Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AFN Health Assessment > Electrolytes: Fluids > Flashcards

Electrolytes: Fluids Flashcards

1
Q

Hypokalemia= k< ____, symptomatic often below _____

A

3.5
3.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hypokalemia causes

A

Redistribution from ECF to ICF

Decreased intake

Total K deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypo K; Redistribution of K from ECF to ICF caused by….

(Some of these are also tx for hyperkalemia)

A

Alkalosis

Insulin

Beta 2 agonists

Hypercalcemia

Hypomagnesemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Things to AVOID in Hypokalemia, due to further K depletion in ECF…

A

Glucose solutions

Hyperventilating (alkalosis)

Rapid correction of acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When replacing K, we should also check and replace ____

A

Mag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

No need to correct chronic Hypokalemia with K < 2.5 mEq/L prior to induction unless _____ therapy

A

Digitalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

k replacement recommendations for dosage

A

Less than or equal to 10 mEq/hour

PO Is safest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hypokalemia effects on NMB drugs?

A

Hypo k causes weakness- weakness augments NMB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hypokalemia effects on EKG

A

Decreased contractility
Hyper-polarized cell (increased gradient)

Flattened t waves

U waves

Increased PRI

Increased QT

atrial of ventricular arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hyperkalemia defined as k > _____, must treat K > ______
Most danger K > ______

A

5.5

6

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S/s of acute hyperkalemia

A

Muscle weakness, especially in legs and respiratory system

Paresthesias (neuro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hyperkalemia conduction changes

A

Prolonged PRI

Peaked T

Loss of P wave

Wide QRS

Vfib/arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Etiology Of hyper K

A

Decreased excretion

ICF to ECF shift

Artificial elevation due to hemolysis of blood sample (double check)

Hypoaldosteronism (aldosterone holds Na and excretes K)

Potassium sparing diuretics (spirolactone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If your Co2 increases 10 mmhg, the pH will ______ by _____, and the plasma K will increase by ______ mEq/L

A

Decrease by 0.1

0.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pH and plasma K are ________ proportional

A

Inversely proportional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Caution with these medications in renal failure patients

A

NSAIDS

ACEI

CSA (cyclosporine A)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Administration of succinylcholine is dangerous due to this effect;

Caution in patients with _______

A

Opens all K pumps and rapidly moves K from intra to extra cellular space, can cause V fib and cardiac arrest

Caution in hyperkalemic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If you must use succinylcholine, this may have a protective effect

A

Hyperventilating prior to injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hyperkalemic patients, take precautions to avoid _______ when managing breathing

A

Hypoventilation, due to increase Co2x decreasing pH, driving more K to ECF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Considering cancelling elective surgery if K>_____.

Do consider if it is acute or chronic. Chronic failure chronic elevation may tolerate

A

5.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Always treat K > _____

A

6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Avoid what induction med in hyperkalemia?

A

Succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Steps to treat hyperkalemia that is life threatening (ekg changes, greater than 6.5, high risk patient)

A

1) stabilize the heart with Ca (CaCl or calcium gluconate). Consider repeating if EKG changes persist

2) shift K into cells- regular insulin (10-20 units) and glucose (25-50 g)

3) beta 2 agonist inhaled- shift K into cells

4) enhance elimination of K- considering patients volume status-

-low volume- resus with .9 nacl then use loop diuretic it UOP is present
-high volume- move straight to diuretic if UOP is present

No UOP? Dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NMDMR consideration with hyper K?

A

skeletal weakness suggests decreased dose for muscle relaxants intraop- titrate to effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

IV fluid considerations for hyperkalemia

A

If using large doses of fluid/ make sure no K.

