Cap. 7 Liquidos, electrolitos y nutrición Flashcards
1
Q
Name the 2 major body fluid compartments:
A
Intracellular and extracellular
2
Q
Extracellular fluid is divided into these 2 subcompartments:
A
Interstitial fluid and intravascular fluid
3
Q
Mnemonic for the composition of body fluid:
A
60, 40, 20; 60% total body weight fluid, 40% total body weight intracellular, 20% total body weight extracellular
4
Q
Approximate percentage of body weight that is fluid:
A
60%
5
Q
Approximate percentage of body fluid that is extracellular:
A
33%
6
Q
Approximate percentage of body weight that is intracellular:
A
66%
7
Q
Percentage of extracellular fluid within the vascular compartment in the venous system:
A
85%
8
Q
Percentage of extracellular fluid within the vascular compartment in the arterial system:
A
15%
9
Q
The approximate percentage of body weight that blood accounts for in an adult:
A
7% (so to estimate how many liters of blood in a 70-kg man; 0.07 × 70 kg = 5 liters)
10
Q
Requirement of water per 24-hour period:
A
~30 to 35 mL/kg
11
Q
Requirement of sodium per 24-hour period:
A
~1 to 2 mEq/kg
12
Q
Requirement of chloride per 24-hour period:
A
~1.5 mEq/kg
13
Q
Requirement of potassium per 24-hour period:
A
~1 mEq/kg
14
Q
Name the sources and the amount of normal daily water loss:
A
Respiratory losses: 500 to 700 cc
Sweat: 200 to 400 cc
Urine: 1200 to 1500 cc
Feces: 100 to 200 cc
15
Q
Name the sources and the amount of insensible fluid loss:
A
Skin: ~300 cc/24 h
Breathing: 500 to 700 cc/24 h
Feces: 100 to 200 cc/24 h
16
Q
General rate of fluid loss during an open abdominal procedure in the absence of measurable blood loss:
A
0.5 to 1.0 L/h
17
Q
Name the sources and the amount of normal daily electrolyte loss:
A
Chloride: 150 mEq, sodium: 100 mEq, potassium: 100 mEq
18
Q
Name the sources and the amount of daily secretions:
A
Saliva: ~1500 cc/24 h Gastric: ~2000 cc/24 h Small intestine: ~3000 cc/24 h Bile: ~1000 cc/24 h Pancreatic: ~600 cc/24 h
19
Q
State the electrolyte composition of sweat:
A
30 to 50 mEq sodium, 5 mEq potassium, 45 to 55 mEq hydrogen
20
Q
State the electrolyte composition of gastric secretions:
A
40 to 65 mEq sodium, 90 mEq hydrogen, 100 to 140 mEq chloride
21
Q
State the electrolyte composition of biliary secretions:
A
135 to 155 mEq sodium, 5 mEq potassium, 80 to 110 mEq chloride, 70 to 90 mEq bicarbonate
22
Q
State the electrolyte composition of pancreatic secretions:
A
135 to 155 mEq sodium, 5 mEq potassium, 55 to 75 mEq chloride, 70 to 90 mEq bicarbonate
23
Q
State the electrolyte composition of ileostomy output:
A
120 to 130 mEq sodium, 10 mEq potassium, 50 to 60 mEq chloride, 50 to 70 mEq bicarbonate
24
Q
State the electrolyte composition of diarrhea:
A
25 to 50 mEq sodium, 35 to 60 mEq potassium, 20 to 40 mEq chloride, 30 to 45 mEq bicarbonate
25
Define the “third space.”
Fluid accumulation in the interstitium of tissues (first 2 spaces: intravascular and intracellular)
26
When does third-spaced fluid tend to mobilize back into the intravascular space?
Postoperative day #3
27
What is the earliest sign of volume excess during the postoperative period?
Weight gain
28
Classic finding with overaggressive nasogastric tube suctioning or long-standing vomiting:
Hypokalemic hypochloremic metabolic alkalosis
29
Name the various mechanisms that loop diuretics employ to decrease pulmonary edema:
Inhibit active sodium absorption in the thick ascending loop of Henle, increase venous capacitance, stimulate vasodilatory prostaglandins leading to increased renal blood flow
30
Formula to calculate serum osmolality:
2 × sodium + urea/2.8 + glucose/18
31
How much sodium and chloride are in normal saline?
154 mEq Na and 154 mEq Cl
32
Composition of lactated Ringer’s:
130 mEq Na+, 109 mEq Cl–, 4 mEq K+, 28 mEq lactate, and 3 mEq calcium
33
How many grams of dextrose in a liter of D5W?
