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ABSITE > 9 Fluid and Electrolytes > Flashcards

9 Fluid and Electrolytes Flashcards

1
Q

Total body water (TBW): fraction of body weight that is water and then further breakdown

A

2/3 (M ~2/3, F a little less, infants a little more) … 2/3 of water is intracellular (mostly muscle) and 1/3 extracellular … (of the extracellular) 2/3 is interstitial and 1/3 is plasma

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2
Q

TBW: roles of proteins vs Na

A

determines plasma/interstitial oncotic P vs intra/extracellular osmotic P

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3
Q

TBW: what determines plasma/interstitial compartment oncotic pressures?

A

proteins

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4
Q

TBW: what determines intracellular/extracellular osmotic pressure?

A

Na

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5
Q

TBW: MC cause of V overload

A

iatrogenic

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6
Q

TBW: first sign of V overload

A

weight gain

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7
Q

TBW: what releases H2O?

A

cellular catabolism releases a significant amnt

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8
Q

plasma osmolarity calculation

A

(2xNa) + (gluc/18) + (BUN/2.8) … normal is 280-295 … water goes from low solute conc (i.e. low osm) to high

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9
Q

electrolyte contents of different fluids … NS, 3%NS, LR

A

0.9% NS = NaCl 154 … 3% NS = NaCl 513 … LR (ionic composition of plasma) Na 130, K 4, Ca 2.7, Cl 105, bicarb 28

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10
Q

V replacements: estimate amnts

A

4cc/kg/hr for first 10kg …. 2 for the the next 10 … 1 for each kg after that

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11
Q

V replacements: best indicator of sufficient V replacement

A

UOP

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12
Q

V replacements: fluid loss w open abdomean

A

0.5-1.0L/h plus measured blood loss (usually don’t replace blood until >500cc)

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13
Q

V replacements: insensible fluid losses amnt and source

A

10cc/kg/day, 75% skin, 25% respiratory, pure water

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14
Q

V replacements: what replacement fluids are used after major adult GI surgery

A

intraop and 1st 24 hours after - use LR … after 24hrs switch to D5 1/2 NS + 20K (b/c 5% dextrose stimulates insulin release, leading to amino acid uptake and protein synthesis, prevents catabolism)

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15
Q

V replacements: amnt of glucose and calories in D5 fluids @ 125/hr

A

150g glucose (525 kcal/day)

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16
Q

GI fluid secretion: amnt from GI system (easy way to remember)

A

biliary system, panc, duo are all 500-1000mL/day …. stomach 1-2L/day

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17
Q

GI fluid secretion: normal Na and K requirements

A

Na 1-2mEq/kg/day … K is 0.5-1.0

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18
Q

GI electrolyte losses: sweat

A

hypotonic, Na conc 35-65

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19
Q

GI electrolyte losses: saliva

A

K, highest conc of K in the whole body

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20
Q

GI electrolyte losses: stomach

A

H and Cl

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21
Q

GI electrolyte losses: pancreas

A

HCO3

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22
Q

GI electrolyte losses: bile

A

HCO3

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23
Q

GI electrolyte losses: small intestine

A

HCO3, K

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24
Q

GI electrolyte losses: large intestine

A

K

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25
Q

GI electrolyte losses: HCO3 soures

A

panc, bile, small intestine (w K)

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26
Q

GI electrolyte losses: K sources

A

saliva (highest conc of K in body), small bowel, large bowel

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27
Q

GI electrolyte losses: replacement fluid for gastric losses

A

D5 1/2 NS w 20mg K

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28
Q

GI electrolyte losses: replacement fluid for panc/biliary/small intestine losses

A

LR and HCO3

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29
Q

GI electrolyte losses: replacement fluid for large intesting losses

A

LR and K

30
Q

GI electrolyte losses: replacement for GI losses (V)

A

1:1

31
Q

GI electrolyte losses: fluids for dehydration (i.e. marathon runner)

A

NS

32
Q

GI electrolyte losses: UOP replacement

A

None needed, >0.5cc/kg/hr is normal post op diruesis (Dr. Hines says typically seen on POD 2-3)

33
Q

K: normal range

A

3.5-5.0

34
Q

K: hyperK dx

A

typically in renal failure patients, EKG shows peaked T

35
Q

K: hyperK tx

A

(1) Ca gluconate (membrane stabilizer for the heart) … (2) sodium bicarb (causes alkalosis, K/H exchange, drives K into cells), insulin (10U) w 1 amp 50% dextrose (more K driven into cells) … (3) kayexelate (more long term, take K out of body) … (4) dialysis if refractory

36
Q

K: hypoK EKG changes and mgmt

A

T waves diappear (usually in the setting of overdiuresis) … may need to correct mag before K

37
Q

Na: normal range

A

135-145

38
Q

Na: hyperNa cause, px, mgmt

A

2/2 dehydration … restlessness, irritability, seizures … correct slowly w D5 water to avoid brain swelling

39
Q

Na: hypoNA causes, px, mgmt

A

2/2 fluid overload are SIADH … HA, n/v, seizures … correct slowly (no more than 1mEq/hr) to avoid central pontine myelinolysis

40
Q

Na: impact of hyperglycemia

A

hyperglycemia causes pseudohyponatremia … for each 100 increment of glucose over normal, add 2 to Na

41
Q

Ca: normal range

A

normal 8.5-10.0, ionized 4.4-5.5

42
Q

Ca: hyperCa - value and sx

A

Ca >13 or ionized >6-7 for sx … causes lethargy

43
Q

Ca: hyperCa - MC causes (benign and malignant)

A

hyperparathryoidism and breast cancer

44
Q

Ca: hyperCa - tx

A

NS at 200-300cc/hr w Lasix

45
Q

Ca: hyperCa - what to avoid?

