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Fiser's ABSITE Ryan > Chapter 9 - Fluids and Electrolytes > Flashcards

Chapter 9 - Fluids and Electrolytes Flashcards

2
Q

% body that is water?

A

2/3 (men); infants with a little more, women with a little less

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3
Q

% TBW that is intracellular?

A

2/3

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4
Q

% of TBW that is extracellular?

A

1/3

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5
Q

% of extracellular water that is interstitial?

A

2/3

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6
Q

% of extracellular water that is in plasma?

A

1/3

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7
Q

What determines the plasma/interstitial compartment osmotic pressures?

A

Proteins

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8
Q

What determines the intracellular/extracellular osmotic pressure?

A

Na

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9
Q

Composition of 0.9 NS?

A

Na 154, Cl 154

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10
Q

Composition of LR?

A

Na 130, K 4, Ca 2.7, Cl 109, bicarb 28

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11
Q

Normal plasma osmolarity?

A

280-295

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12
Q

What is the best indicator of adequate volume replacement?

A

Urine output

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13
Q

What are the insensible fluid lossess in a day?

A

10ml/kg/day; 75% skin, 25% respiratory

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14
Q

Why switch to D5 1/2 NS after 24h?

A

5% dextrose will stimulate insulin release, resulting in amino acid uptake and protein synthesis (prevents protein catabolism)

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15
Q

How much glucose will D51/2NS @ 125 provide?

A

150g glucose per day

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16
Q

Amount of fluid secreted by the stomach?

A

1-2L/day

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17
Q

Amount of fluid secreted by the biliary system?

A

500-1000ml/day

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18
Q

Amount of fluid secreted by the pancreas?

A

500-1000ml/day

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19
Q

Amount of fluid secreted by the duodenum?

A

500-1000ml/day

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20
Q

What is the normal K+ requirement?

A

0.5-1 mEq/kg/day

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21
Q

What is the normal Na+ requirement?

A

1-2 mEq/kg/day

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22
Q

Which secretion has the highest concentration of K+ in the body?

A

Saliva

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23
Q

Fluid replacement for gastric losses?

A

D51/2NS w/ 20 of K

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24
Q

Fluid replacement for pancreatic, biliary, small intestine losses?

A

LR with HCO3-

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25
Q

Fluid replacement for large intestine losses?

A

LR with K+

26
Q

At what rate should GI losses be replaced?

A

cc/cc

27
Q

Treatment for hyperkalemia?

A

Calcium gluconate (membrane stabilizer), sodium bicarb (causes alkalosis, KI enters cell in exchange for H), 10U insulin and 1 amp of 50% dextrose, kayexalate, dialysis

28
Q

EKG findings with hypokalemia?

A

Loss of T waves

29
Q

Symptoms of hypernatremia?

A

Restlessness, irritability, ataxia, seizures

30
Q

How do you calculate the free water deficit?

A

0.6 x pt’s wt (kg) x [(Na+/140)-1]

31
Q

How do you calculate the water requirement?

A

(Desired change in Na over 1 days x TBW)/(Desired Na+ after giving water requirement)

32
Q

Rate at which you should change Na?

A

No more than 0.7 mEq/h (16 mEq/day)

33
Q

Symptoms of hyponatremia?

A

Headaches, delirium, seizures, nausea, vomiting

34
Q

How do you calculate the sodium deficit?

A

0.6 x (weight in kg) x (140 - Na)

35
Q

Treatment for hyponatremia?

A

Water restriction, then diuresis, then NaCl replacement

36
Q

Why correct hyponatremia slowly?

A

To avoid central pontine myelinosis (no more than 1 mEq/h

37
Q

Most common malignant cause of hypercalcemia?

A

Breast cancer

38
Q

Treatment for hypercalcemia?

A

NS @ 200-300/hr, lasix; NO LR or thiazide diuretics

39
Q

Symptoms of hypocalcemia?

A

Hyperreflexia, Chvostek’s sign, perioral tingling and numbness, Trousseau’s sign, prolonged QT

40
Q

What is the protein adjustment for calcium?

A

For ever 1g decrease in protein, add 0.8 to Ca

41
Q

Which patients get hypermagnesemia?

A

Burn, trauma, renal dialysis pts

42
Q

Treatment for hypermagnesemia?

A

Calcium

43
Q

What is the anion gap?

A

Na - (HCO3 + Cl); normal <10-15

44
Q

What causes anion gap acidosis?

A

Methanol, Uremia, Diabetic ketoacidosis, Paraldehydes, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates

45
Q

What causes normal gap acidosis?

A

Due to loss of Na/HCO3- (ileostomies, small bowel fistulas)

46
Q

Treatment of metabolic acidosis?

A

Treat underlying cause; keep pH >7.2 with bicarb, severely decreased pH can affect myocardial contractility

47
Q

What causes metabiolic alkalosis?

A

Usually a contraction alkalosis; NGT (hypochloremic, hypokalemic and paradoxical aciduria)

48
Q

What causes the paradoxical aciduria of metabolica alkalosis?

A

Na+/H+ excanger activated in effort to reabsorb water, plus K+/H+ exchanger in an effort to reabsorb K+ leads to H+ in the urine

49
Q

What causes hypokalemia in metabolic alkalosis?

A

Loss of water causes kidney to reabsorb Na in exchange for K, losing K

50
Q

What is the best test for azotemia?

A

FeNa = (urine Na/Cr)/(plasma Na/Cr)

51
Q

What is the FeNa, urine Na, and BUN/Cr ratio in a prerenal patient?

A

FeNa 20

52
Q

Why is myoglobin toxic to renal cells?

A

Converted to ferrihemate in acide environment

53
Q

What is the treatment of myoglobinuria?

A

Alkalinize urine

54
Q

What is tumor lysis syndrome?

A

Release of purines and pyramidines which leads to increased PO4 and uric acid as well as decreased Ca

55
Q

Treatment for tumor lysis syndrome?

A

Hydration, allopurinol, diuretics, alkalinization of urine

56
Q

Metabolism of Vitamin D?

A

Made in skin (UV rays) from 7-dehydrocholesterol –> to liver for (25-OH) –> to kidney for (1-OH)

57
Q

What does the active form of Vitamin D do?

A

Increases calcium-binding protein, leading to increased intestinal Ca absorption

58
Q

What are the effects of chronic renal failure on Vit D and Ca?

A

Decreased active vitmain D (dec. 1-OH hydroxylation) leading to decreased Ca reabsorption from gut

59
Q

Why does chronic renal failure cause anemia?

A

Low erythropoietin

60
Q

What are the effects of increased Angiotensin II from decreased ECV?

A

Increase CO, increased peripheral resistance; increased sympthetic nerve activity; increased aldosterone; decreased renal blood flow, decreased GFR

Fiser's ABSITE Ryan (50 decks)

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