50 g; D5W is a 5% solution of dextrose (5 g dextrose/100 cc × 1000 cc/1 L = 50 g dextrose)
34
The 2 “rules” for the calculation of maintenance fluids:
100/50/20 rule and 4/2/1 rule; for both rules cc/kg for first 10 kg/cc/kg for next 10 kg/cc/kg for every kg >20 kg
35
Name the standard maintenance fluid used in an adult:
D5 1/2 normal saline (NS) with 20 mEq KCl
36
Name the standard maintenance fluid used in a pediatric patient:
D5 1/4 NS with 20 mEq KCl
37
Usual minimal urine output for an adult:
~30 mL/h or 0.5 mL/kg/h
38
How much of a 1-L NS bolus will stay intravascular in a 5-hour period?
~200 cc or 20%
39
Normal range for sodium:
135 to 145 mEq/L
40
Define pseudohyponatremia and list causes:
Spuriously low lab result for sodium; hyperglycemia, hyperlipidemia, hyperproteinemia
41
Name the 3 types of hyponatremia:
Hypovolemic, euvolemic, hypervolemic
42
Name surgical causes of hypovolemic hyponatremia:
Burns, diaphoresis, diuretics, hypoaldosteronism, NG suctioning, pancreatitis, vomiting
43
Name surgical causes of euvolemic hyponatremia:
CNS abnormalities, drugs, syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
44
Name surgical causes of hypervolemic hyponatremia:
Congestive heart failure, cirrhosis, iatrogenic, renal failure
45
Signs and symptoms of hyponatremia:
Coma/confusion, ileus, lethargy, nausea/vomiting, seizure, weakness
46
Treatment of hypovolemic hyponatremia:
Correct the underlying cause, give IV NS
47
Treatment of euvolemic hyponatremia (SIADH):
Acute treatment with furosemide and normal saline; fluid restriction
48
Treatment of hypervolemic hyponatremia (dilutional):
Fluid restriction and diuretics
49
Grave consequence of correcting hyponatremia too quickly:
Myelinolysis (formerly known as central pontine myelinolysis)
50
Formula to calculate the sodium deficit:
(normal sodium concentration – observed sodium concentration) × total body water; Remember: total body water = 0.6 × weight (kg)
51
Approximately how much does the apparent serum sodium concentration fall for each 100 mg/dL rise in blood glucose level above normal?
1.6 to 3.0 mEq/L
52
Maximal rate of sodium correction for acute hyponatremia:
1 to 2 mEq/L/h for 3 to 4 hours until neurologic symptoms subside or until plasma Na is >120 mEq/L
53
Maximal rate of sodium correction for chronic hyponatremia:
0.5 to 1 mEq/L/h or no faster than 10 to 12 mEq/L in the first 24 hours and 18 mEq/L in the first 48 hours
54
Name surgical causes of hypernatremia:
Dehydration, diabetes insipidus, diaphoresis, diarrhea, diuresis, iatrogenic, vomiting
55
Signs and symptoms of hypernatremia:
Confusion, peripheral/pulmonary edema, respiratory paralysis, stupor, seizures, tremors
56
Treatment of hypernatremia:
Slow supplementation of 1/4 NS or 1/2 NS over days
57
Formula to calculate the free water deficit:
Total free water deficit = 0.6 × weight (kg) × [(Serum Na+/140) – 1]
58
What is the normal range for potassium:
3.5 to 5.0 mEq/L
59
Critical values for potassium:
K <2.8 mEq/L or >6.0 mEq/L
60
Name some surgical causes of hypokalemia:
Alkalosis, diuretics, drugs (steroids/antibiotics), diarrhea, iatrogenic, insulin, intestinal fistula, NG suctioning, vomiting
61
Signs and symptoms of hypokalemia:
Ileus, weakness, tetany, nausea/vomiting, paresthesia
62
EKG findings of hypokalemia:
Flattened T waves, U waves, ST segment depression, atrial fibrillation, premature atrial complexes/premature ventricular complexes
63
Acute treatment for hypokalemia:
IV KCl
64
Maximum amount of potassium that can be administered through a peripheral IV:
10 mEq/h
65
Maximum amount of potassium that can be administered through a central line:
20 mEq/h
66
Most common cause for an electrolyte mediated ileus in a surgical patient:
Hypokalemia
67
Digitalis toxicity is worsened by this electrolyte condition:
Hypokalemia
68
Name surgical causes of hyperkalemia:
Iatrogenic, diuretics, acidosis, trauma, hemolysis, renal failure, blood transfusion
69
Signs and symptoms of hyperkalemia:
Areflexia or decreased deep tendon reflexes, paresthesia, paralysis, weakness, and respiratory failure
70
EKG findings of hyperkalemia:
Peaked T waves, prolonged PR, wide QRS, depressed ST segment, ventricular fibrillation, bradycardia
71
What is the treatment for hyperkalemia?
