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ABSITE Slayer > Cap. 7 Liquidos, electrolitos y nutrición > Flashcards

Cap. 7 Liquidos, electrolitos y nutrición Flashcards

1
Q

Name the 2 major body fluid compartments:

A

Intracellular and extracellular

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2
Q

Extracellular fluid is divided into these 2 subcompartments:

A

Interstitial fluid and intravascular fluid

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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

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4
Q

Approximate percentage of body weight that is fluid:

A

60%

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5
Q

Approximate percentage of body fluid that is extracellular:

A

33%

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6
Q

Approximate percentage of body weight that is intracellular:

A

66%

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7
Q

Percentage of extracellular fluid within the vascular compartment in the venous system:

A

85%

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8
Q

Percentage of extracellular fluid within the vascular compartment in the arterial system:

A

15%

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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)

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10
Q

Requirement of water per 24-hour period:

A

~30 to 35 mL/kg

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11
Q

Requirement of sodium per 24-hour period:

A

~1 to 2 mEq/kg

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12
Q

Requirement of chloride per 24-hour period:

A

~1.5 mEq/kg

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13
Q

Requirement of potassium per 24-hour period:

A

~1 mEq/kg

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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

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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

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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

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17
Q

Name the sources and the amount of normal daily electrolyte loss:

A

Chloride: 150 mEq, sodium: 100 mEq, potassium: 100 mEq

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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
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19
Q

State the electrolyte composition of sweat:

A

30 to 50 mEq sodium, 5 mEq potassium, 45 to 55 mEq hydrogen

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20
Q

State the electrolyte composition of gastric secretions:

A

40 to 65 mEq sodium, 90 mEq hydrogen, 100 to 140 mEq chloride

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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

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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

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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

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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

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25
Q

Define the “third space.”

A

Fluid accumulation in the interstitium of tissues (first 2 spaces: intravascular and intracellular)

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26
Q

When does third-spaced fluid tend to mobilize back into the intravascular space?

A

Postoperative day #3

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27
Q

What is the earliest sign of volume excess during the postoperative period?

A

Weight gain

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28
Q

Classic finding with overaggressive nasogastric tube suctioning or long-standing vomiting:

A

Hypokalemic hypochloremic metabolic alkalosis

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29
Q

Name the various mechanisms that loop diuretics employ to decrease pulmonary edema:

A

Inhibit active sodium absorption in the thick ascending loop of Henle, increase venous capacitance, stimulate vasodilatory prostaglandins leading to increased renal blood flow

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30
Q

Formula to calculate serum osmolality:

A

2 × sodium + urea/2.8 + glucose/18

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31
Q

How much sodium and chloride are in normal saline?

A

154 mEq Na and 154 mEq Cl

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32
Q

Composition of lactated Ringer’s:

A

130 mEq Na+, 109 mEq Cl–, 4 mEq K+, 28 mEq lactate, and 3 mEq calcium

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33
Q

How many grams of dextrose in a liter of D5W?

A

50 g; D5W is a 5% solution of dextrose (5 g dextrose/100 cc × 1000 cc/1 L = 50 g dextrose)

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34
Q

The 2 “rules” for the calculation of maintenance fluids:

A

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

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35
Q

Name the standard maintenance fluid used in an adult:

A

D5 1/2 normal saline (NS) with 20 mEq KCl

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36
Q

Name the standard maintenance fluid used in a pediatric patient:

A

D5 1/4 NS with 20 mEq KCl

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37
Q

Usual minimal urine output for an adult:

A

~30 mL/h or 0.5 mL/kg/h

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38
Q

How much of a 1-L NS bolus will stay intravascular in a 5-hour period?

A

~200 cc or 20%

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39
Q

Normal range for sodium:

A

135 to 145 mEq/L

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40
Q

Define pseudohyponatremia and list causes:

A

Spuriously low lab result for sodium; hyperglycemia, hyperlipidemia, hyperproteinemia

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41
Q

Name the 3 types of hyponatremia:

A

Hypovolemic, euvolemic, hypervolemic

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42
Q

Name surgical causes of hypovolemic hyponatremia:

A

Burns, diaphoresis, diuretics, hypoaldosteronism, NG suctioning, pancreatitis, vomiting

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43
Q

Name surgical causes of euvolemic hyponatremia:

A

CNS abnormalities, drugs, syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

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44
Q

Name surgical causes of hypervolemic hyponatremia:

