Chapter 2: Fluids and Electrolytes Flashcards
A 46yo woman underwent total thyroidectomy for multinodular goiter. On the second post-op morning she complains of circumoral tingling and numbness at her fingertips. The most likely additional finding in this pt will be:
Carpopedal spasm
A 30yo woman underwent total parathyroidemectomy for hyperPTH and 2 hyperplastic adenomas are removed. One half of the right inferior gland was implanted in the sternocleidomastoid muscle. On POD#1, she complains of generalized muscle scramps and she is slightly confused. What is the most likely diagnosis?
Severe hypocalcemia
A 63yo woman had a celiotomy for a recurrent bowel obstruction. One week post-op she develops a high output enterocutaneous fistula. Subsequent evaluation indicated the fistula involves her distal small bowel. The most appropriate fluid for replacing the loss from fistula is:
Ringer’s Lactate
A 38yo woman recovering from a laproscopic cholecystectomy returns to the office 5days after surgery complaining of RUQ pain. She is midly jaundiced. Subsequent workup suggests a bile leak, and a percutaneous drain is placed after ERCP is unsuccessful. Over the next 24 hours, almost 600 mL of bile-colored fluid is collected from the drain. The electrolyte composition of the fluid in the drain is closest to:
Na+ 130 mEq/L; Cl- 100 mEq/L; K 4.0 mEq/L, Bicarbonate 25 mEq/L
A 68yo woman underwent a subtotal gastric resection for a distal gastric cancer. Her stomach was reconstructed with a gastrojejunostomy. On POD3, large amt of bilious drainage is noted coming from a drain placed in her RUQ (800 mL in the last 24 hrs). The most likely represents which of the following?
A biliary leak from the duodenal stump
A 2week old boy is brought to the ED b/c of two days of nonbilious vomiting, lethargy, and low urine output. The boy is somnolent. His abdomen is nontender. Ultrasonography shows a hypertrophied pylorus. The most likely metabolic derangement is:
Hypochloremic hypokalemic metabolic alkalosis
A 17yo girl with anorexia nervosa was admitted to the hospital for total parental nutritional support. Two days after the start of her treatment, she experiences proximal muscle w/n and visual defects. This pt most likely has:
Hypophosphatemia
A 34yo man is admitted from the ED for surgery for a perforated appendicitis. He has diatbetes that he controls w/ oral medications. During the preop workup he is noted to have a severely elevated serum glucose and his serum sodium level is 124 mEq/L. The hyponatremia should not be treated initially b/c with hyperglycemia:
Measured serum sodium concentration decreases as a result of dilution in response to the osmolar gradient created by the increase in serum glucose
A 28yo man is admitted following a motorcycle crash in which he sustained a fractured left tibia, multiple left rib fractures, and a head injury. One week after the injury he is suspected of having SIADH because of depedent edema and a persistent low urine output in spite of normal vital signs . He has a serum sodium of 130 mEq/L, and his Hb and hct have slowly decreased to 9.2 gm/dl and 28% respectively. The most appropriate treatment of the suspected SIADH at this time should be:
Water restriction to less than 1000 mL/day
A 40yo man comes to the ED with a 4day history of N/V. He has had burning abd, epigastric pain for at least 1 week. He takes a beta blocker for HTN. His temp is 37.5 degrees C, BP on admission is 110/90 mmHg, his pulse is 104, and his RR is 14. He weighs 80 kg. Which of the following lab tests would provide the most assistance in the diagnosis and treatment of this patient?
Serum electrolytes