IV calcium, sodium bicarbonate, dextrose and insulin (1 amp 50% dextrose and 10 U insulin), albuterol, kayexalate, furosemide, dialysis
72
Most of the calcium in the body is contained within:
Bone
73
Percentage of serum calcium that is nonionized and bound to plasma protein:
~50%
74
Percentage of serum calcium that is nonionized and bound to substances other than plasma protein in the plasma:
5%
75
How much does a 1-g drop in protein decrease the measured total serum calcium?
0.8 mg/dL
76
In the setting of rapid transfusion, how much calcium should be given per 500 cc of transfused blood?
0.2 g/500 cc transfused blood
77
Name some surgical causes of hypocalcemia:
Acute pancreatitis, aminoglycosides, diuretics, hypomagnesemia, intestinal bypass, osteoblastic metastasis, renal failure, rhabdomyolysis, sepsis, short bowel syndrome, vitamin D deficiency
78
Formula to determine the calcium level with hypoalbuminemia:
Serum calcium + [(4 – measured albumin) × 0.8]
79
Signs and symptoms of hypocalcemia:
Abdominal cramping, Chvostek signs, confusion, depression, hallucinations, increased deep tendon reflexes, laryngospasm, paranoia, perioral paresthesia, seizures, stridor, tetany, Trousseau sign
80
Define Chvostek sign:
Tapping of facial nerve with resultant facial muscle spasm
81
Define Trousseau sign:
Utilization of a blood pressure cuff to occlude blood flow to the forearm with resultant latent tetany evidenced by carpal spasm
82
EKG findings hypocalcemia:
Peaked T waves, prolonged QT and ST intervals
83
Acute treatment of hypocalcemia:
IV calcium supplementation
84
Chronic treatment of hypocalcemia:
PO calcium and vitamin D supplementation
85
Mnemonic for hypercalcemia:
Chimpanzees: Calcium supplementation, hyperparathyroidism (primary/tertiary)/hyperthyroidism, iatrogenic/immobility, milk alkali syndrome/mets, Paget disease, Addison disease/acromegaly, neoplasm, Zollinger-Ellison syndrome, excessive vitamin A, excessive vitamin D, sarcoid
86
Signs and symptoms of hypercalcemia:
Polydipsia, polyuria, and constipation and the classic “stones, bones, abdominal groans, and psychiatric overtones”
87
EKG findings of hypercalcemia:
Prolonged PR interval and shortened QT interval
88
Acute treatment for hypercalcemic crisis:
Normal saline volume expansion with furosemide diuresis
89
Additional options for treating hypercalcemia:
Bisphosphonates, calcitonin, mithramycin, steroids, and dialysis
90
What kind of diuretic should be avoided in the face of hypercalcemia?
Thiazide diuretics (calcium-sparing diuretic)
91
Normal range for magnesium:
1.5 to 2.5 mEq/L
92
Electrolyte abnormality associated with “impossible to correct” hypokalemia and hypocalcemia:
Hypomagnesemia
93
Name surgical causes of hypomagnesemia:
Aminoglycosides, diarrhea, gastric suctioning, hypocalcemia, renal failure, total parenteral nutrition (TPN), vomiting
94
Signs and symptoms of hypomagnesemia:
Asterixis, Chvostek sign, dysrhythmias, increased deep tendon reflexes, tachycardia, tetany, tremor, ventricular ectopy, vertigo
95
Treatment for acute hypomagnesemia:
IV magnesium sulfate (or magnesium chloride)
96
Treatment for chronic hypomagnesemia:
PO magnesium oxide
97
Name surgical causes of hypermagnesemia:
Iatrogenic, renal failure, TPN
98
Signs and symptoms of hypermagnesemia:
IV calcium, dextrose and insulin, dialysis, Lasix
99
Normal range for phosphorus:
2.5 to 4.5 mg/dL
100
Critical value for phosphorus:
<1.0 mg/dL
101
Name surgical causes of hypophosphatemia:
Alcohol abuse, gastrointestinal losses, inadequate supplementation, medications, renal loss, sepsis
102
Signs and symptoms of hypophosphatemia:
Ataxia, cardiomyopathy, hemolysis, poor response to pressors, rhabdomyolysis, neurologic dysfunction, weakness
103
Treatment for acute hypophosphatemia:
IV sodium phosphate or potassium phosphate
104
Treatment for chronic hypophosphatemia:
PO replacement (Neutra phos)