A

LR b/c contains K … thiazide diuretics b/c retain Ca

46
Q

Ca: hyperCa - mgmt of pts w malignant disease

A

mithramycin, calcitonin, alendronic acid, dialysis

47
Q

Ca: hypoCa - amnts

A

Ca <8, ionized <4

48
Q

Ca: hypoCa - px

A

hyperreflexia, Chovstek’s sign (tapping on face produces twitching), perioral tingling and numbness, Trosseau’s sign (carpopedal spasm), prolonged QT intervals … can occur after parathyroidectomy

49
Q

Ca: hypoCa - replacement

A

may need to fix Mag first

50
Q

Ca: hypoCa - protein adjustment for Ca

A

(protein i.e. albumin) … for every 1g decrease in protein add 0.8 to Ca

51
Q

Mag: normal range

A

2.0-2.7

52
Q

Mag: need to replete this before repleting what?

A

K and Ca

53
Q

Mag: hyperMag px and tx

A

lethargic state, usually in renal failure pts taking Mag containing products … tx w Ca

54
Q

Mag: hypoMag px (and typical setting)

A

usually after massive diuresis, chronic TPN without mineral replacement, EtOH abuse … similar sx to hypoCa - hyperreflexia, Chovstek’s sign (tapping on face produces twitching), perioral tingling and numbness, Trosseau’s sign (carpopedal spasm), prolonged QT intervals

55
Q

metabolic acidosis: anion gap calculation and normal

A

nL <10-15 … Na - (HCO3 + Cl)

56
Q

metabolic acidosis: high anion gap acidosis causes

A

MUDPILES - Methanol, Uremia, DKA, Par-aldehydes, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates

57
Q

metabolic acidosis: normal anion gap acidosis causes

A

usually loss of Na/HCO3 (i.e. ileostomies, small bowel fistulas)

58
Q

metabolic acidosis: tx

A

treat the underlying cause, keep pH > 7.2 with bicarb, severely low pH can impact the myocardial contractility

59
Q

metabolic alkalosis: typical cause

A

usually contraction alkalosis

60
Q

describe acid/base abnormality seen w NGT suction, plus tx and mechanism

A

hypochloremic hypokalemic metabolic alkalosis w paradoxical aciduria … tx w NS (need to correct the Cl deficit) … mech: (1) loss of H and Cl from stomach leads to hypochloremia and alkalosis, (2) loss of water causes kidneys to reabsorb Na in exchange for K (Na/K ATPase) thus losing K (i.e. hypoK), (3) Na/H exchanger activated to reabsorb water also K/H exchanger activated to reabsorb K leads to paradoxical acirduria

61
Q

acid/base abnL: respiratory and renal compensation

A

resp - CO2 regulation, takes minutes … renal - HCO3 regulation, takes hours to days

62
Q

acid/base abnL: Winters formula

A

PCO2 = 1.5 x HCO3 + 8 … +/- 2 = expected CO2 compensation in the setting of metabolic acidosis

63
Q

acute renal failure: FeNa formula and use

A

(urine Na / Cr) / (plasma Na / Cr), best test for azotemia

64
Q

acute renal failure: prerenal findings

A

fena <1%, urine Na <20, BUN/Cr >20, Uosm >500

65
Q

acute renal failure: how much renal mass must be damaged before there’s an increase in BUN or Cr

A

70%+

66
Q

acute renal failure: prevent damage 2/2 contrast dyes

A

prehydration is best prevention, HCO3 and N-acetylcysteine

67
Q

acute renal failure: myoglobin mech of damage and tx

A

myoglobin is converted to herrihemate in acidic environment –> toxic to renal cells … tx = alkalinize urine

68
Q

tumor lysis syndrome: mechanism

A

release of purines and pyrimidines –> increase PO4 and uric acid, decrease Ca … leads to inc BUN and Cr (renal damage), EKG changes

69
Q

tumor lysis syndrome: tx

A

hydration (best) … rasburicase (converts uric acid into inactive metabolite allantoin) … allopurinol (dec uric acid production) … diruetics … alkalinize urine

70
Q

vit D (cholecalciferol): production

A

skin: UV converts 7-dehydrocholesterol to cholecalciferol –> cholecalciferol goes to liver to +25-OH –> to kidney for +1-OH –> now active vitamin D –> increases Ca-binding protein and leads to increased intestinal absorption of Ca

71
Q

chronic renal failure: lab findings

A

(1) anemia 2/2 low erythropoietin … (2) decrease active vit D (dec 1-OH hydroxylation) leads to decreased Ca reabsorption from the gut and decreased Ca-binding protein

72
Q

transferrin and ferritin

A

transferrin is Fe transporter … ferritin is storage form of Fe

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