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Basic Principles > 2 - Electrolytes and Fluids > Flashcards

2 - Electrolytes and Fluids Flashcards

1
Q

What factors regulate total body sodium?

A

Aldosterone

ANP

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2
Q

What factor alters [Na+]?

A

ADH

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3
Q

What is the difference between total body sodium and sodium concentration?

A

Total body sodium means that there is an increased amount of sodium located in the body. Usually this means there is also an increase in the amount of water in the body, so the sodium concentration does not change.

Sodium concentration refers to the ratio of sodium to water.

Aldosterone regulates the total number of sodium cells. ADH causes serum concentration by decreasing the amount of water, thereby increasing the Na concentration.

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4
Q

What regulates total body potassium?

A

Aldosterone

Intrinsic renal mechanisms

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5
Q

What regulates [K]?

A

Insulin

Epinephrine

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6
Q

What regulates total body Ca?

A

Vit D and PTH

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7
Q

What regulates [Ca]?

A

Vit D and PTH

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8
Q

How are Mag and Phos regulated?

A

Both total body and serum concentrations are regulated by intrinsic renal methods

with minimal input from PTH

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9
Q

the blood–brain barrier is poorly permeable to _______ but freely permeable to _______

A

Sodium

Water

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10
Q

How is serum osmolality determined?

A

2 x serum sodium + serum glucose + serum urea

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11
Q

A patient has a normal [Na] but an elevated serum osmolality. What is a likely explanation?

A

Increased glucose or BUN

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12
Q

What is the name of the vasopressin mediated water channel in the distal tubule?

A

Aquaporin 2

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13
Q

What can result from increasing serum Na too quickly?

A

Central Pontine Myelinolysis

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14
Q

How quickly should serum sodium be increased?

A

< 12 mEq/L/day

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15
Q

Carcinoid Syndrome

A

When a carcinoid tumore metastasizes to the liver and secretes its hormone into the portal vein and general circulation

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16
Q

What is the most common hormone carcinoids secrete?

A

Serotonin

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17
Q

Clinical manifestations of carcinoid syndrome

A

Flushing

Intestinal Motility (diarrhea)

R sided heart issues (TRegurg, pulm stenosis)

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18
Q

What are the components of TBW (Total Body Water)?

A

ICV (40% of total body weight)

ECV (20% total body weight)

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19
Q

What are the components of ECV (extracellular volume)?

A

Plasma (3L, 1/5 of of ECV)

Remainder is IFV (interstitial fluid volume)

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20
Q

Red cell volume contributes to ICV or ECV?

A

ICV!

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21
Q

Why is the brain so sensitive to changes in sodium?

A

The blood brain barrier is completely impermeable to sodium, so sodium levels directly influence fluid movement in and out of the cerebral circulation

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22
Q

Compare and contrast the effects of hypertonic saline and mannitol

A

Both cause a decrease in brain water

3% saline causes increased intravascular volume

mannitol causes diuresis, leading to decreased intravascular volume

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23
Q

Is mild hypovolemia associated with metabolic alkalosis or acidosis?

What about severe hypovolemia

A

Mild: alkalosis

Severe: Acidosis

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24
Q

How is sodium plasma concentration effected by glucose levels?

A

Glucose holds water within the extracellular space, cause dilutional hyponatremia

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25
Q

Why does serum hyponatremia with a normal serum os occur in renal failure?

A

Because BUN is distributed in the ECV and ICV

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26
Q

What is the cornerstone of SIADH treatment

A

Freewater restriction

Elimination of precipitating cause

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27
Q

What is the difference between cerebral salt wasting and SIADH?

A

in cerebral salt wasting, ADH secretion is normal and is treated with steroids

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28
Q

What is the difference between aldosterone and ADH?

A

Both cause water retention BUT

aldosterone does it by increasing sodium and decreasing potassium/Hydrogen (maintain electrical charge)

ADH does it by acting directly on aqauporins to retain water

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29
Q

What is normal intracellular K concentration

A

150

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30
Q

Acute _____ kalemia hyperpolarizes cell membrane

A

Hypokalemia, because the electrical gradient is suddenly widened between the intra and extra cellular spaces

This is why cardiac cells are more irritable, and why arteries have hypertension

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31
Q

Both metabolic and respiratory alkalosis lead to _____kalemia

A

hypokalemia

REMEMBER emia refers to the blood

hypokalemia means the amount of potassium in the blood, not the body

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32
Q

What are ECG changes associated with HYPOkalemia

A

flat or inverted T waves, prominent U waves, and ST segment depression

Ectopy

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33
Q

For a patient with DKA who has hypokalemia and is acidotic, when should potassium be repleted?