105
Name surgical causes of hyperphosphatemia:
Chemotherapy, hyperthyroidism, renal failure, sepsis
106
Signs and symptoms of hyperphosphatemia:
Calcification, heart block
107
List the disturbances seen with tumor lysis syndrome:
Hypocalcemia, hyperkalemia, hyperuricemia, hyperphosphatemia
108
Name the important intracellular buffer:
Phosphate buffer system and proteins
109
Name the primary extracellular buffering system:
Bicarbonate-carbonic acid system
110
Henderson-Hasselbalch equation:
pH = pK + log [HCO3]/[CO2]
111
Formula to calculate the anion gap:
Anion gap = Sodium – (bicarbonate + chloride)
112
Mnemonic for anion gap acidosis:
Mudpiles: methanol, uremia, diabetic ketoacidosis, paraldehyde, isoniazid, lactic acidosis, ethylene glycol, salicylates
113
Formula for functional excretion of sodium (FeNa):
FeNa = (urine sodium/urine creatinine)/(plasma sodium/plasma creatinine)
114
List some common laboratory values seen in a prerenal state:
BUN/Cr ratio >20, FeNa <1%, urine sodium <20, urine osmolality >500 mOsm
115
The term for the initial period during the activation of stress hypermetabolism where there is a decrease in oxygen consumption, cellular shock, and fluid imbalance lasting 24 to 36 hours:
Ebb phase
116
The term for the adaptation of the body to the ebb phase of stress hypermetabolism where body temperature, metabolic rate, and nitrogen loss are increased:
Flow phase
117
Sepsis/surgery/trauma can increase the kcal requirement by:
20% to 40%
118
The percentage increase of the basal metabolic rate for every degree above 38°C:
10%
119
General method to calculate the calorie requirement for a burn patient:
25 kcal/kg/d + (30 kcal/d × %burn)
120
General method to calculate the protein requirement for a burn patient:
1 to 1.5 g/kg/d + (3 g × %burn)
121
Level of albumin that is a strong risk factor for morbidity/mortality after surgery:
<3.0 g/dL
122
Pregnancy can increase the kcal requirement by:
300 kcal/d
123
What fuel source does the brain use during progressive starvation?
Ketones
124
Most efficient form for the storage of calories:
Triglycerides
125
Amino acid that is the primary substrate for gluconeogenesis:
Alanine
126
Only amino acids to increase during stress:
Alanine and phenylalanine
127
Primary enzyme responsible for the transamination of amino acids (ammonia, α-ketoglutarate):
Glutamate dehydrogenase
128
Where does gluconeogenesis occur during late starvation?
Kidney
129
Name the places where glycogen is stored and the rough percentages:
One-third in liver and two-thirds in skeletal muscle
130
How long does it take to deplete glycogen stores during starvation?
24 to 36 hours
131
List obligate glucose users in the body:
Adrenal medulla, peripheral nerves red blood cells, white blood cells
132
Carbohydrate digestion begins with this enzyme:
Salivary amylase
133
What is the protein requirement for an average healthy adult male?
1 g protein/kg/d; 20% from essential amino acids
134
Protein digestion begins with this enzyme:
Pepsin
135
1 g of nitrogen is contained in how many grams of protein:
6.25 g of protein contains 1 g nitrogen
136
Formula to calculate the nitrogen balance:
(Nin – Nout) = [(protein/6.25) – (24 hour urine N + 4 g)]
137
Name the branched chain amino acids:
Isoleucine, leucine, valine
138
Where are branched chain amino acids metabolized?
Muscle
139
List the nutrients included in immune-enhancing formulas:
Arginine, glutamine, ω-3 fatty acids, ω-6 fatty acids
140
Where is iron absorbed?
Most in duodenum and some in jejunum
141
Where is Vitamin B12 (cobalamin) absorbed?
Terminal ileum
142
Where are bile salts absorbed?
Terminal ileum
143
Where are fat soluble vitamins absorbed?
Terminal ileum
144
Name the fat soluble vitamins:
Vitamin A, D, E, K
145
Where is calcium absorbed?
Actively in the duodenum and passively in the jejunum
146
What vitamin increased the oral absorption of iron?
