47. Fluids and electrolites

Question 1

Bicarbonate administration

Answer 1

0.3 x weight x base deficit

Question 2

Ringer lactate osmolality and negative effects

Answer 2

265 mosm/kg
Lactate. Avoid in kidney failure (associated with encephalopathy and cardiac toxicity) and in liver failure (due to hepatic metabolism of lactate)

Question 3

TURP s. characteristics

Answer 3

HypoNa, intravascular overload and edema
Onset from 15 min to 24h

Question 4

Prevention of TURP s.

Answer 4

Isotonic saline with bipolar diathermy
Monitoring (terminate if 1.5l women 2l man)
1 hour irrigation
Intravesical pressure less than 15-25 mmHg

Question 5

Treatment of TURP s.

Answer 5

Stop irrigation. Fluid restriction. Loop d.
Hypertonic saline if severe hypoNa
Mg for seizures

Question 6

Osmolality

Answer 6

Na x 2 + BUN/2.8 + Glu / 1.8

Question 7

Changes in Ca related to pH

Answer 7

Decrease 0.1 pH increase 1 mEq of Ca

Question 8

Na in normal saline

Answer 8

154 mmol / l

Question 9

Lithium and K

Answer 9

Lithium can cause hypokalemia

Question 10

Hypokalemia treatment

Answer 10

0.5 mEq / Kg / h
40 mEq / l (more irritate veins, only central line)

Question 11

HyperK and ECG

Answer 11

5.5 - 6.5 peak T
6.5 - 7. 5 Prolongs PR
> 7.5 Wide QRS
> 9 bradicardia, arrest

Question 12

Hyperventilation and Ca

Answer 12

Can produce hypoCa, numbness in the mouth

Question 13

Chvostek / Trousseau

Answer 13

Ch in hypoCa
Tr in hyperCa
In HypoMg both

Question 14

What ion participates in the osmoregulation in the hipothalamus

Answer 14

Na

Question 15

Mg effects

Answer 15

Reduction in pain
Reduces neuromuscular transmission
Sympatholysis
Anticonvulsant
Cortical depression at high levels
Vasodilation
Antiarrhythmics
Improved myocardial O2 supply-to demand ratio
Bronchodilation
Renal vasodilation and diuresis
Antiinflammatory
Adaptive immunity
Tocolysis

Question 16

Electrolytes
Excess gastric loss

Answer 16

because of obstruction,
vomiting, or excess nasogastric suction results in loss of Na+, K+, Cl−, and acid.

Question 17

Electrolytes
Loss of small bowel secretions

Answer 17

results in high losses of Na+, Cl−, and HCO3− with lesser K+ losses.

Question 18

Electrolytes
Large bowel losses,

Answer 18

such as in diarrhea, deplete
large quantities of K+ with lesser losses of Na+ and
HCO3−.

Question 19

HypoNa algorithm

Answer 19

Question 20

HyperNa algorithm

Answer 20