A

Before the correction of the acidosis

BECAUSE

Potassium is going to start moving back into cells and drop off precipitously once pH is controlled

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34
Q

what does insulin administration decrease potassium levels?

A

Activates the Na-K ATPase pump, moving K into the cell

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35
Q

Why do B adrenergics like albuterol help lower potassium?

A

Increases uptake of potassium in skeletal muscle cells

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36
Q

What is the ECV:ICV ratio of CA

A

10,000 to 1

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37
Q

Acidemia _____ Ca

Alkalosis _____ Ca

A

increases

decreases

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38
Q

What causes hypocalcemia?

A

Failed PTH or calcitriol

Calcium chelation or precipitation

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39
Q

What is the hallmark symptom of hypocalcemia?

A

increased neuronal membrane irritability and tetany

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40
Q

____ in Magnesium and _____ in phosphate lower calcium levels

A

Decrease, increase

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41
Q

What is the rule of 10’s for emergency calcium administration

A

10ml

of 10%

over 10 minutes

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42
Q

What is the effect of calcium on digitalis?

A

Makes it more toxic

Be careful giving calcium to patients who are on dig

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43
Q

Why is total serum calcium a poor indicator of calcium status if albumin is low?

A

A significant amount of circulating calcium is bound to albumin, but the not the functional calcium. So if your albumin is low it will decrease your total calcium content, but it doesn’t effect your ionized calcium

44
Q

What causes hypercalcemia?

A

Bone resorption

45
Q

what is the first line drug treatment for hypercalcemia

A

biphosphonates

46
Q

What is the second line treatment for hypercalcemia

A

Calcitonin

Fast acting, but doesn’t work in about 25% of people

More effective if given with glucocorticoids

47
Q

What is net filtration pressure?

A

The sum effect of all the intra and extra capillary pressures

48
Q

Positive net filtration favors fluid _______

A

exudation into tissues

49
Q

Negative net filtration favors ______

A

Fluid reabsorption into vasculature

50
Q

Venous capillary net filtration is ______

Arterial capillary net filtration is ______

A

Negative

Positive

51
Q

How does the glycocalyx regulate osmotic pressure?

A

Binds with circulating albumin!

52
Q

What is the preferred fluid for patients at risk for cerebral edema?

A

NS, slightly hyperosmolar

53
Q

Which patients should not get LR?

A

DKA (lactate breakdown in the liver produces glucose)

TBI (mildly hypotonic, can cause cerebral edema)

54
Q

What are some of the benefits of plasmalyte?

A

Buffered (preserves physiologic pH)

Doesn’t contain calcium

Doesn’t use lactate as buffer

55
Q

What disease process causes specific damage to the glycocalyx?

A

hyperglycemia

56
Q

What do DO2 and VO2 represent?

A

Oxygen delivery

Oxygen consumption

57
Q

What is primary hemostasis?

A

Platelets adhere to sites of endothelial disruption, undergo activation to recruit more platelets and amplify the platelet response, and then cross-link with fibrin, the end product of the plasma clotting factor cascade, to form a platelet plug.

58
Q

What happens when the endothelial lining (glycocalyx) is disrupted?

A

Platelets adhere to the collagen in the broken matrix

59
Q

Does anemia increase or decrease platelet function?

A

decreases

60
Q

How much should hemoglobin and Hct increase for each unit of PRBCs?

A

1 g/dl

3%

61
Q

What types of patients benefit from maintaining platelet count > 50?

A

Eye surgeries, polytrauma

62
Q

What is alloimmunization?

A

Exposure to a foreign antigen, initial exposure doesn’t prompt a reaction but the second does

Rh and second pregnancy

Multiple blood transfusions, especially platelets

63
Q

What is the leading cause of transfusion associated mortality?

A

TRALI

64
Q

What is Post Transfusion Purpura?

A

Rare, severe thrombocytopenia after transfusion

Almost always in previously pregnant women

Destroys platelets

IVIG is first line of defense

65
Q

What is the most common hereditary bleeding disorder?

A

vWD (von Willenbrand)

66
Q

vWD is an disorder of _______ hemostasis

A

Primary

67
Q

How is hemophilia inherited?

A

X linked, almost entirely affects males

68
Q

Hemophilia A is a defect in which clotting factor?

A

VIII (8)

69
Q

List two forms of hereditary hypercoagulopathy

A
  1. FVL mutation
  2. Protein C and S deficiencies

Both act on factor V

70
Q

What are the leading causes of Vit K deficiency

A

Liver insufficiency

Sterile gut in newborns

ABX treatment

71
Q

How is Vit K synthesized?