Vitamin C
147
Fuel for colonocytes:
Short-chain fatty acids (butyrate)
148
Fuel for small bowel enterocytes:
Glutamine
149
Primary fuel for cancer cells:
Glutamine
150
Term for an acute form of childhood protein-energy malnutrition characterized by anorexia, edema, enlarged liver with fatty infiltrates, irritability, and ulcerating dermatoses:
Kwashiorkor
151
Term for severe protein-energy malnutrition characterized by energy deficiency and characterized by extensive tissue/muscle wasting and variable edema:
Marasmus
152
How many kcal are there in a gram of dextrose?
3.4 kcal/g
153
How many kcal are there in a gram of oral carbohydrates?
4 kcal/g
154
How many kcal are there in a gram of protein?
4 kcal/g
155
How many kcal are there in a gram of fat?
9 kcal/g
156
List metabolic complications from TPN:
- Acid-base abnormalities
- Excessive glucose resulting in hyperosmolar nonketotic coma with resultant dehydration
- Increase in CO2 production
- Lipogenesis with resulting fatty liver/hepatic abnormalities
157
Maximal glucose administration for TPN delivered through a central line:
3 g/kg/h
158
For an average healthy adult male, what percentage of calories should come from fat?
30%
159
Rate that should not be exceeded with fat infusion:
2.5 g/kg/d
160
Name an amino acid solution that contains an increased percentage of branched chain amino acids that is used in patients with encephalopathy:
Hepatamine 8% amino acid solution
161
The caloric value from the lipid propofol is stored in:
1 kcal/cc
162
Formula to calculate the ideal body weight for a man:
106lb+6lbfor everyinchover 5ft
163
Formula to calculate the ideal body weight for a woman:
105lb +5lbf or every inch over 5ft
164
List the rough percentage of calories from carbohydrates in TPN:
50% to 60%
165
List the rough percentage of calories from proteins in TPN:
10% to 20%
166
List the rough percentage of calories from lipids in TPN:
20% to 30%
167
Electrolyte abnormalities found with refeeding syndrome:
Hypokalemia, hypomagnesemia, hypophosphatemia; occurs when feeding after prolonged malnutrition/starvation
168
The best parameter to check for adequate nutritional status:
Prealbumin
169
Half-life of retinol-binding protein:
~12 hours
170
Half-life of prealbumin:
2 to 3 days
171
Half-life of transferrin:
8 to 9 days
172
Half-life of albumin:
14 to 20 days
173
Formula for the respiratory quotient:
RQ = CO2 produced/O2 consumed
174
Respiratory quotient for carbohydrate:
1
175
Respiratory quotient for ethanol:
0.67
176
Respiratory quotient for fat:
0.7
177
Respiratory quotient during hyperventilation:
>1.1
178
Respiratory quotient to indicate lipogenesis or overfeeding:
>1.0
179
Respiratory quotient in starvation:
0.6 to 0.7 (fat is fuel source during starvation)
180
Ideal respiratory quotient during mixed substrate oxidation:
0.85 to 0.95
181
Respiratory quotient <0.82 indicates:
Occurrence of protein oxidation; increase total energy intake by increasing carbohydrates and caloric intake
182
Respiratory quotient >1 indicates:
Excessive calorie load; decrease carbohydrate intake and caloric intake
183
List the effects seen with chromium deficiency:
Encephalopathy, hyperglycemia, neuropathy
184
List the effects seen with cobalamin (B12) deficiency:
Beefy tongue, megaloblastic anemia, peripheral neuropathy
185
List the effects seen with copper deficiency:
Pancytopenia
186
List the effects seen with essential fatty acids deficiency:
Dermatitis, hair loss, thrombocytopenia
187
List the effects seen with folate deficiency:
Glossitis, megaloblastic anemia
188
List the effects seen with niacin deficiency:
Diarrhea, dermatits, dementia (Pellagra)
189
List the effects seen with phosphate deficiency:
Encephalopathy, decreased phagocytosis, weakness
190
List the effects seen with pyridoxine (B6) deficiency:
Glossitis, peripheral neuropathy, sideroblastic anemia
191
List the effects seen with thiamine (B1) deficiency:
Cardiomyopathy, peripheral neuropathy, Wernicke encephalopathy
192
List the effects seen with zinc deficiency:
Hair loss, rash, poor healing
193
List the effects seen with vitamin A deficiency:
Night blindness
194
List the effects seen with vitamin D deficiency:
Rickets, osteomalacia
195
List the effects seen with vitamin E deficiency:
Neuropathy
196
List the effects seen with vitamin K deficiency:
Coagulopathy
