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Goljan Lecture Notes > Chapter 5: Water, Electrolyte, Acid-Base, and Hemodynamic Disorders > Flashcards

Chapter 5: Water, Electrolyte, Acid-Base, and Hemodynamic Disorders Flashcards

1
Q

What is the order from largest to smallest of fluid compartment sizes in the body?

A

ICF > ECF

interstitial > vascular

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2
Q

What are the most important ECF and ICF cations?

A

Na+ and K+

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3
Q

What is the equation for pOsm?

A

pOsm = 2(Na+) + serum glucose/18 + serum BUN/2.8 = 275-295 mOsm/kg

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4
Q

What direction does H2O shift during hyponatremia?

A

from ECF to ICF

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5
Q

What type of fluid causes NON-pitting edema?

A

exudates and lymphatic fluid

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6
Q

What type of fluid causes PITTING edema?

A

transudates

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7
Q

What are causes of pitting edema (transudate)?

A 
chronic liver dz (decreased albumin production)
malabsorption syndrome (poop it out)
nephrotic syndrome (pee it out)
low protein intake (Kwashiorkor)
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8
Q

MCC lymphedema

A

postradical mastectomy

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9
Q

What is the ratio of ECF to ICF?

A

⅓ to ⅔

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10
Q

What is the sequelae of hyponatremia?

A

H2O moves from ECF to ICF –> cerebral edema –> mental status changes

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11
Q

What is the sequelae of hypernatremia?

A

H2O moves from ICF to ECF –> neurons shrink –> mental status changes

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12
Q

What 2 molecules control water in the ECF?

A

Na+ and glucose

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13
Q

H2L shifts do NOT occur with alterations in urea concentration. Why?

A

B/c urea is a permanent solute and diffuses b/t the ECF and ICF without altering the osmotic gradient.

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14
Q

What findings are seen with a DECREASE in total body Na+?

A

decrease skin turgor
dry mucus membranes
decrease BP
increase pulse when sitting/standing up

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15
Q

What findings are seen with an INCREASE in total body Na+?

A

pitting edema

body cavity effusions

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16
Q

What clinical conditions result in an isotonic loss of fluid?

A

hemorrhage

diarrhea

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17
Q

MCC of low osmolarity in plasma?

A

hyponatremia (usually d/t prob in the kidney)

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18
Q

When serum Na+ is <120, the answer is ALWAYS…

A

SIADH

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19
Q

What are causes of SIADH?

A 
Small cell carcinoma of the lung
sulfonylurea medications (diabetes)
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20
Q

In oral rehydration therapy for cholera, what molecules must be included in the treatment to be effective?

A

glucose and Na+

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21
Q

What part of the vasculature controls your diastolic BP?

A

peripheral resistance arterioles

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22
Q

What is the treatment for isotonic loss?

A

normal saline

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23
Q

Baroreceptors are innervated by which nerves?

A

CN 9 and 10

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24
Q

Will you show signs of dehydration if you only lose water?

A

NO. You will show signs of dehydration if you lose H2O AND Na+

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25
Q

What does the TILT Test show?

A

Hypovolemic State

e.g. lady was lying down, her BP and pulse were normal but when they sat her up, the BP decreased and pulse went up.

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26
Q

What is the Rx for isotonic gain?

A

restrict water and loop diuretics

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27
Q

What can cause hypertonic loss?

A

loop diuretics/thiazides (excessive)
Addison
decrease in 21-hydroxylase

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28
Q

What is the Rx for hypertonic loss?

A

infuse normal saline or equivalent

29
Q

What occurs if you correct for hyponatremia too rapidly?

A

central pontine myelinolysis

30
Q

What can cause hypotonic fluid gain?

A

compulsive water drinker

31
Q

What is the Rx for hypotonic water gain?

A

restrict water

32
Q

Heavy metal poisoning (Pb or Hg) damages what organ? What is this condition called?

A

Proximal tubule cells undergo coagulation necrosis –> nephrotoxic acute tubular necrosis –> hyponatremia, hypoglycemia, hypouricemia, and hypophosphatemia

Called FANCONI Syndrome

33
Q

What causes K+ to move out of cells?

A

acidosis
digitalis
beta-blockers
succinylcholine

34
Q

What causes K+ to move into the cell?