A

Congestive heart failure, cirrhosis, iatrogenic, renal failure

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45
Q

Signs and symptoms of hyponatremia:

A

Coma/confusion, ileus, lethargy, nausea/vomiting, seizure, weakness

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46
Q

Treatment of hypovolemic hyponatremia:

A

Correct the underlying cause, give IV NS

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47
Q

Treatment of euvolemic hyponatremia (SIADH):

A

Acute treatment with furosemide and normal saline; fluid restriction

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48
Q

Treatment of hypervolemic hyponatremia (dilutional):

A

Fluid restriction and diuretics

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49
Q

Grave consequence of correcting hyponatremia too quickly:

A

Myelinolysis (formerly known as central pontine myelinolysis)

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50
Q

Formula to calculate the sodium deficit:

A

(normal sodium concentration – observed sodium concentration) × total body water; Remember: total body water = 0.6 × weight (kg)

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51
Q

Approximately how much does the apparent serum sodium concentration fall for each 100 mg/dL rise in blood glucose level above normal?

A

1.6 to 3.0 mEq/L

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52
Q

Maximal rate of sodium correction for acute hyponatremia:

A

1 to 2 mEq/L/h for 3 to 4 hours until neurologic symptoms subside or until plasma Na is >120 mEq/L

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53
Q

Maximal rate of sodium correction for chronic hyponatremia:

A

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

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54
Q

Name surgical causes of hypernatremia:

A

Dehydration, diabetes insipidus, diaphoresis, diarrhea, diuresis, iatrogenic, vomiting

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55
Q

Signs and symptoms of hypernatremia:

A

Confusion, peripheral/pulmonary edema, respiratory paralysis, stupor, seizures, tremors

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56
Q

Treatment of hypernatremia:

A

Slow supplementation of 1/4 NS or 1/2 NS over days

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57
Q

Formula to calculate the free water deficit:

A

Total free water deficit = 0.6 × weight (kg) × [(Serum Na+/140) – 1]

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58
Q

What is the normal range for potassium:

A

3.5 to 5.0 mEq/L

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59
Q

Critical values for potassium:

A

K <2.8 mEq/L or >6.0 mEq/L

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60
Q

Name some surgical causes of hypokalemia:

A

Alkalosis, diuretics, drugs (steroids/antibiotics), diarrhea, iatrogenic, insulin, intestinal fistula, NG suctioning, vomiting

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61
Q

Signs and symptoms of hypokalemia:

A

Ileus, weakness, tetany, nausea/vomiting, paresthesia

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62
Q

EKG findings of hypokalemia:

A

Flattened T waves, U waves, ST segment depression, atrial fibrillation, premature atrial complexes/premature ventricular complexes

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63
Q

Acute treatment for hypokalemia:

A

IV KCl

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64
Q

Maximum amount of potassium that can be administered through a peripheral IV:

A

10 mEq/h

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65
Q

Maximum amount of potassium that can be administered through a central line:

A

20 mEq/h

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66
Q

Most common cause for an electrolyte mediated ileus in a surgical patient:

A

Hypokalemia

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67
Q

Digitalis toxicity is worsened by this electrolyte condition:

A

Hypokalemia

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68
Q

Name surgical causes of hyperkalemia:

A

Iatrogenic, diuretics, acidosis, trauma, hemolysis, renal failure, blood transfusion

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69
Q

Signs and symptoms of hyperkalemia:

A

Areflexia or decreased deep tendon reflexes, paresthesia, paralysis, weakness, and respiratory failure

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70
Q

EKG findings of hyperkalemia:

A

Peaked T waves, prolonged PR, wide QRS, depressed ST segment, ventricular fibrillation, bradycardia

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71
Q

What is the treatment for hyperkalemia?

A

IV calcium, sodium bicarbonate, dextrose and insulin (1 amp 50% dextrose and 10 U insulin), albuterol, kayexalate, furosemide, dialysis

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72
Q

Most of the calcium in the body is contained within:

A

Bone

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73
Q

Percentage of serum calcium that is nonionized and bound to plasma protein:

A

~50%

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74
Q

Percentage of serum calcium that is nonionized and bound to substances other than plasma protein in the plasma:

A

5%

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75
Q

How much does a 1-g drop in protein decrease the measured total serum calcium?

A

0.8 mg/dL

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76
Q

In the setting of rapid transfusion, how much calcium should be given per 500 cc of transfused blood?

A

0.2 g/500 cc transfused blood

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77
Q

Name some surgical causes of hypocalcemia:

A

Acute pancreatitis, aminoglycosides, diuretics, hypomagnesemia, intestinal bypass, osteoblastic metastasis, renal failure, rhabdomyolysis, sepsis, short bowel syndrome, vitamin D deficiency

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78
Q

Formula to determine the calcium level with hypoalbuminemia:

A

Serum calcium + [(4 – measured albumin) × 0.8]

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79
Q

Signs and symptoms of hypocalcemia:

A

Abdominal cramping, Chvostek signs, confusion, depression, hallucinations, increased deep tendon reflexes, laryngospasm, paranoia, perioral paresthesia, seizures, stridor, tetany, Trousseau sign

80
Q

Define Chvostek sign:

A

Tapping of facial nerve with resultant facial muscle spasm

81
Q

Define Trousseau sign:

A

Utilization of a blood pressure cuff to occlude blood flow to the forearm with resultant latent tetany evidenced by carpal spasm

82
Q

EKG findings hypocalcemia:

A

Peaked T waves, prolonged QT and ST intervals

83
Q

Acute treatment of hypocalcemia:

A

IV calcium supplementation

84
Q

Chronic treatment of hypocalcemia:

A

PO calcium and vitamin D supplementation

85
Q

Mnemonic for hypercalcemia:

A

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
Q

Signs and symptoms of hypercalcemia:

A

Polydipsia, polyuria, and constipation and the classic “stones, bones, abdominal groans, and psychiatric overtones”

87
Q

EKG findings of hypercalcemia:

A

Prolonged PR interval and shortened QT interval

88
Q

Acute treatment for hypercalcemic crisis:

A

Normal saline volume expansion with furosemide diuresis

89
Q

Additional options for treating hypercalcemia:

A

Bisphosphonates, calcitonin, mithramycin, steroids, and dialysis

90
Q

What kind of diuretic should be avoided in the face of hypercalcemia?

A

Thiazide diuretics (calcium-sparing diuretic)

91
Q

Normal range for magnesium:

A

1.5 to 2.5 mEq/L

92
Q

Electrolyte abnormality associated with “impossible to correct” hypokalemia and hypocalcemia:

A

Hypomagnesemia

93
Q

Name surgical causes of hypomagnesemia:

A

Aminoglycosides, diarrhea, gastric suctioning, hypocalcemia, renal failure, total parenteral nutrition (TPN), vomiting

94
Q

Signs and symptoms of hypomagnesemia:

A

Asterixis, Chvostek sign, dysrhythmias, increased deep tendon reflexes, tachycardia, tetany, tremor, ventricular ectopy, vertigo

95
Q

Treatment for acute hypomagnesemia:

A

IV magnesium sulfate (or magnesium chloride)

96
Q

Treatment for chronic hypomagnesemia:

A

PO magnesium oxide

97
Q

Name surgical causes of hypermagnesemia:

A

Iatrogenic, renal failure, TPN

98
Q

Signs and symptoms of hypermagnesemia:

A

IV calcium, dextrose and insulin, dialysis, Lasix

99
Q

Normal range for phosphorus:

A

2.5 to 4.5 mg/dL

100
Q

Critical value for phosphorus:

A

<1.0 mg/dL

101
Q

Name surgical causes of hypophosphatemia:

A

Alcohol abuse, gastrointestinal losses, inadequate supplementation, medications, renal loss, sepsis

102
Q

Signs and symptoms of hypophosphatemia:

A

Ataxia, cardiomyopathy, hemolysis, poor response to pressors, rhabdomyolysis, neurologic dysfunction, weakness

103
Q

Treatment for acute hypophosphatemia:

A

IV sodium phosphate or potassium phosphate

104
Q

Treatment for chronic hypophosphatemia:

A

PO replacement (Neutra phos)

105
Q

Name surgical causes of hyperphosphatemia:

A

Chemotherapy, hyperthyroidism, renal failure, sepsis

106
Q

Signs and symptoms of hyperphosphatemia:

A

Calcification, heart block

107
Q

List the disturbances seen with tumor lysis syndrome:

A

Hypocalcemia, hyperkalemia, hyperuricemia, hyperphosphatemia

108
Q

Name the important intracellular buffer:

A

Phosphate buffer system and proteins

109
Q

Name the primary extracellular buffering system:

A

Bicarbonate-carbonic acid system

110
Q

Henderson-Hasselbalch equation:

A

pH = pK + log [HCO3]/[CO2]

111
Q

Formula to calculate the anion gap:

A

Anion gap = Sodium – (bicarbonate + chloride)

112
Q

Mnemonic for anion gap acidosis:

A

Mudpiles: methanol, uremia, diabetic ketoacidosis, paraldehyde, isoniazid, lactic acidosis, ethylene glycol, salicylates

113
Q

Formula for functional excretion of sodium (FeNa):

A

FeNa = (urine sodium/urine creatinine)/(plasma sodium/plasma creatinine)

114
Q

List some common laboratory values seen in a prerenal state:

A

BUN/Cr ratio >20, FeNa <1%, urine sodium <20, urine osmolality >500 mOsm

115
Q

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:

A

Ebb phase

116
Q

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:

A

Flow phase

117
Q

Sepsis/surgery/trauma can increase the kcal requirement by:

A

20% to 40%

118
Q

The percentage increase of the basal metabolic rate for every degree above 38°C:

A

10%

119
Q

General method to calculate the calorie requirement for a burn patient:

A

25 kcal/kg/d + (30 kcal/d × %burn)

120
Q

General method to calculate the protein requirement for a burn patient:

A

1 to 1.5 g/kg/d + (3 g × %burn)

121
Q

Level of albumin that is a strong risk factor for morbidity/mortality after surgery:

A

<3.0 g/dL

122
Q

Pregnancy can increase the kcal requirement by:

A

300 kcal/d

123
Q

What fuel source does the brain use during progressive starvation?

A

Ketones

124
Q

Most efficient form for the storage of calories:

A

Triglycerides

125
Q

Amino acid that is the primary substrate for gluconeogenesis:

A

Alanine

126
Q

Only amino acids to increase during stress:

A

Alanine and phenylalanine

127
Q

Primary enzyme responsible for the transamination of amino acids (ammonia, α-ketoglutarate):

A

Glutamate dehydrogenase

128
Q

Where does gluconeogenesis occur during late starvation?

A

Kidney

129
Q

Name the places where glycogen is stored and the rough percentages:

A

One-third in liver and two-thirds in skeletal muscle

130
Q

How long does it take to deplete glycogen stores during starvation?

A

24 to 36 hours

131
Q

List obligate glucose users in the body:

A

Adrenal medulla, peripheral nerves red blood cells, white blood cells

132
Q

Carbohydrate digestion begins with this enzyme:

A

Salivary amylase

133
Q

What is the protein requirement for an average healthy adult male?

A

1 g protein/kg/d; 20% from essential amino acids

134
Q

Protein digestion begins with this enzyme:

A

Pepsin

135
Q

1 g of nitrogen is contained in how many grams of protein:

A

6.25 g of protein contains 1 g nitrogen

136
Q

Formula to calculate the nitrogen balance:

A

(Nin – Nout) = [(protein/6.25) – (24 hour urine N + 4 g)]

137
Q

Name the branched chain amino acids:

A

Isoleucine, leucine, valine

138
Q

Where are branched chain amino acids metabolized?

A

Muscle

139
Q

List the nutrients included in immune-enhancing formulas:

A

Arginine, glutamine, ω-3 fatty acids, ω-6 fatty acids

140
Q

Where is iron absorbed?

A

Most in duodenum and some in jejunum

141
Q

Where is Vitamin B12 (cobalamin) absorbed?

A

Terminal ileum

142
Q

Where are bile salts absorbed?

A

Terminal ileum

143
Q

Where are fat soluble vitamins absorbed?

A

Terminal ileum

144
Q

Name the fat soluble vitamins:

A

Vitamin A, D, E, K

145
Q

Where is calcium absorbed?

A

Actively in the duodenum and passively in the jejunum

146
Q

What vitamin increased the oral absorption of iron?

A

Vitamin C

147
Q

Fuel for colonocytes:

A

Short-chain fatty acids (butyrate)

148
Q

Fuel for small bowel enterocytes:

A

Glutamine

149
Q

Primary fuel for cancer cells:

A

Glutamine

150
Q

Term for an acute form of childhood protein-energy malnutrition characterized by anorexia, edema, enlarged liver with fatty infiltrates, irritability, and ulcerating dermatoses:

A

Kwashiorkor

151
Q

Term for severe protein-energy malnutrition characterized by energy deficiency and characterized by extensive tissue/muscle wasting and variable edema:

A

Marasmus

152
Q

How many kcal are there in a gram of dextrose?