A

Bacteria in the gut

Bile salts in the liver

72
Q

Which coagulation factors are produced by the liver

A

2

5

7

9

10

11

73
Q

Is a PT or aPTT acute in chronic renal failure?

A

NO

74
Q

DIC is consumptive _____ and ______

A

coagulopathy and thrombocytopenia

75
Q

What is the treatment for coagulopathy in DIC?

For thrombocytopenia?

A

Plasma

Platelets

76
Q

GP IIb/IIIa receptor blockers

A

epciximab

tirofibin, eptifibitide

inhibit the cross linkage of fibrin

77
Q

Vitamin K Antagonists

A

Warfarin

inhibit synthesis of Vit K dependent factors

78
Q

ADP Receptor Antagonists

A

prevent the expression of GP IIb/IIIa on the surface of activated platelets, thereby inhibiting platelet adhesion and aggregation

clopidogrel, ticagrelor

79
Q

Cyclooxygenase Inhibitors

A

Apirin and NSAIDs

80
Q

What is the role of COX-1?

A

plays an integral part in maintaining the integrity of the gastric lining, renal blood flow, and initiating the formation of TxA2, an important molecule for platelet aggregation.

81
Q

what are the key characteristics of HIT?

A

Thrombocytopenia, but increased coaguability

82
Q

What is the treatment for HIT?

A

D/C Heparin

Start thrombophylaxis

Exclude thrombosis

DON’T GIVE PLATELETS

83
Q

Parenteral Direct Thrombin Inhibitors

A

Argatroban, Bivalirudin

84
Q

rFVIIIa

A

Recombinant factor 8a

Designed for hemophiliacs, but used in postpartum hemorrhage, trauma, reversal of various anticoagulants, and high-risk cardiac surgery.

85
Q

Why is DDAVP used in bleeding disorders?

A

improves hemostasis and platelet function

86
Q

Antifibrinolytics

A

TXA

derivatives of lysine

competitively inhibit the binding site on plasminogen, preventing cleavage to plasmin and the resultant fibrinolysis

87
Q

What blood type is a universal recipient? Why?

A

AB

Have A and B antigens

Do not have A or B antibodies

88
Q

What blood type is universal donor? Why?

A

Do no have antigens

Have anti-bodies to A and B

89
Q

Why does distal renal tubular acidosis hypokalemia?

A

Major water/sodium loss is caused by dRTA, so aldosterone is synthesized and decreases K levels

90
Q

If sodium is low and the serum os is high or normal, what does that mean?

A

Some other substance (mannitol, glucose, BUN, ethanol etc.) is in the PV pulling water into the capillaries. Total body sodium is normal, but the capillaries are overfilled so the low Na is dilutional

91
Q

If sodium is low and serum osmolality is low, what should you check next?

A

Urine osmolality and urine sodium

92
Q

What are the top two diseases associated with SIADH?

A

Small cell lung CA

Brain problems

93
Q

How does plasma [Na+] related to total body sodium?

A

It doesn’t!

Sodium concentration measures fluid status, not the amount of sodium in the body

94
Q

What is the most common cause of hyperkalemia?

A

Drugs!

NSAIDS, ACE inhibitors, cyclosporines

95
Q

Which two types of acidosis cause shifts in K?

Which two do not?

A

Respiratory and Mineral Metabolic Acidosis

Organic metabolic acidosis (lactic acidosis, ketoacidosis)

96
Q

What are three methods for shifting K intracellularly?

A

glucose and insulin

bicarb

Albuterol (B2 agonists)

97
Q

If phosphate is high, Ca is _____

A

Low

98
Q

Magnesium is an endogenous _______ and stabilizes _______

A

calcium antagonist

axonal membranes

Competes with Ca for binding sites in pres-synaptic terminals, meaning it requires more Ca to cause depolarization

99
Q

Hypomagnesemia is characterized by:

A

increased neuronal excitability, muscle irritability and tetany

100
Q

Of all the isotonic crystalloids, NS is the least ______.

Why?

A

Physiologic.

Contains proportionally more Cl

101
Q

What is the primary role of NS in anesthesia?

A

given in small volumes for neuro patients

102
Q

NS is the preferred fluid for which patient?

A

those at risk for cerebral edema

103
Q

Why is NS sometimes the only option for patients in ESRD?

A

They can’t tolerate the K level of other isotonics

104
Q

When is LR contraindicated?

Why?

A

TBI

Neurovascular insults

Slightly hypo-osmolar

105
Q

A patient with a BG of 220 should probably not receive _______

A

Colloids

Hyperglycemia is known to injure the endothelial glycocalyx

Basic Principles (15 decks)

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