Electrolytes

Question 1

Hyponatremic patients become symptomatic usually at?

Answer 1

Below 125 meq/L

Question 2

Agressive hyponatremia correction efffect (1)

Answer 2

Central pontine myelinolysis

Question 3

Patients at greatest risk to develop neurologic sequelae from a hyponatremic eqpisode?

Answer 3

Females of reproductive age, especially during menstruation. There may be an estrogen-related impairment of the adaptive ability of the brain in the setting of hyponatremia.

Question 4

The most common cause of postoperative hyponatremia is?

Answer 4

SIADH & water retention

Question 5

Generally elective surgery should be delayed if serum sodium levels exceed?

Answer 5

150 meq/L

Question 6

Hypernatremia increases or decreases minimal alveolar concentration?

Answer 6

Increases

Question 7

Hypokalemia produces electrocardiogram abnormalities and cardiac arrhythmias when serum K decreases to what level?

Answer 7

3 meq/L

Question 8

If potassium is administered, how much should be administered and how fast should it be administered?

Answer 8

Potassium should be administered at a rate no greater than 0.5 to 1 mEq/L. As a safety measure, no more than 20 mEq of potassium, diluted in a carrier and run through a controlled infusion pump, should be connected into a patient’s intravenous lines at any one time.

Question 9

Hyperkalemia >___ mEq/L should be corrected before elective procedures.

Answer 9

6

Usually dialysis is the treatment.

Question 10

How is hyperkalemia treated?

Answer 10

1) Treat cardiotoxicity with intravenous calcium chloride.
2) Potassium shifting (hyperventilation, b-adrenergic
stimulation, sodium bicarbonate, and insulin with glucose)
3) Excretion (diuretics, kayexelate, dialysis)

Question 11

When other causes have been ruled out, persistent and refractory hypotension in trauma or other critically ill patients may be caused by (2)?

Answer 11

Hypocalcemia or hypomagnesemia

Question 12

DO2 (oxygen delivery) value?

Answer 12

800-1200 mL/min

Question 13

VO2 (oxygen supply) value?

Answer 13

200-300 mL/min

Question 14

At what point is DO2crit reached?

Answer 14

As long as the patient is euvolemic, DO2crit is not reached until hemoglobin decreases to about 3.5 g/dl.

Question 15

Temperature storage for:

1) Platelet
2) RBCs

Answer 15

1) 20-22C

2) 4C

Question 16

Blood components at greatest risk for bacterial infection?

Answer 16

Platelets due to higher temp storage

Question 17

Transfusion reaction most commonly caused by clerical errors and transfusion of the wrong unit.

Answer 17

ABO incompatibility

Question 18

Nice to know

Answer 18

Federal regulation requires that at least 70% of transfused red blood cells survive 24 hours after CPDA-1 and for 42 days when AS-1 (Adsol) or AS-3 (Nutrice) is added.

Question 19

Changes in stored blood that reduce post-transfusion viability are known as?

Answer 19

Storage lesions

Question 20

Criteria for TRALI

Answer 20

1) Acute onset: often occurring in less than 2 hours after a transfusion, but usually less than 6 hours
2) Pulmonary arterial occlusion pressure 18 mm Hg
3) Bilateral infiltrates
4) PaO2/FiO2 <300 mmHg
5) No acute lung injury existed prior

Question 21

Transfusions in emergency situations do not allow time for a complete crossmatch. Under these circumstances the fastest choice is to use what type of blood?

Answer 21

O, Rh-negative (or Rh positive in males), uncrossmatched blood

Question 22

What are some of the complications of massive blood transfusion? (3)

Answer 22

1) Coagulopathy
2) Metabolic disturbances
3) Hypothermia

Question 23

What are coagulation disorders secondary to massive blood transfusion? (3)

Answer 23

1) Dilutional thrombocytopenia
2) Decreased factor V and VIII
3) DIC

Question 24

Hypothermia (34-36C) during blood transfusion increases blood loss by how many percent?

Answer 24

16%

Question 25

Erythropoietin stimulates erythrocyte production in how many days?

Answer 25

5-7