Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

TBW: roles of proteins vs Na

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

TBW: what determines plasma/interstitial compartment oncotic pressures?

A

proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

TBW: what determines intracellular/extracellular osmotic pressure?

A

Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TBW: MC cause of V overload

A

iatrogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

TBW: first sign of V overload

A

weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TBW: what releases H2O?

A

cellular catabolism releases a significant amnt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

V replacements: best indicator of sufficient V replacement

A

UOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

V replacements: insensible fluid losses amnt and source

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

150g glucose (525 kcal/day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

GI fluid secretion: normal Na and K requirements

A

Na 1-2mEq/kg/day … K is 0.5-1.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GI electrolyte losses: sweat

A

hypotonic, Na conc 35-65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

GI electrolyte losses: saliva

A

K, highest conc of K in the whole body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

GI electrolyte losses: stomach

A

H and Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

GI electrolyte losses: pancreas

A

HCO3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

GI electrolyte losses: bile

A

HCO3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

GI electrolyte losses: small intestine

A

HCO3, K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

GI electrolyte losses: large intestine

A

K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
GI electrolyte losses: HCO3 soures
panc, bile, small intestine (w K)
26
GI electrolyte losses: K sources
saliva (highest conc of K in body), small bowel, large bowel
27
GI electrolyte losses: replacement fluid for gastric losses
D5 1/2 NS w 20mg K
28
GI electrolyte losses: replacement fluid for panc/biliary/small intestine losses
LR and HCO3
29
GI electrolyte losses: replacement fluid for large intesting losses
LR and K
30
GI electrolyte losses: replacement for GI losses (V)
1:1
31
GI electrolyte losses: fluids for dehydration (i.e. marathon runner)
NS
32
GI electrolyte losses: UOP replacement
None needed, >0.5cc/kg/hr is normal post op diruesis (Dr. Hines says typically seen on POD 2-3)
33
K: normal range
3.5-5.0
34
K: hyperK dx
typically in renal failure patients, EKG shows peaked T
35
K: hyperK tx
(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
K: hypoK EKG changes and mgmt
T waves diappear (usually in the setting of overdiuresis) ... may need to correct mag before K
37
Na: normal range
135-145
38
Na: hyperNa cause, px, mgmt
2/2 dehydration ... restlessness, irritability, seizures ... correct slowly w D5 water to avoid brain swelling
39
Na: hypoNA causes, px, mgmt
2/2 fluid overload are SIADH ... HA, n/v, seizures ... correct slowly (no more than 1mEq/hr) to avoid central pontine myelinolysis
40
Na: impact of hyperglycemia
hyperglycemia causes pseudohyponatremia ... for each 100 increment of glucose over normal, add 2 to Na
41
Ca: normal range
normal 8.5-10.0, ionized 4.4-5.5
42
Ca: hyperCa - value and sx
Ca >13 or ionized >6-7 for sx ... causes lethargy
43
Ca: hyperCa - MC causes (benign and malignant)
hyperparathryoidism and breast cancer
44
Ca: hyperCa - tx
NS at 200-300cc/hr w Lasix
45
Ca: hyperCa - what to avoid?
LR b/c contains K ... thiazide diuretics b/c retain Ca
46
Ca: hyperCa - mgmt of pts w malignant disease
mithramycin, calcitonin, alendronic acid, dialysis
47
Ca: hypoCa - amnts
Ca <8, ionized <4
48
Ca: hypoCa - px
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
Ca: hypoCa - replacement
may need to fix Mag first
50
Ca: hypoCa - protein adjustment for Ca
(protein i.e. albumin) ... for every 1g decrease in protein add 0.8 to Ca
51
Mag: normal range
2.0-2.7
52
Mag: need to replete this before repleting what?
K and Ca
53
Mag: hyperMag px and tx
lethargic state, usually in renal failure pts taking Mag containing products ... tx w Ca
54
Mag: hypoMag px (and typical setting)
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
metabolic acidosis: anion gap calculation and normal
nL <10-15 ... Na - (HCO3 + Cl)
56
metabolic acidosis: high anion gap acidosis causes
MUDPILES - Methanol, Uremia, DKA, Par-aldehydes, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates
57
metabolic acidosis: normal anion gap acidosis causes
usually loss of Na/HCO3 (i.e. ileostomies, small bowel fistulas)
58
metabolic acidosis: tx
treat the underlying cause, keep pH > 7.2 with bicarb, severely low pH can impact the myocardial contractility
59
metabolic alkalosis: typical cause
usually contraction alkalosis
60
describe acid/base abnormality seen w NGT suction, plus tx and mechanism
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
acid/base abnL: respiratory and renal compensation
resp - CO2 regulation, takes minutes ... renal - HCO3 regulation, takes hours to days
62
acid/base abnL: Winters formula
PCO2 = 1.5 x HCO3 + 8 ... +/- 2 = expected CO2 compensation in the setting of metabolic acidosis
63
acute renal failure: FeNa formula and use
(urine Na / Cr) / (plasma Na / Cr), best test for azotemia
64
acute renal failure: prerenal findings
fena <1%, urine Na <20, BUN/Cr >20, Uosm >500
65
acute renal failure: how much renal mass must be damaged before there's an increase in BUN or Cr
70%+
66
acute renal failure: prevent damage 2/2 contrast dyes
prehydration is best prevention, HCO3 and N-acetylcysteine
67
acute renal failure: myoglobin mech of damage and tx
myoglobin is converted to herrihemate in acidic environment --> toxic to renal cells ... tx = alkalinize urine
68
tumor lysis syndrome: mechanism
release of purines and pyrimidines --> increase PO4 and uric acid, decrease Ca ... leads to inc BUN and Cr (renal damage), EKG changes
69
tumor lysis syndrome: tx
hydration (best) ... rasburicase (converts uric acid into inactive metabolite allantoin) ... allopurinol (dec uric acid production) ... diruetics ... alkalinize urine
70
vit D (cholecalciferol): production
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
chronic renal failure: lab findings
(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
transferrin and ferritin
transferrin is Fe transporter ... ferritin is storage form of Fe

ABSITE (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions