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APA 1 > electrolytes > Flashcards

electrolytes Flashcards

1
Q

Total body water is _____ of total body weight

A

60%

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2
Q

Intracellular volume is _____ total body weight

A

40% or 2/3

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3
Q

Extracellular volume is _____ total body weight

A

20% or 1/3

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4
Q

Extracellular is split up into what 2 fluid volumes?

A

Interstitial 75%

Plasma volume 25%

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5
Q

TBW is ___% of a man’s weight

TBW is ___% of a woman’s weight

TBW is ___% of an infant’s weight

A

55%
45%
80%

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6
Q

Obese individuals have _____ TBW per weight than non-obese individuals

A

less

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7
Q

Fluid compartments are divided by

A

water-permeable membranes.

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8
Q

Intracellular space is separated from the extracellular space by the

A

cell membrane

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9
Q

The ______ _______ separates the components of the extracellular space.

A

Capillary membrane

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10
Q

all of the fluid compartments are trying to reach equilibrium, what allows this to not happen?

A

membranes

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11
Q

the intracellular fluid compartment has high concentrations of

A

potassium
phosphate
magnesium

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12
Q

in the intracellular fluid compartment, what is the primary cation

A

potassium

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13
Q

in the intracellular fluid compartment, what is the primary anion

A

phosphate

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14
Q

What maintained the high concentration of K+ in the ICP

A

Na, K, ATPase (3Na in:2 K out)

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15
Q

Extracellular fluid compartments have high concentrations of

A

Na and Cl

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16
Q

in the extracellular fluid compartment, what is the primary cation

A

Na

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17
Q

in the extracellular fluid compartment, what is the primary anion

A

Cl

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18
Q

1/4 of ECV is high concentration of

A

plasma proteins (albumin

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19
Q

Capillary membrane essentially impermeable to plasma proteins and they remain in the _______ ________

A

vascular space

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20
Q

interstitial fluid is _____ of ECV

A

3/4

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21
Q

What is a normal serum osmolality

A

285-295

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22
Q

How do you calculate a serum osmolality

A

(2(NA)) + (BUN/2.8) + (Glucose/18) = serum osmolality

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23
Q

Why is the intravascular fluid space the chief focus of fluid therapy?

A

Because it is an accessible fluid compartment

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24
Q

Starling forces: hydrostatic pressure in the capillaries (Pc) is the

A

blood pressure

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25
Q

Starling forces: Hydrostatic pressure in the interstitium (Pi) is

A

low

slightly negative d/t lymphatics

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26
Q

What is the main determinant of osmotic pressure?

A

albumin

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27
Q

a positive net driving force favors

A

filtration into tissues (interstitial fluid)

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28
Q

a negative net driving force favors

A

reabsorption into vasculature

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29
Q

Factors affecting fluid movement: osmolarity

A

An expression of the number of osmoles of a solute in a LITER of solution

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30
Q

Factors affecting fluid movement: osmolality

A

An expression of the number of osmoles of a solute in a KILOGRAM of solvent

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31
Q

Factors affecting fluid movement: tonicity

A

How a solution affects cell volume
For example – isotonic, hypertonic, hypotonic
Isotonic solutions approximately 285 mOsm/L

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32
Q

How does a hypertonic solution more fluid

A

fluid moves out of cell (shrinking cell)

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33
Q

How does a hypotonic solution move fluid

A

fluid moves into the cell (can burst)

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34
Q

Isotonic osmolality should be the same as

A

serum osmolality

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35
Q

What is the difference between hypovolemia and dehydration?

A

HYPOVOLEMIA
Loss of extracellular fluid
Absolute loss of fluid from the body
Reduced circulating volume

DEHYDRATION
Concentration disorder
Insufficient water present in relation to sodium levels

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36
Q

What is hypervolemia?

A

Excess of fluid volume in an isotonic concentration

Not usually a problem in surgical patients

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37
Q

What type of surgical patients would you see hypervolemia in?

A

CHF
Renal Failure
Overhydration with isotonic fluids

38
Q

_____ and ____ are responsible for the normal osmotic activity of the ECF

A

Na and Cl

39
Q

All gain/loss of Na+ is accompanied by gain/loss of

A

water

40
Q

Na:
intracellular
Extracellular

A

intracellular 25
Extracellular 140

maintained by Na, K, ATPase pump

41
Q

Lack of permeability to sodium changes the osmotic gradients between fluid compartments, leading to precedence of sodium over plasma proteins as the most important osmotically active substance influencing the _____ _______ of the brain

A

water content

42
Q

What is the most common electrolyte abnormality in hospitalized patients

A

hyponatremia

can be caused by a loss of Na or to much water

43
Q

What are some S/S of hyponatremia?

A

headache, malaise, agitation, coma, cerebral edema (MOST signifiant), confusion

Anorexia, N/V

cramps, weakness

44
Q

What are some causes of hyponatremia?

A 
Vomiting 
Diarrhea
Diuretics 
Adrenal insufficiency
Syndrome of inappropriate secretion of antidiuretic hormone
Renal failure
Water intoxication
CHF
Liver failure
Nephrotic syndrome
45
Q

Treatment of hyponatremia

A

fluid restriction

admin of hypertonic saline AND osmotic or loop diuretic

3% saline if symptomatic

46
Q

How quickly should Na be replaced?

A

no more than 1-2 meq/hr (no more than 10 in 24 hours)

47
Q

What happens if you correct Na levels too rapidly

A

Correction of serum sodium levels too rapidly can result in neurologic damage and myelinolysis!!!

48
Q

Most common cause of hypernatramia is

A

excessive loss of water or inadequate water intake

49
Q

What else can cause hypernatremia

A

Exogenous Na+ load
Primary hyperaldosteronism
Diabetes insipidus
Renal dysfunction

50
Q

S/S of hypernatremia

A

thirst, weakness, seizure, hallucinations, irritability, disorientation, coma, intracranial bleeding

hypervolemia

polyuria or oliguria, renal insufficiency

51
Q

treatment for hypernatremia

A

Correction of hypernatremia is accomplished by replacing the water deficit

Plasma sodium should be decreased by 1-2mEq/hr until the patient is clinically stable.

52
Q

Which electrolyte is largely responsible for resting membrane potential

A

potassium

53
Q

how is potassium balanced

A

GI absorption and renal excretion

54
Q

Causes of hypokalemia

A 
Gastrointestinal losses
Systemic alkalosis
(Diabetic ketoacidosis) wrong
Diuretic therapy
Sympathetic nervous system stimulation
Poor dietary intake
55
Q

the most common electrolyte abnormality encountered during clinical practice

A

hypokalemia

56
Q

CV manifestations of hypokalemia

A

ST-segment depression
Presence of U wave
Flattened or inverted T waves
Ventricular ectopy

57
Q

neuromuscular manifestations with hypokalemia

A

Weakness ( respiratory muscle)
Decreased reflexes
Confusion

58
Q

what will you see with a K < 2.5

A

paresthesia, depressed deep tendon reflexes, fasciculations, muscle weakness

59
Q

Below what K level do you question whether the surgery needs to be done now

A

<3

60
Q

At what K level do you start to see U waves on the EKG

A

2

61
Q

Treatment for hypokalemia

A

IV potassium supplements (up to 40mEqs can be given per hour)

62
Q

What do you NOT want to do when a patient has hypokalemia

A

Avoid hyperventilation of the lungs (makes you more alkalotic and drives K into cells)

Avoid glucose containing IV solutions (If you give glucose, body produces more insulin – drive K into cells )

Avoid rapid infusion of IV K+ supplements

63
Q

Causes of hyperkalemia

A

Renal failure
Potassium-sparing diuretics
Excessive IV K+ supplements
Excessive use of salt substitutes (Mrs Dash)

Metabolic or respiratory acidosis
Digitalis intoxication
Insulin deficiency
Hemolysis
Tissue and muscle damage after burns
Administration on succinylcholine
64
Q