LR, K is low, but without elimination can build in high doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Magnesium controls ______ reabsorption in renal tubules

A

k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

______ stabilizes membranes, influences releases of neurotransmitters at the NMJ.

Can inhibit entry of Ca into presynaptic nerve terminals

Endogenous Ca antagonist

A

Magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

This electrolyte is an endogenous NMDA receptor antagonist

A

Magnesium

Blocks N-methyl receptor, similar to ketamine?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Essential co factor to many enzymatic reactions; DNA and protein synthesis, energy metabolism, glucose utilization, FFA synthesis

A

Magnesium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Hypomagnesemia= mag < ____ mEq/L

A

1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Hypomagnesemia caused by….

A

Inadequate intake

Protracted vomiting, diarrhea

Renal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Hypomagnesemia signs and symptoms

A

Skeletal muscle spasms and weakness

CNS irritability

Seizures, hyper-reflexia, confusion, ataxia, cardiac irritability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Hypomagnesemia tx

A

MgSO4 bolus- 1 go over 15-20 mins

Rate no greater than 1 mEq/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Hypomagnesemia anesthetic consideration;

A

Look for associated disturbances; Hypokalemia, hyponatremia, hypocalcemia

Frequently occurs in alcoholic patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Hypermagnesemia = mag > _____ mEqs/L

A

2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Hypermagnesemia associated with….

A

Acute or chronic renal failure

Toxemia from magnesium therapy

Overadmin if magnesium containing compounds (ie antacids, cathartics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Hypermagnesemia s/s

A

Skeletal muscle weakness

Can lead to respiratory arrest

Vasodilation, hypotension

Myocardial depression, hypotension

Complete heart block

Hyporeflexia, diminished DTR

sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Hypermagnesemia tx….

A

Stop mag therapy/intake- (often infused in OB)

Increase excretion (loop diuretic)

Antagonize CV or NM toxicity with CaCl or Ca gluconate (transient effect, gives time to excrete mag)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Anesthetic considerations in Hypermagnesemia

A

Magnesium potentials the action of NDMR- NMB will last LONGER

Intubation for pt if respiratory reflexes become compromised (OB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What type of calcium is measured (physiologically active) for our purposes

A

Ionized calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Calcium is found primarily in ____ and then _____ fluid

A

Bone

ECF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

___- _____ % of calcium is protein bound to albumin in the plasma

A

40-45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Calcium is regulated by these two hormones—

And what endocrine organ!

A

Calcitonin

Parathyroid hormone

Parathyroid glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

_______ is essential for all movement, all normal excitation-contraction coupling of myocardial and skeletal muscle

A

Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

_________ is the neurotransmitter released into the synaptic gap

A

Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

______ causes the plateau phase of cardiac muscle cells

A

Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Hypocalcemia-
Serum ca < ____ mg/dl
Ionized Ca< ____ mEq/L

A

8.5
2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Hypocalcemia etiologies;

A

Malabsorption

Increased excretion due to renal insufficiency

Hypoparathyroidism

Chelation from citrate in blood transfusions (transient, negligible unless renal/hepatic failure or hypothermia)

Shift into cell with alkalosis IE acute resp alkalosis (increased mV, this is the reason hyperventilation of anxiety can cause parasthesias of the lips)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Hypocalcemia: s/s

A

CNS; parasthesias (especially circumpolar) confusion, seizures

CV; decrease myocardial contractility, hypotension, cardiac failure, arrhythmias. Negative inotropy- decreased camp, decreased cardiac AP

NM; twitching, cramping, trousseaus sign, chevosteks sign, convulsions, laryngospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Major airway consideration/caution with hypocalcemia

A

Laryngospasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Hypocalcemia/ effect on EKG

A

Prolonged QTC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Anesthetic considerations for hypocalcemia-

A

Replace calcium, evaluate pt history, renal function, serum phosphate (inversely proportional)

Avoid alkalosis- drives Ca into cells

Monitor Ionized calcium

Monitor patient with replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Calcium replacements;

A

CaCl; 3-5 ml of 10%
13.6 mEq per gram

CaGluc; 10-20 ml of 10%
4.65 mEq per gram

54
Q

Caution treating Hypokalemia without correction of _______ ; may precipitate tetany

A

Calcium

55
Q

Calcium replacement may antagonize what medication

A

CCB

56
Q

Hypercalcemia=
Ca> ____ mg/dl
Ionized ca > ____ mEqs/L

A

8.5

2.25

57
Q

Causes of Hypercalcemia

A

Decreased renal excretion secondary to hyperparathyroidism

Immobility (causing shift from bones to cells)

Bone malignancies

Increased intake (antacids, vitamin D)

58
Q

Hypercalcemia s/s

A

Muscle weakness

CNS depression

Nephrolithiasis

Increased sensitive to digoxin

HTN

Prolonged PR, WIDE QRS

59
Q

Hypercalcemia tx;

A

Hydration with NS plus lasix to inhibit renal reabsorption and promote Ca excretion

Dialysis

Chelators (phosphate, EDTA)

Biphosphonates (inhibit bone breakdown, slow onset, long duration ) used on osteoporosis and bone malignancies

Calcitonin (fast onset, short duration) used with biphosphates

60
Q

Hypercalcemia anesthetic considerations;

A

IV Phosphate use is faster- but oral is safer

LOWER doses of NDMR if skeletal muscle weakness

Invasive monitoring with decreased cardiac function

Acute acidosis increases ionized Ca

Caution with EDTA; significant hypocalcemia can result

61
Q

When waking someone up; with muscle weakness secondary to electrolyte imbalance _______ may be impaired

A

Respiratory function;

May not be able to breathe on their own

62
Q

Anion gap equation.

A

AG= (Na+K) - (HCo3+Cl)

63
Q

Normal anion gap

A

10 +- 2 mEqs/L

64
Q

An anion gap means that there is ________ amount of charged ions that are not included in a metabolic panel. This is suggestive of ______ _______ such as DKA, lactic acidosis.

A

Unmeasured

Organic acidosis

65
Q

Normal anion gap in a patient with metabolic acidosis indicates ________, commonly from renal or GI bicarb losses such as renal tubular acidosis or diarrhea

A

Hyperchloremic acidosis

66
Q

Most common electrolyte disturbance in hospitalized patients 

A

Hyponatremia

67
Q

Hyponatremia is commonly due to an excess in ______ , for example in instances of SIADH

A

Total body water

68
Q

The blood brain barrier is poorly permeable to sodium but very permeable to water therefore a rapid decrease in sodium will cause _______

A

Brain and water swelling, cerebral edema 

69
Q

Hyponatremia S/S

A

Arterial hypertension

Increased CVP

Pulmonary edema

Decreased cardiac function

Arrhythmias

Malaise

Headache

Lethargy

Seizures/coma

70
Q

Hyponatremia = sodium < ____

GA safe is Na plasma >_____

A

135

130

71
Q

Anesthetic implications for hyponatremia?

A

Can you manage the underlying cause?

Can sx be postponed? Symptoms and urgency.

72
Q

Principal extra cellular cation

A

Na

73
Q

Essential for Action potentials in neuro in cardiac tissue

A

Na

74
Q

Correction of hyponatremia,
“ too fast too soon versus too slow too late”

Equation; 

A

0.6 X (Wt in Kg) X (desired sodium-actual sodium) = total amount of milliequivalents needed to replace deficit

Half is replaced in the first eight hours the remainder over 24 to 72 hours if signs and symptoms resolve

75
Q

Recommended solution for treating non-emergent hypo natremia

A

0.9 Normal saline with loop diuretic (free water excess) and monitor of sodium levels

76
Q

Recommendation for sodium increase

Non-emergent?

Emergent?

A

Non emergent;
< 1-2 mEqs/hour

< or equal to 8 mEq per day

Emergent; Raise slowly to approximately 120 to 1 25 mEq per liter, by max 10-20 mEq/L in 24 hrs

77
Q

Emergent hyponatremia correction solution; (emergent due to complications including CNS/neuro and cardiac)

A

3% NS bolus, monitor Na levels

78
Q

Risk of fast of hyponatremia

A

Pontine demyelination

79
Q

Surgery specific considerations regarding hyponatremia and transurethral resection of the prostate

A

Hypotonic irrigation fluid during resection moves across prostate into venous sinuses and plasma resulting in increase in total body water and decrease in sodium

If possible use neuraxial block to keep patient awake and monitor for neurological changes use isotonic solution to replace fluid and blood loss

80
Q

Hypernatremia can be ________ or relative to _____ , meaning due to dehydration.

A

Absolute

TBW

81
Q

plasma sodium greater ____ than causes water loss from cells and crenation

A

145

82
Q

__________ Is common in geriatric patients due to decreased thirst and loss of ability to concentrate urine

A

Hypernatremia

83
Q

Hyponatremia signs and symptoms—

A

Tremors

weakness

irritability,confusion

seizures, coma

hypovolemia

renal insufficiency

diabetes insipidus

84
Q

Hypovolemic hypernatremia is due ______ loss to exceeding ______ loss

A

Water loss

Sodium loss

85
Q

Hypovolemic hypernatremia; etiologies

A

Diarrhea
vomiting
osmotic diuresis
inadequate intake
fever
burns
exposed surgical areas

prolong positive pressure ventilation without humidity

86
Q

Symptoms of hypovolemic hypernatremia

A

Hypotension
decrease CVP
decreased urine output
decreased skin turgor
increased heart rate

87
Q

Fluid replacement recommendations for hyponatremic hypovolemia

A

If hemodynamically unstable replace with a .45 or .9 Saline, Then calculate Freewater deficit and replace with D5W or hypotonic fluids

88
Q

Hypervolemic hypernatremia is due to Na overload….
Name a few causes-

A

Dialysis with hypertonic solution

treatment with hypertonic saline

bicarb administration

89
Q

Symptoms of hypervolemic hypernatremia

A

Increase weight
increase blood pressure
Edema
CHF
Rales

90
Q

Treatment for hypervolemic hypernatremia

A

Excess sodium removed by dialysis or diuretics

Water deficit replaced by D5W

91
Q

Caution using LR with what conditions?

A

Metabolic or respiratory alkalosis

Hepatic or renal failure

92
Q

Is LR compatible with blood products?

A

No- has calcium

93
Q

LR is not a good maintenance fluid due to…

A

Low k 4
Low na 130

94
Q

Normal saline compared with plasma regarding pH osmolarity and chloride

A

Low pH 
High osmolarity
high chloride

95
Q

Excessive administration of normal saline (greater than 2 to 3 L) can cause what?

A

Hyperchloremic metabolic acidosis

This can take days to resolve in patients with renal insufficiency or failure

96
Q

Risks associated with hypertonic saline use (3%)

A

Overshoot of sodium to hypernatremia- (pontine demyelination)

Hyperchloremia

Cellular dehydration and crenation

97
Q

When using hypertonic saline (ie for tx of cerebral edema) ; goals to achieve plasma sodium of _____- _____, and increased no more than _____ mEqs per 24 hours. 

A

145-155

10-20

98
Q

Uses for hypertonic saline;

A

Severe symptomatic hyponatremia

Fluid resuscitation

Increased ICP

99
Q

D5W is considered ____tonic 

A

Hypotonic

100
Q

PH of normal saline (0.9)

Sodium of normal saline

Chloride of normal saline

A

5.6

154

154

101
Q

Equation for hourly maintence requirements

A

4-2-1 rule…. first 10 kg multiplied by four ML‘s per KG per hour, Next 10 kg multiplied by two in miles per KG per hour. Remaining kilograms multiplied by one hour per KG per hour

102
Q

How much fluid do you add to plan for bowel prep

A

1 L Replace upfront

103
Q

NPO replacement equation

A

Hours NPO times hourly maintenance requirement by the 421 rule. replace over the first 2 to 3 hours of surgery

104
Q

Minimal moderate and severe third space losses based on potential tissue trauma

Minimal ______
Moderate _____
Severe _____

A

0-2 ml/kg/hr

2-4 ml/kg/hr

4-8 ml/kg/hr

105
Q

True surgical loss replacement with Crystalloid and colloid, Proportional recommendations

A

Crystalloid 3 to 1
Colloid 1 to 1

106
Q

An open surgery would be considered what type of potential or evaporated of Thirdspace loss?

