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CNSC EXAM 2020 > Ch 7: Fluids, Electrolytes, and Acid Base Disorders > Flashcards

Ch 7: Fluids, Electrolytes, and Acid Base Disorders Flashcards

1
Q

What is the dominant extracellular osmole holding water in the extracellular space?

A

Sodium

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2
Q

What is the formula for adjusted body weight in obesity?

A

Obesity adjusted weight = [(actual BW- IBW) x0.25} + IBW

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3
Q

What are normal potassium requirements?

A

Normal potassium requirements range from 0.5-2.0 mEq/kg

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4
Q

What does an anion cap calculate, and what is the normal range?

A

Metabolic acidosis; Normal anion gap is 9 mEq/L (range 3-11 mEq/L)

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5
Q

What is the most common reason for hypercalcemia? (total serum > 10.2 or ionized> 1.3)

A

Hyperparathyroidism or cancer with bone metastasis

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6
Q

Low serum calcium stimulates release of _____ which ____ bone resorption, augments renal ____ of calcium, and ______ vitamin D which in turn_____ intestinal calcium absorption.

A

PTH; increases, conservation; activates; increases

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7
Q

Of all the body tissues, which is least hydrated?

A

Adipose; individuals with more body fat have proportionally less total body water

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8
Q

How can chronic or asymptomatic hypocalcemia can be treated?

A

Oral Calcium and Vitamin D supplements

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9
Q

What is the main intracellular anion and also helps maintain normal pH and bone and cell membrane composition?

A

Phosphorus

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10
Q

What is the primary intracellular osmole holding water within the cells?

A

Potassium

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11
Q

_____ is released by thyroid gland in response to elevated serum calcium concentrations (inhibits bone resorption and increases urinary Ca excretion)

A

Calcitonin (inhibits bone resorption and increases urinary Ca excretion)

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12
Q

By how much do fluid needs increase in patients with a temperature?

A

7% for each degree F above normal

13% for each degree C above normal

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13
Q

How much fluid does a healthy adult require?

A

30-40 mL of fluid per kg of body weight/d

Weight based equations tend to over overestimate fluid requirements for large people and underestimate those for small people

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14
Q

What % of body weight is water?

A

50-60%

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15
Q

What is the targeted rate of sodium correction for hyponatremia?

A

To prevent osmotic demyelination, targeted rate of sodium correction for hyponatremia should not exceed 10-12 mEq/L/d if acute or 6-8 mEq/L/day if chronic or duration is unknown

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16
Q

To prevent dehydration, some experts discourage use of energy-based formulas in patients > 65 years and instead recommend which formula?

A

Adjusted Holliday-Segar (1,500 mL for first 20kg of body weight + 15 mL/kg for remaining body weight)

30 mL/kg with a minimum of 1500 mL

1500-2000 mL/day

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17
Q

Which direct measurement of Ca is the most accurate method to assess calcium abnormalities?

A

Ionized Calcium

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18
Q

What % of TBW is contained in the ICF and ECF?

What % of TBW accounts for the TCF?

A

2/3rds of TBW is contained in ICF
1/3 is in ECF.

The TCF accounts for about 3% of TBW

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19
Q

What is considered clinically relevant hyponatremia?

A

< 130 mEq/L

20
Q

What is the normal pH of arterial blood?

A

pH of arterial blood is normally maintained within a narrow range of 7.35-7.45

21
Q

Which electrolyte should be repleted before potassium?

A

Magnesium (potassium levels are rarely corrected unless the magnesium deficit is corrected first)

22
Q

Which drugs are implicated in the etiology of hypocalcemia?

A

Bisphosphonates,calcitonin, furosemide, foscarnet, and long-term therapy with phenobarbital and phenytoin.

23
Q

What is the calculation for corrected calcium?

A

Corrected total serum Ca= Measured total serum Ca + {0.8 x (4-serum albumin)}

24
Q

What is contained the the extracellular fluid?

A

Intravascular and interstitial spaces.

25
Q

Where is Magnesium mostly found?

A

Intracellular fluid

26
Q

How much sodium is contained in normal (0.9%) saline?

A

Sodium - 154 mEq/L and Chloride 154 mEq/L.

27
Q

Which acid base disorder is consequence of chronic diuretic therapy?

A

Metabolic acidosis; caused by loss of bicarbonate poor, chloride rich extracellular fluid leading to contraction of extracellular fluid volume

28
Q

Which mineral is absorbed in the small intestine with only about 10% lost in urine and feces?

A

Potassium

29
Q

What is the equation for converting mg to mEq

A

mg x valence/ atomic weight

30
Q

How should mild hypercalcemia, defined as a total serum calcium of 10.3-11.9 mg/dL, be treated?

A

Mild hypercalcemia usually responds to hydration and ambulation and requires no further intervention.

31
Q

Which electrolyte abnormality may sulfamethoxazole/trimethoprim cause?

A

Hyperkalemia

32
Q

What is first line treatment for hyperkalemic emergencies?

A

Calcium Gluconate

33
Q

Prolonged NGT suction can cause loss of which electrolyte?

A

Potassium

Nasogastric output results in a loss of gastrointestinal secretions primarily from the stomach. Hypokalemia is a common issue with continued nasogastric output as the normal potassium concentration of gastric fluid is 10 mEq/L. Other possible electrolyte abnormalities include hyponatremia and hypochloremia.

Bicarbonate, calcium and phosphorus are not directly lost from gastric suction.

34
Q

Which acid base disorder is most likely to occur from diarrhea?

A

Metabolic acidosis; Diarrhea induces gastrointestinal losses of bicarbonate and can cause a metabolic acidosis (normal anion gap).

35
Q

Metastatic calcification is a complication of what?

A

Hyperphosphatemia

This occurs when the calcium-phosphorus product exceeds 55 mg^2/dL^2.

Additional consequences of hyperphosphatemia include secondary hyperparathyroidism and renal osteodystrophy.

36
Q

Patients with chronic heart failure are typically on a loop diuretic. These patients are at risk for what?

A

Azotemia; Loop diuretics are known to cause electrolyte abnormalities as a result of increased urine output. Specific disturbances include excess potassium and magnesium excretion which can result in hypokalemia and hypomagnesemia. Azotemia can occur related to volume depletion.

37
Q

A patient with chronic heart failure on high-dose furosemide is started on enteral nutrition for an inability to consume adequate oral nutrition. Despite a slow advancement to goal feeding rate, he suffers from electrolyte imbalance and peripheral neuritis. Deficiency of which vitamin should be suspected in the cause of his symptoms?

A

Thiamin

38
Q

A patient with refractory hypokalemia should be assessed for what related electrolyte disorder?

A

Hypomagnesemia

39
Q

Symptoms of manganese toxicity are associated most commonly with accumulation of the mineral in which organ?

A

Brain

40
Q

Metabolic acidosis, tissue catabolism, and pseudohyperkalemia results in an extracellular shift of which electrolye?

A

potassium

41
Q

What is the difference between hypervolemia vs dehydration?

A

Dehydration is the loss of water only; whereas hypovolemia is excessive fluid loss (often due to hemorrhage, vomiting, diarrhea, and/or diuresis)

42
Q

What is the principal cation in the ECFF?

A

Sodium; it is the major osmotic determinant in regulating ECF volume and water distribution in the body

43
Q

What is the appropriate treatment for SIADH?

A

Fluid restriction of 500-1000 mL/day

44
Q

True or false: Dextrose solutions should be avoided in a hypokalemic patient?

A

True; dextrose solutions may worsen hypokalemia by stimulating insulin release that promotes intracellular shift in potassium

45
Q 
What are fluid needs for the following age groups?
18-55 years old
55-75 years old
>75 years old 
Fluid restricted
A

18-55 years old: 35 mL/kg
55-75 years old: 30 mL/kg
>75 years old: 25 mL/kg
Fluid restricted: < 25 mL/kg

CNSC EXAM 2020 (42 decks)

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