulin deficiency, digoxin toxicity
Slow pulse, disordered membrane polarization causing neuromuscular issues, cardiac dysrhythmia
Peaked t wave and heart blocks
K restriction, fluids and loop diuretics, iv dextrose and insulin, calcium gluconate (decrease cell membrane excitability), sodium polystyrene sulfonate, sodium bicarb, dialysis
What is the normal range for calcium? What are their functions? Where is it absorbed and what vitamin plays a role? What is it regulated by and how? Is phosphorus directly or inversely proportional to calcium?

What are the values for hypocalcemia? Causes? SS? Treatment?
What are the values for hypercalcemia? Causes? SS? Treatment?
t9-10.5 mg/dL
Bone and teeth health, neuromuscular, blood clotting, cell functions
Gi system, D3
Kidneys through PTH which increases serum ca and calcitonin which decreases serum ca thru inhibiting osteoclast activity
Inversely

Less than 9 mg/dL
Lack of d3 or ca intake, inactivity, decrease PTH, increase phosphorus, malabsorption (celiac or chrons), acute pancreatitis, chronic kidney disease, medications (loop diuretics, laxatives, mg)
Muscle spasms/hyperactivity, confusion, prolong st and qt intervals, and positive trousseaus/chvostecks sign
Monitor cardiac and muscle function, oral calcium, oral vitamin d, iv ca through a central line, medications like diuretics and lithium

Greater than 10.5 mg/d
HICAL GH
Hyperparathyroidism, intake, calcium excretion decreased (thiazide diuretics cancer kidney failure), adrenal insufficiency, lithium (decreases phosphorus), glucocorticoids (prevent bone reabsorption of ca), and hyperthyroidism
Muscle weakness/hypoactivity, kidney stones, prolonged st interval shortened qt interval
Monitor cardiac, renal, neuro, and Gi function, decrease ca intake, give fluids, consider medications liike lithium and diuretics
What is the journey of water from mouth to exit? What are the 7 major functions of the renal system and the assessments/lab tests for each, as well as overall kidney functin?
Mouth, esophagus, stomach, intestines, absorb, liver, inferior vena cava, heart, lungs, heart, orta, abdominal aorta, afferent arterioles, bowmans capsule, glomerulus, proximal tubule, loop of henle, distal tubule, collecting duct, ureter, bladder, urethra, out

FE balance (Na, cl, k, weight alterations)
Acid-base balance (H, HCO3, and pH)
Excretion of metabolic waste (Bun, uric acid, creatinine)
Excretion of bioactive substances (medication blood levels)
Regulation of arterial BP (blood pressure)
Regulation of RBC production (CBC)
Regulation of Vitamin D production (Vitamin D and calcium)
Kidney function (output, GFR, UACR)
What determines GFR? What regulates this? What is the normal rate of filtration formation and how much filtrate is made per day? How much of the rate is reabsorbed and how much actually ends up in urine? What is the average output of urine? Minimum? What kind of transport is used in tubular reabsorption?

For the proximal tubule, what % of reabsorption of water and electrolytes are reabsorbed here? Which electrolytes are reabsorbed here? Is it highly or barely permeable to water? If glucose levels are high, what will happen? What is secreted here?

What does the Loop of Henle control? What hormone influences it? What occurs in the descending and ascending limb/what processes and what can't happen?

What cannot be absorbed in the distal tubules and collecting duct? What medications act on these and what does the last do? What other two things occur here?
Capillary filtration pressure, colloid/capillary osmotic pressure, capillary permeability
Constriction and relaxation of arterioles, angiotensin II
115-125 mL/min, 180 L per day..... 1mL in urine, 124 mL absorbed
60 mL/hr, 30 mL/hr
Active and passive

65%
Na, K, Cl, HCO3
Highly
Glucose will spill into the urine
H+ and medications

Urine concentration
ADH
Descending-reabsorb waste/water
Ascending-Reabsorption of Na, Cl, and K through ATPase active transport BUT NO WASTE/water

Water and sodium
ADH, aldosterone, and thiazide diuretics which inhhibit NaCl reabsorption
Na and K exchange, regulation of K
Is acute renal failure reversible? What is altered? What are the morbidity and mortality rates like? Do we want to recognize and treat this early? What do we want to improve, discontinue, and what treatment?

What are the prerenal, intrarenal, and postrenal causes of renal failure? What can chronic kidney disease lead to? What are they staged based on? 3 Causes?
Yes
Decrease GFR, accumulation of Bun, and alteration in FE
High
Yes
REnal perfusion, nephrotoxic drugs, dialysis

Prerenal-decreased perfusion from things like lack of volume or hypotension
Intrarenal-direct nephron damage (lk,e drugs)
Postrenal-obstruction of urine flow from things like BPH, UTI, tumors, strictures, stenosis, calculi)
Loss of nephrons and failure
GFR
Diabetes, hypertension, glomerulonephritis
For diuretics overall, what is their MOA? What other ions can be lost? What are the 4 types of diuretics?

Name the primary loop diuretic. MOA? Use? Effectiveness? Adverse effects? Caution (2)?

Name the primary potassium-sparing diuretic. Strong or weak? MOA? Adverse effect? Do you take potassium?

Name the primary thiazide diuretic. Is this the least or most frequently prescribed? MOA? Use? Adverse effects? Caution?

Name the primary osmotic diuretic. hat is the MOA? Use? Side Effects? What kind of IV tubing? Whta do we assess and monitor?
Block sodium reabsorption thus decreasing water rebasorption
Mg, K, P04, Ca, HCO3
Osmotic, potassium sparing, thiazide, loop

Furosemide (Lasix)
Inhibit Na and Cl reabsorption in the loop of Henle, causing excretion of na, k, cl, and water
Fluid retention, CHF, liver and renal disease
Very
Dehydration, hypotension, hypokalemia
Digoxin toxicity, supplement potassium

Spironolactone aldactone
Weak
Block aldosterone's actions on the distal tubule which increases Na excretion and K retention
Hyperkalemia
No

Hydrochlorothiazide
Most
Acts on distal tubule to block reabsorption of Na
CHF, hypertension, edema
Dehydration, loss of Na, K, Cl
Dig therapy, supplement potassium, monitor BP and fluid balane

Mannitol (osmitrol)
Block reabsorption of water to increase the concentration of the filtrate
Cerebral edema
Pulmonary congestion, Fe imbalance, dry mouth, dehydration, thirst, headache, blurred vision, dizziness, nausea, chest pain
Filtered IV tubing
Renal function, CV status, and fluid balance
Extravasation
Name the nephrotoxic drugs. In a urinalysis, what should be the daily output? What should and shouldn't be present in urine? What is the GFR range and what number constitutes renal failure? BUN? Creatinine + what constitutes lack of renal function/what percent?

How is pH regulated? What are the lab values for uric acid? What produces this and what can high levels of this cause? How is urea or BUN produced + what does it correspond with? What produces serum creatinine? Which type of drugs are excreted in urine? Where is erythropoietin made and what does this cause? Where is vitamin D activated and what is the range for vitamin D?

What do we assess with relation to the kidney section?
Aminoglycoside, ace inhibitors, amphotericin B, cisplatin, cyclosporine, foscarnet, NSAIDS, pentamidine, contrast dyes
1500 mL/day, metaoblic waste no leukocytes proteins glucose
115-125 mL/min, below 60 mL/min
10-20 mg/dL
.6-1.3 mg/dL
Elevation up to 3 times=75% loss of function

Conservation of bicarbonate and elimination of hydrogen
.16-.51 mmol/L
Purine metabolism, gout and kidney stones
Protein metabolism, lower GFR
Muscle metabolism
Non-protein bound
Kidneys, RBC production
kidneys, 5-75 ng/mL

Lung sounds
VS
Fluid status
Urine output
Potassium
Edema
Weight
What does pH reflect/determine? How are acids formed? What is the body's normal pH and how is this maintained? Do small changes in H have a large or little effect? True or false, most conditions disrupt acid-base balance which is less harmful than the disease itself? In which direction is acidic and basic? Where is death?

What is the first system that maintains acid-base homeostasis? What compartments do these occur in? Name and explain the 4 buffers + make sure to state the first one's example. What is the limit + explain?

What are the two other systems? How is pH managed? What is the equation? Which system regulates Co2 and which regulates bicarb? What will each system do?
Reflect hydrogen concentration, determine acidity/alkalinity
The end product of metabolism
7.35-7.45, H is excreted or neutralized
Large
FALSE_more harmful
below 7.35 acidic, above 7.45 basic, death at 6.8 and 7,8

Chemical buffer systems
ICF and ECF
Protein-negatively charged and bind with hydrogen-mainly hemoglobin
Ionic shift-Intracellular K exchanges for extracellular H
Bone buffer-Ca and phosphate exchange, release carbonate
Carbonic acid-bicarbonate buffer
Capacity limit-binds free H but doesn't remove from body

Respiratory and renal
Balancing hco3- and h2co3
CO2 + H20-----H2CO3____H+ + HCO3-
Resp, renal
Resp-ventilation increase to expel or decrease to retain
Renal-acidic or alkaline urine
How long do the chemical buffer systems take? Lung ventiation, ionic shifts, kidney tubules, and bone?

What increases/decreases in acidosis? Alkalosis? What are the four categories of acid-base imbalance, what is elevated/decreased, and why?

What is the number for respiratory acidosis? What is another name for the elevated carbon dioxide in respiratory acidosis? What is the overall cause and what are four examples? What are the ss? Compensatory mechanisms? treatment?

What is the number for respiratory alkalosis? What 3 things cause this overall? What are the causes of this too? Are they acute or chronic? What are the ss? Compensatory mechanisms? Treatment?
Instantaneous
Minutes-hours
2-4 hours
Hours to days
Hours to days

Increase H, decrease HCO3
Decrease H, increase HCO3
Respiratory acidosis-increse in Pco2 due to ventilation depression
Respiratory alkalosis-decrease in pc03 due to alveolar hyperventilation
Metabolic acidosis-decrease of HCO3- or increase in noncarbonic acid
Metabolic alkalosis-increase in HCO3 caused by excessive loss of metabolic acids

PaCO2>45 mmHg
Hypercapnia
Acute respiratory failure (lung disease, disorders of the chest wall, respiratory depression, severe obesity)
CNS depression (like headache, vision issues, coma, tiredness, confusion), rapid shallow breathing, muscle tremors
Increase renal excretion of H and reabsorption of HCO3
Address underlying cause and give IV solutions containing lactate

PaCO2<35 mmHg
Hyperventilation, loss of CO2, a decrease of carbonic acid
Hypoxemia dt disease hf or high altitudes, fever, sepsis, mechanical issues with ventilation, anxiety
Both
Confusion, coma, dizziness, numbness, tingling
Increase renal reabsorption of H and excretion of HCO3
Address the underlying cause, rebreathe expired air, IV solutions containing chloride
What is the number for metabolic acidosis? What are the 5 causes? What are the SS? Compensatory mechanisms? Treatment?

What is the number for metabolic alkalosis? Causes? SS? Compensatory mechanisms? Treatment?
HCO3-<22 mEq/L
Renal dysfunction, severe diarrhea, lactic acidosis, ketoacidosis, aspirin overdose
Lethargy/headache/coma, cardiac dysrhythmia, NV, diarrhea
Hyperventilation (Kussmaul), kidney excretion of H and conservation of HCO3
Adress underlying cause, give IV with lactate

HCO3 > 26 mEq/L
HCO3- excess or H+ loss
Loss of acid (suctioning or vomiting)
Alkaline drugs (TPN LR antacid)
Muscle weakness/cramps/hyperactive reflexes, confusion, convulsions, atrial tachycardia
Respiratory hypoventialtion, renal excretion of HCO3 and conservation of H
Address underlying cause and give IV with chloride
Drugs:

Name the isotonic IV fluids. What are these used for? What to monitor? Name the hypotonic IV fluids. What to monitor? What are these used for? Name the hypertonic IV fluids. What are these used for? How to administer?

Name the four colloids. What are these used for and what effect do they have?

How does sodium bicarb work and what is it used for? Same with sodium polystyrene sulfonate?
.9% NaCl (normal saline)
Lactated ringers (LR)
5% dextrose in water (D5W)
Blood loss/intravascular volume deficity (increase blood volume)
Vitals and signs of fluid overload

.45% NaCl (1/2 NS)
.33 % NaCl
.2% NaCl
2.5% dextrose in water
Cellular dehydration (from hypernatremia)
Vital signs, signs of increse ICP, careful using inpeopel with HF and renal problems

3% NaCl/NS
5% NaCl/NS
anything above D5W like D10W
5% dextrose in lactated ringers (D5LR)
5% dextrose in .45% NaCl/ 1/2 NS
5% dextrose in .9% NaCl/NS
Cerebral edema, hypoglycemia, hyponatremia
Infuse slowly, administer via central line, give with diuretics

Dextran, blood products, albumin, hetastarch
For increasing blood volume
Hypertonic

Releases bicarbonate when ingested and is absorbed to decrease acidity, used for metabolic acidosis
Binds to and excrete potassium to reduce serum potassium levels, used for hyperkalemia
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