A

insulin

beta2- agonists

35
Q

What is the MCC of hypokalemia?

A

loop diuretics

36
Q

What is the ECG change seen with hyperkalemia?

A

peaked T waves

37
Q

What is the MCC of respiratory acidosis?

A

chronic bronchitis

38
Q

What is the MCC of respiratory alkalosis?

A

anxiety

39
Q

What are risk factors for venous thrombi?

A

stasis
hyper coagulable state
endothelial damage

40
Q

MC site for venous thrombosis

A

deep veins, lower extremity below the knee

41
Q

What type of embolism results from fracture of a long bone?

A

fat embolism

42
Q

How long does it take for a fat embolism to typically occur?

A

1-3 days

43
Q

How long does it take for an amniotic fluid embolism to occur?

A

during labor or immediately postpartum

44
Q

What is the pathogenesis of decompression sickness?

A

rapid ascent causes nitrogen gas bubbles in vessel lumens and tissue (e.g. joints)

45
Q

What findings will you see in a patient with hypovolemic shock in terms of CO, LVEDP, PVR, and mixed venous oxygen content (MVO2)?

A

CO decreased
LVEDP decreased
PVR increased
MVO2 decreased (blood moving slower through vessels so O2 is able to be absorbed in tissue more)

46
Q

What physical findings will you see in a patient with hypovolemic shock?

A

cold/clammy skin
hypotension
tachycardia
decreased urine output

47
Q

What is the treatment for hypovolemic shock?

A

fluid replacement

48
Q

What is the MC site of infection leading to sepsis?

A

lungs

49
Q

What is the MCC of death in ICUs?

A

septic shock

50
Q

MCC of sepsis due to gram + organisms

A

coagulase-negative Staphylococci

51
Q

MCC of gram negative septic shock

A

E. coli

52
Q

MCC of fungal septic shock

A

Candida species

53
Q

What is the most important factor for producing septic shock in Gram positive pathogens?

A

lipoteichoic acid

54
Q

What findings will you see in a patient with septic shock in terms of CO, LVEDP, PVR, and mixed venous oxygen content (MVO2)?

A

CO increased
LVEDP decreased
PVR decreased
MVO2 increased (tissues unable to extract O2 from blood b/c moving too quickly)

55
Q

What physical findings will you see in a patient with septic shock?

A

warm skin
strong peripheral pulses
hypotension
DIC (d/t endotoxins which activate macrophages, complement system, and tissue thromboplastin)

56
Q

What findings will you see in a patient with cardiogenic shock in terms of CO, LVEDP, PVR, and mixed venous oxygen content (MVO2)?

A

CO decreased
LVEDP increased
PVR increased
MVO2 decreased

57
Q

MCC of death in shock

A

Multiple Organ Dysfunction Sydrome (MODS)

58
Q

What is the main factor controlling the TPR or PVR?

A

radius of ARTERIOLES

59
Q

What controls the viscosity in the blood?

A

hemoglobin

60
Q

What organ suffers greatest from decreased blood flow?

A

Kidney

61
Q

What type of damage occurs to the kidney with decreased blood flow and how?

A

decreased blood flow –> ischemia (esp. of medulla) –> acute tubular necrosis –> oliguria and increased BUN/Cr ratio –> eventual COAGULATION NECROSIS

62
Q

If an African American woman comes into your office with microscopic hematuria, what should you test for and why?

A

Test for Sickle Cell Trait

Low O2 content in the medulla can induce sickling

63
Q

Where in the brain is the respiratory center?

A

medulla oblongata

64
Q

Barbiturates will lead to respiratory acidosis or alkalosis?

A

respiratory acidosis

65
Q

A “thumb print” sign with a swollen epiglottis in a child with inspiratory stridor is most likely indicative of what type of infection?

A

acute epiglottis due to H. influenzae

66
Q

MCC of meningitis in 1 mo - 18 years?

A

N. meningitis

67
Q

Paralysis of the diaphragm will decrease or increased CO2 in the body?

A

increase

68
Q

Paralysis of the diaphragm due to many diseases (polio, ALS, Guillain-Barre) will result in a respiratory acidosis or alkalosis?

A

respiratory acidosis

Goljan Lecture Notes (4 decks)

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