FEK AB Flashcards
Transfusion amount for pediatrics
10cc/kg
Components of LR
Na 130 Cl 109 K 4 ** Ca 3 ** Lactate 28 pH 6.5
pH NS
6
How much Na do pts need mEq/kg/day? K?
Na - 1-2 mEq/kg/day (~1L 1/2NS)
K - 0.5-1 (~20mEq added to fluids)
Replace high NGT output with…?
NS
Replace high volume bile leak with…?
LR (bc lose bicarb)
Replace severe diarrhea with…?
LR (need potassium)
Largest GI loss of potassium is where?
colon
Equation: serum osms
2NA + glucose/18 + BUN/2.8
Max rate of hyponatremic correction
max. 1 mEq/hr
Mgmt SIADH
- fluid restrict
- hypertonic saline
- demeclocycline, vaptan (V2-R antag)
Urine osm vs. Serum osm: dilutional hypoNa
urine osm low
serum osm low
Urine osm vs. Serum osm: SIADH
urine osm high
serum osm low
What is pseudohypoNa?
2/2 hyperglycemia, hyperproteinemia, hyperTG
Equation: Na deficit
(desired Na - actual Na) x TBW = mEq Na needed
Equation: free water deficit
(actual Na - desired Na) / (desired Na) * TBW
Urine osm vs. Serum osm: diabetes insipidus
urine osm low
serum osm high
Urine osm vs. Serum osm: iatrogenic hyperNa
urine osm high
serum osm high
Mgmt: central diabetes insipidus
DDAVP
Correcting Ca in hypoalbuminemia pt
for every point <4 (nl albumin), add 0.8 to calcium
Non-gap metabolic acidosis
[HARDASS] hyperalimentation addison's disease renal tubular acidosis diarrhea (or high stomal output) acetazolamide spironolactone saline infusion
MCC metabolic alkalosis (2)
- NG suction
- contraction alkalosis (CHF pt that is over-diuresed) - need to give them back Cl
Change of ? in pH for every ? change of CO2
0.1 change in pH for every 12 of CO2
Sepsis resuscitation bolus amount
30cc/kg bolus
Resuscitation bolus for peds? How about for blood?
bolus 20 cc/kg.
transfuse 10 cc/kg.
Urine abnormality in pyloric stenosis baby s/p emesis
paradoxical aciduria + hypoCl hypoK met alkalosis
Hyperhomocystinemia associated with…? (vascular)
increased risk arterial and venous thrombi
Persistent elevation of K always associated with…?
impaired urinary excretion of K
Primary reasons of decreased urinary K excretion are…?
- hypovolemia
- hypoaldo
- renal failure
- drugs (spironolactone, NSAIDs)
EKG changes: hyperK
- quick repolarization -> peaked T-waves and short QT interval
- delayed depolarization -> loss of P-wave and widened QRS interval
Cytokines stimulate release of what chemicals during sepsis?
cortisol + glucagon + catecholeamines
Lab tests to eval short-term nutrition status vs. long-term
short: prealbumin (1/2 life 2d) + retinol-binding protein (1/2 life 12hrs)
long: albumin (10d) + transferrin (20d)
Why excess carbs -> RQ>1?
bc excess carbs -> lipogenesis -> large amts CO2 produced
Equation: FENa%
100 x PcrUna/PnaUcr
Sxs hypoP (<0.07)
muscle weakness (affects diaphragm most) -> resp failure
K+ secretion highest in…?
colon>salivary>gastric>bile,panc,duo,ileum
What kind of feeding for burn pts?
Enteral feeding (decreases gastroparesis)
What kind of feeding for major head or torso trauma pts?
Postpyloric enteral feeding
Min amount exogenous glucose needed per day to decrease protein breakdown
100g glucose
In metabolic acidosis, renal regulation of serum pH dependent on what transporter?
Na+/H+ antiporter in proximal tubules
Why not give bicarb for lactic acidosis?
bicarb + protein -> carbonic acid + CO2 -> conversion metabolic to respiratory acidosis, which has greater neg inotropic effects
What is ceruloplasmin?
storage and transport cuproprotein
Zn deficiency sxs
eczematoid rash, papular perioral, and perianal eruptions, taste atrophy, diarrhea
Cu deficiency sxs
microcytic anemia, neuro (ataxia, spasticity, muscle weakness)
Selenium deficiency sxs
cardiomyopathy
Essential fatty acid deficiency sxs
dry, scaly dermatitis, loss of brittle nails, easy bruising, diarrhea
Essential amino acid deficiency sxs
decreased immune function
Energy source during fasting/starvation?
Primary fuel: glucose
Next option: glycogen (avail for 6hrs)
Next option: FFA (avail 5 days)
Starvation phase: glucose taken from breakdown of muscle of protein into AA, which are then converted to glucose by liver
Majority of ingested proteins are absorbed in intestines as…?
dipeptide vs. tripeptides via peptide transporter 1 (PEPT1)
MCC endogenous hypercortisolism (Cushing syndrome)
ACTH-dependent 2/2 pituitary adenoma (Cushing disease)
How many gram protein in 1g nitrogen?
6.25g protein
Equation: non-protein caloric requirement for burn pts
25 kcal/kg/d*kg + (30 kcal/day * %TBSA)
Equation: protein gram req for burn pts
1 g/kg/d*kg + (3 g/day * %TBSA)
Definition of respiratory quotient (RQ)
ratio CO2 produced to O2 consumed
Starvation vs. hypermetabolism
Starvation: goal to preserve lean body mass and reduce protein wasting (fat is primary fuel source - RQ 0.7)
Hypermetabolism: will have rapid loss of lean body mass; mobilization of proteins + increase gluconeogenesis -> mixed RQ 0.8-0.95
Why use D1/4NS+20K in children <2 as opposed to D1/2NS?
children <2 have ineffective concentrating ability of distal nephrons so have difficulty with Na excretion
Prerenal BUN/Cr ratio
> 20
Prerenal FEna
<1%
Prerenal spot urine Na
<10
How to calculate ideal body weight (used for TPN req calculations)
IBW (male) = 50kg + 2.3kg x height(in)-60in
IBW (female) = 45.5kg + “”