A

3.4 kcal/g

153
Q

How many kcal are there in a gram of oral carbohydrates?

A

4 kcal/g

154
Q

How many kcal are there in a gram of protein?

A

4 kcal/g

155
Q

How many kcal are there in a gram of fat?

A

9 kcal/g

156
Q

List metabolic complications from TPN:

A
  • 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
Q

Maximal glucose administration for TPN delivered through a central line:

A

3 g/kg/h

158
Q

For an average healthy adult male, what percentage of calories should come from fat?

A

30%

159
Q

Rate that should not be exceeded with fat infusion:

A

2.5 g/kg/d

160
Q

Name an amino acid solution that contains an increased percentage of branched chain amino acids that is used in patients with encephalopathy:

A

Hepatamine 8% amino acid solution

161
Q

The caloric value from the lipid propofol is stored in:

A

1 kcal/cc

162
Q

Formula to calculate the ideal body weight for a man:

A

106lb+6lbfor everyinchover 5ft

163
Q

Formula to calculate the ideal body weight for a woman:

A

105lb +5lbf or every inch over 5ft

164
Q

List the rough percentage of calories from carbohydrates in TPN:

A

50% to 60%

165
Q

List the rough percentage of calories from proteins in TPN:

A

10% to 20%

166
Q

List the rough percentage of calories from lipids in TPN:

A

20% to 30%

167
Q

Electrolyte abnormalities found with refeeding syndrome:

A

Hypokalemia, hypomagnesemia, hypophosphatemia; occurs when feeding after prolonged malnutrition/starvation

168
Q

The best parameter to check for adequate nutritional status:

A

Prealbumin

169
Q

Half-life of retinol-binding protein:

A

~12 hours

170
Q

Half-life of prealbumin:

A

2 to 3 days

171
Q

Half-life of transferrin:

A

8 to 9 days

172
Q

Half-life of albumin:

A

14 to 20 days

173
Q

Formula for the respiratory quotient:

A

RQ = CO2 produced/O2 consumed

174
Q

Respiratory quotient for carbohydrate:

A

1

175
Q

Respiratory quotient for ethanol:

A

0.67

176
Q

Respiratory quotient for fat:

A

0.7

177
Q

Respiratory quotient during hyperventilation:

A

> 1.1

178
Q

Respiratory quotient to indicate lipogenesis or overfeeding:

A

> 1.0

179
Q

Respiratory quotient in starvation:

A

0.6 to 0.7 (fat is fuel source during starvation)

180
Q

Ideal respiratory quotient during mixed substrate oxidation:

A

0.85 to 0.95

181
Q

Respiratory quotient <0.82 indicates:

A

Occurrence of protein oxidation; increase total energy intake by increasing carbohydrates and caloric intake

182
Q

Respiratory quotient >1 indicates:

A

Excessive calorie load; decrease carbohydrate intake and caloric intake

183
Q

List the effects seen with chromium deficiency:

A

Encephalopathy, hyperglycemia, neuropathy

184
Q

List the effects seen with cobalamin (B12) deficiency:

A

Beefy tongue, megaloblastic anemia, peripheral neuropathy

185
Q

List the effects seen with copper deficiency:

A

Pancytopenia

186
Q

List the effects seen with essential fatty acids deficiency:

A

Dermatitis, hair loss, thrombocytopenia

187
Q

List the effects seen with folate deficiency:

A

Glossitis, megaloblastic anemia

188
Q

List the effects seen with niacin deficiency:

A

Diarrhea, dermatits, dementia (Pellagra)

189
Q

List the effects seen with phosphate deficiency:

A

Encephalopathy, decreased phagocytosis, weakness

190
Q

List the effects seen with pyridoxine (B6) deficiency:

A

Glossitis, peripheral neuropathy, sideroblastic anemia

191
Q

List the effects seen with thiamine (B1) deficiency:

A

Cardiomyopathy, peripheral neuropathy, Wernicke encephalopathy

192
Q

List the effects seen with zinc deficiency:

A

Hair loss, rash, poor healing

193
Q

List the effects seen with vitamin A deficiency:

A

Night blindness

194
Q

List the effects seen with vitamin D deficiency:

A

Rickets, osteomalacia

195
Q

List the effects seen with vitamin E deficiency:

A

Neuropathy

196
Q

List the effects seen with vitamin K deficiency:

A

Coagulopathy

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