A

Severe 4-8 ml/kg/hr

107
Q

Equation for Estimated blood volume

A

EBV= TYPICAL blood volume X pt wt in kg

108
Q

Estimated blood volume an adult male

A

75 ml/kg

109
Q

Estimator blood volume an adult female

A

70 ml/kg

110
Q

Estimated blood volume in a school age child

A

75 ml/kg

111
Q

Estimated blood volume in a child one to 12 months old

A

80 ml/kg

112
Q

Estimated blood volume in a neonate

A

85 ml/kg

113
Q

Equation for allowable blood loss

A

ABL= (EBV* (Hct initial-Hct final))/ Hct initial

Hct of 24 is approximately Hgb of 8

This equation In practice tells you when to draw blood and check your hemoglobin

114
Q

What is the fluid recommendation in a lung resection?

A

Minimize fluids and use pressers if necessary due to post pneumonectomy pulmonary edema complications

Avoid use of blood products due to inflammatory response

115
Q

Consideration regarding fluid in liver failure or transplant

A

Use colloids, Consider use of Colloid replacement early

Multiple comorbidities confound food management including cerebral edema hepatorenal syndrome and electrolyte disturbances

116
Q

Replace paracentesis of greater ____ than liters with _____

A

4 L

Albumin 1:1

117
Q

Burn patient formula a.k.a. Parkland formula

A

BSA BURNED X WT (kg) X 4 = total volume in the first 24 hours

Give first half in the first eight hours
Give second half over the following 16 hours

Consider I’ll be there in after the first 24 hours

118
Q

What is the lethal triad of trauma

A

Acidosis
hypothermia
coagulopathy

119
Q

Pneumoperitoneum for surgery can cause pressure and decrease blood flow to kidneys causing retained sodium and activation of RASS and decreasing UOP—-
Anesthetic caution

A

Do not give too much volume do to transient intraoperative oliguria

120
Q

Fluid recommendation for sepsis

A

Aggressive early fluid replacement

121
Q

This liposuction technique is common and the risk is _____ With greater than 5 L removed

A

Tumescent technique

Cardio pulmonary complications and collapse

122
Q

Goals of goal directed fluid therapy

A

Adequate O2 delivery to tissue

Normothermia

Prevention of fluid access

123
Q

Adequate delivery of oxygen to tissues is measured by

A

Preload
Adequate hemoglobin
Normal cardiac indices
SVI

124
Q

Six acceptable levels of goal directed fluid therapy

A

Ph
Lactate
Anion gap
Coagulation profile
Electrolytes
Glucose

125
Q

What fluid should be used for resuscitation in nephrotic syndrome

A

Albumin

126
Q

Hyperchloremia may contribute to watch dysfunction

A

Renovascular construction

127
Q

Judicious use of fluid in renal patients is important, these patients have a tendency of what metabolic dysfunction

A

Hyperchloremic metabolic acidosis

128
Q

And cerebral edema neurosurgical patients do not give what fluid

A

Glucose containing solutions as they exacerbate intercranial ischemia

129
Q

Fluid considerations with congestive heart failure

A

Judicious load management due to risk of postop Thirdspace redistribution and increased cardiac work

130
Q

Disadvantage of colloids and caution with patients with this electrolyte abnormality due to binding proteins

A

Hypocalcemia

AFN Health Assessment (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions