Acid/Base/Fluid

Question 1

ECF vs ICF

Answer 1

ECF 1/3 Sodium - blood and interstitial

ICF 2/3 Potassium - in cell

Question 2

Hypotonic fluid - Solute? Types? Distributed?

Answer 2

Solute free
D5, 1/2NS
Proportionately (25% stays in blood)

Question 3

Isotonic - Types? Distributed?

Answer 3

NS, LR

All ECF -> 25% blood

Question 4

Hypertonic - Type? Distribution and response?

Answer 4

3%NS
To ECF causing gradient move water out of cell
Increase osmolality of both

Question 5

Holliday Segar adults >65

Answer 5

1500 mL for 1st 20 kg + 15 mL/kg rest

or do
30 mL/kg with minimum 1500

Question 6

Normal osmolality

Answer 6

280-295 mOsm/kg

Question 7

Water balance regulated by

Answer 7

Anti diuretic hormone

Question 8

Hyponatremia - Osmolality and types

Answer 8

<275 mOsm/kg
Hypovolemic: Lose more Na
Hypervolemic: Fluid retention - need Na and FR
Euvolemic: SIAD, excess ADH - need FR

Question 9

Hypernatremia - Osmolarity and types

Answer 9

> 290
Hypovolemic: Increased loss fluid - give isotonic fluid
Euvolemic: Diabetes insipidus - replace water/electrolytes
Hypervolemic: Excess fluid/steroid - diuertic

Question 10

Causes hypokalemia (8)

Answer 10

Catecholamines
diuretics
met alkalosis
hydrocortisone
Catabolism
ADH and aldosterone
Diarrhea/NG loss
Metabolic alkalosis

Question 11

Meds cause hyperkalemia

Answer 11

ACE inhibitor, NSAIDS, Cyclosporine, Digoxin, Heparin, Succinylcholine
If symptomatic, give Ca Glu`

Question 12

Mag - Normal, where, causes what

Answer 12

1.8-2.8, mostly ICF

Cause low k and Ca - give Mag first

Question 13

Treat hypermagnesemia

Answer 13

IV Ca Glu

Question 14

Ca and Ionized Ca levels

Answer 14

8. 6-10.2

1. 12-1.3

Question 15

Causes hypocalcemia (6) and meds (4)

Answer 15

Low D, Low PTH, CRRT, hungry bone syndrome (s/p thyroidectomy), sepsis, rhabdo
Calcitonin, phenytoin, phenobarbital, furosemide

Question 16

Treat hypercalcemia

Answer 16

Mild: Hydrate, ambulate
Severe: furosemide, calcitonin, dialysis

Question 17

Phos level and where

Answer 17

2.7-4.5

Intracellular

Question 18

Complication of hyperphosphatemis

Answer 18

Tissue calcification

Question 19

H2CO3

Answer 19

Carbonic acid

Question 20

HCO3 and level

Answer 20

Bicarb

22-26

Question 21

PO2 and level

Answer 21

Ability hgb carry O2

80-100

Question 22

PCO2 and ABG level

Answer 22

Ability lungs excrete CO2
35-45
High: Acidosis
Low: Alkalosis

Question 23

Anion gap and calculate

Answer 23

Determine which metabolic acidosis
Serum Na - (Serum Cl + serum Bicarb)
Normal 9

Question 24

Respiratory acidosis and causes

Answer 24

High PCO2 and compensatory HCO3

Hypoventilation, drugs, respiratory disease, sleep apnea, overfeeding, perfusion problems

Question 25

Respiratory alkalosis and causes

Answer 25

Low PCO2 and compensatory low HCO3

Anxiety/hyperventilation, pain, asthma/PNA, catecholamines

Question 26

Metabolic acidosis and causes

Answer 26

Low HCO3 and compensatory decrease PCO2
Normal AG: Diarrhea or renal loss HCO3, ingest aluminum
High AG: Lactic acid, DKA, starvation, alcoholic, renal failure, salicylates, methanol, ethanol

Question 27

Metabolic alkalosis and cause

Answer 27

High HCO3 and compensatory high PCo2
Urine Cl <20 : GI loss/NG suction/renal loss Cl, excess bicarb, diuretic
Urine Cl >20: Steroids, cushing, hyperaldosterone, hypokalemia, tobacco

Question 28

Metabolic alkalosis often due to

Answer 28

Overtreating acidosis or d/y hypokalemia

Kidneys correct by excrete HCO3 unless they’re impaired

Question 29

Every 1 g/dL decrease in Albumin

Answer 29

+2.5 to AG

Question 30

Cause hypomagnesemia

Answer 30

DKA, alcohol, ostomy, SBS, GBx

Question 31

Lactic acid and renal failure can cause

Answer 31

Metabolic acidosis

Question 32

Diuretic can cause (met/resp what)

Answer 32

Metabolic alkalosis