14.7.2013 Flashcards
Why infants lose more fluid than adults?
- larger body surface area relative to body weight
- higher metabolic rate
- immature kidney function
- larger percentage of Extracellular body fluid
Insensible fluid loss
Loss from lungs and skin
Split up of daily fluid intake
Water- 1.5L
Food- 800ml
Water of oxidation-300ml
Split up of daily fluid loss
Skin- 600ml
Lungs- 400ml
Urine -1.5L
Stools-100ml
Intracellular fluid constitutes _______ % of TBW
40%
Extracellular fluid constitutes ________ % of TBW
20%
Interstitial fluid accounts for _____ % of Extracellular fluid
75
Transcellular fluid
CSF pleural Eye Joint Lymphatics
Interstitial fluid is ______ % of TBW
15%
_______ % of full term neonates body weight is water
80%
________ % of a 60 yr old man body weight is water
45%
Why amount of water content in body decreases with old age?
In old age,
Skeletal muscle(contains water) mass decreases
Fat mass increases
Difference btw osmosis and diffusion
Fluids move in osmosis
Solutes move in diffusion
Urine concentrating ability appears after age of
3 months
Kidneys must excrete ______ ml of fluid per hour to excrete solute load
20
Atleast 500ml per day
Conversion of angiotensin 1 to angiotensin 2 takes place in
Lungs
Angiotensin 1 formation takes place in
Liver
Signs of dehydration in elderly
Confusion
Subnormal temperature
Tachycardia
Pinched facial expression
Insensible water loss depends on
Humidity
BSA
respiratory rate and depth
Normal serum sodium
135-145mEq/L
Normal serum K+
3.5-5 mEq/L
Total serum calcium
8.9-10.1mg/dl
Ionised calcium level
4.4-5.3 mg/dl
Normal serum phosphates
2.5-4.5 mg/dl
Or
1.8-2.6 mEq/L
Normal serum magnesium
1.5 -2.5 mEq/L
Normal serum chloride level
98-108 mEq/L
Concentrations of various NaCl containing electrolyte solutions
5%. 855mEq/L
3% 513mEq/L
0.9% 154mEq/L
0.45% 77mEq/L
Composition of ringer lactate
Na - 130mEq/L K - 4mEq/L Cl - 109mEq/L Ca - 3mEq/L Lactate - 28mEq/L
Normal urine protein:creatinine ratio
Less than 0.2
Indications for renal replacement therapy in CKD
Without diabetes- GFR less than 10ml/min
With diabetes- GFR less than 15ml/min
Stages of CKD
1- greater than 90ml/min 2- 60-89ml/min 3- 30-59ml/min 4- 15-29ml/min 5- less than 15ml/min
Immunoglobulin deposited in IgA nephropathy
Polymeric IgA1
Causes of secondary IgA nephropathy
Cystic fibrosis
Celiac disease
IBD
Rx of IgA nephropathy
ACE inhibitors
Immunosuppression
Bicarbonate is responsible for buffering
Blood
Interstitial fluid
The kidneys of older adults can’t handle excess acids because
Ammonia production decreases with age
Causes of increased anion gap
Hypermagnesimia
Increase in paraproteins
Blood pressure cuff,dimensions
Length 80%
Width 40% of upper arm circumference
Positioning of blood pressure cuff
Medially
Adults- 2.5 cm above antecubital fossa
Children- just above antecubital fossa
Normal CVP
2-8 mm Hg
Normal PAWP
4-12 mm of Hg
Lab findings in dehydration
Elevated Hct
Na greater than 145mEq/L
Serum osmolality greater than 300mosm/Kg
Urine specific gravity above 1.030
Signs of hypervolemia
S3
Veins remain distended for more than 5s when elevated above heart level
Rx of pts who cannot tolerate hemodialysis
Continuous renal replacement therapy(CRRT)
Effect of heparin on Na level
Hyponatremia
Drugs causing hypernatremia
Antacids containing soda.bicarb
Sodium polystyrene Sulfonate
Ticarcillin disodium clavulinate potassium
IV NaCl
Presentation of hypernatremia
Skin flushed
Agitated
Low grade fever
Thirst
SALT