CV manifestations of hyperkalemia

A 
Tall, peaked and elevated T waves
Widened QRS complex
Prolonged PR interval
Flattened or absent P wave
ST segment depression
Cardiac arrest
tachycardia
Vfib
65
Q

Treatment for hyperkalemia

A

Insulin and glucose to shift K+ into cells

IV calcium to antagonize cardiac effects of hyperkalemia

albuterol, hyperventilate

66
Q

What is the upper limit of K for elective procedures

A

5.5

67
Q

Where is Magnesium stores
___ - ____% in muscle & bones
____% in cells
____% in serum

A

40-60%
30%
1%

68
Q

Where does regulation of magnesium occur

A

intestines and kidneys

69
Q

T/F: Mag is a cofactor in enzymatic reactions (Energy metabolism, protein synthesis, neuromuscular excitability, function of NA-K-ATPase)

A

True

70
Q

Causes of hypomag

A 
Inadequate dietary intake of magnesium
TPN without magnesium supplementation
Starvation
Gastrointestinal losses
Diarrhea
Fistulas
Nasogastric suctioning
Vomiting
Chronic alcoholism
71
Q

ECG changes with hypomag

A 
Flat T-waves
U-waves
Prolonged QT interval
Widened QRS
Atrial and Ventricular PVCs
72
Q

Low Mag has inhibitory effect on NA-K-ATPase which

A

alters the resting membrane potential

73
Q

How do you replace IV mag?

A

1-2 g over 5 min with EKG monitoring

followed by a continuous IV infusion of 1-2g/hr

74
Q

causes of hypermag

A 
Iatrogenic administration	
Preeclampsia
Antacids/laxatives
Renal failure
Adrenal insufficiency
75
Q

what S/S at each mag level
4-7
10
10-15

A

4-7 = drowsiness, decreased deep tendon reflexes, weakness

10 = respiratory depression

10-15 = respiratory paralysis, coma

15-20 = cardiac arrest

76
Q

What do you use as an antagonist in urgent hypermag situations (bradycardia, heart block, Resp depression)

A

Calcium

77
Q

Mag will potentiate _______, but not enough to clinically effect us

A

NDNMBs

78
Q

Where is the majority of calcium found

A

99% in bones

1% in plasma and body cells

79
Q

What is the second messenger that couples cell membrane receptors to cellular responses

A

Calcium

Muscle contraction, hormones, neurotransmitters, coagulation, myocardial contractility

80
Q

PTH move ca -

CalcitonIN moves Ca

A

out of bones

INto the bones

81
Q

Causes of hypocalcemia

A

Hypoparathyroidism
Malignancy
Chronic renal insufficiency

82
Q

How does hyperventilation effect calcium

A

Hyperventilation leads to alkalosis which facilitates protein-binding of Ca

83
Q

Why do you give Ca when doing large blood transfusions

A

Citrate in banked blood binds Ca

84
Q

Neuro S/S of hypocalcemia

A 
Cramps
Weakness
Chvostek sign
Trousseau sign
Seizure
Numbness
tingling
85
Q

CV S/S of hypocalcemia

A 
Dysrhythmias
Prolonged QT interval
T-wave inversion
Hypotension
Decreased myocardial contractility
86
Q

Pulmonary S/S of hypocalcemia

A

Laryngospasm
Bronchospasm
Hypoventilation

87
Q

How to correct low Ca levels

A

Infusion of Ca Chloride (best option, more rapid correction)

Ca gluconate (slower)
3g Ca gluconate = 1 g Ca Chloride
88
Q

Causes of hypercalcemia

A

Hyperparathyroidism (>50% cause)

Tumors/malignancy

Calcium mobilization from bone due to immobility

89
Q

CV S/S of hypercalcemia

A

Hypertension
Heart block
Shortened QT interval
Dysrhythmias

90
Q

Neuromuscular S/S of hypercalcemia

A

Muscle weakness
Decreased deep tendon reflexes
Sedation

91
Q

Treatment of hypercalcemia

A

treat underlying cause
give adequate fluids/loop diuetics

If hypercalcemia with life threatening dysrhythmias = emergent dialysis

APA 1 (7 decks)

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