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Surgery > Fiser ABSITE Ch. 9 Fluids > Flashcards

Fiser ABSITE Ch. 9 Fluids Flashcards

1
Q

Roughly ___ of the total body weight is water (men); ___ have a little more body water, ____ have a little less

A

2/3, infants, women

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2
Q

2/3 of water weight is located where? and the other 1/3?

A

intracellular (mostly muscle), extracellular

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3
Q

2/3 of extracellular water is located where? and the other 1/3?

A

interstitial, plasma

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4
Q

What determines plasma/interstitial compartment osmotic pressures? what about intracellular/extracellular?

A

proteins, Na

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5
Q

Most common cause of volume overload? what is the first sign?

A

iatrogenic, weight gain

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6
Q

What is the meqs in 0.9% NS?

A

Na 154 and Cl 154

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7
Q

Lactated Ringer’s has the ionic composition of plasma, what is it?

A

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

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8
Q

How to calculate plasma osmolarity and what is the range of normal?

A

(2 x Na) + (glucose/18) + (BUN/2.8)

280-295

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9
Q

How to estimate volume replacement in cc/kg/hr

A

4 cc/kg/hr for first 10 kg
2 cc/kg/hr for second 10 kg
1 cc/kg/hr each kg after that
(110 cc/hr for 70 kg man)

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10
Q

What is the best indicator for adequate volume replacement?

A

urine output

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11
Q

During open abdominal operations, fluid loss is ___ L/hr unless there are measurable blood losses

A

0.5-1.0 L/hr

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12
Q

Usually do not have to replace blood lost unless it is >____ cc

A

500

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13
Q

Insensible fluid losses is ___ cc/kg/day, 75% skin, 25% respiratory (pure water)

A

10

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14
Q

IV replacement after major adult GI surgery:
During operation and 1st 24 hours use ____.
After 24 hrs switch to ___

A

LR

D5 1/2 NS with 20 mEq K

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15
Q

D5 1/2 NS @ 125/h provides 150g glucose per day or ___ kcal/day

A

525

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16
Q

Stomach secretes ___ L/day

A

1-2

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17
Q

Biliary system secretes ___ mL/day

A

500-1000

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18
Q

Pancreas secretes ___ mL/day

A

500-1000

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19
Q

Duodenum secretes ____ mL/day

A

500-1000

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20
Q

Normal K+ requirement is ___ mEq/kg/day

A

0.5-1.0

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21
Q

Normal Na+ requirement is ___ mEq/kg/day

A

1-2

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22
Q

Which bodily fluid has the highest concentration of K+

A

saliva

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23
Q 
Primary electrolyte(s) lost in the:
Stomach?
Pancreas?
Bile?
Small Intestine?
Large Intestine?
A 
Stomach H+, Cl-
Pancreas HCO3-
Bile HCO3-
Small intestine HCO3-, K+
Large intestine K+
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24
Q

Gastric losses should be replaced with which fluid?

A

D5 1/2 NS with 20 mEq K+

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25
Q

Pancreatic/biliary/small intestine losses should be replaced with which fluid?

A

LR with HCO3-

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26
Q

Large intestine (diarrhea) losses should be replaced with which fluid?

A

LR with K+

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27
Q

GI losses should generally be replaced ___ ?

A

cc/cc

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28
Q

UO should be kept at least ___ cc/kg/hr; should not be replaced; usually a sign of normal postoperative diuresis

A

0.5

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29
Q

Normal range of K+

A

3.5-5.0

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30
Q

Initial finding of hyperkalemia on EKG?

A

peaked T waves

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31
Q

Tx for hyperkalemia:
____ membrane stabilizer for heart
____ causes alkalosis, K enters cell in exchange for H
____ K driven into cells along with glucose
___ binder
___ if refractory

A 
Calcium gluconate
Bicarb
10 U insulin and 1 ampule of 50% dextrose
Kayexalete
Dialysis
32
Q

EKG with hypokalemia?

A

t waves disappear

33
Q

Hypokalemia tx: may need to replace ___ before you can correct K+

A

Mg+

34
Q

Normal range of sodium?

A

135-145

35
Q

What are the sx of hypernatremia?

A

restlessness, irritibility, ataxia, seizures

36
Q

Correct hypernatremia with ___ slowly to avoid ___

A

D5W, brain swelling

37
Q

Formula for total body water?

A

0.6 x patient’s weight

38
Q

Formula for total free water deficit

A

TBW x (([Na+]/140) -1)

39
Q

Formula for water requirement in hypernatremia

A

Water requirement = (desired change in Na+ over 1 day x TBW) / desired Na+ after giving the water requirement

For a 70 kg man with Na 165 = (16 x 42)/149 = 4.5 L

40
Q

In hypernatremia change Na at ____ mEq/h

A

0.7

41
Q

Sx of hyponatremia

A

headaches, delirium, seizures, nausea, vomiting

42
Q

Formula for Na deficit in hyponatremia

A

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

43
Q

What is the first tx for hyponatremia? second? third?

A

water restriction, diuresis, NaCl replacement

44
Q

Why is Na corrected slowly In hyponatremia and what is the rate?

A

avoid central pontine myelinosis, 1 mEq/h

45
Q

What is the formula for correcting Na in pseudohyponatremia caused by hyperglycemia?

A

for each 100 increment of glucose over normal add 2 points to the Na value

46
Q

What is the normal Ca range?

A

8.5-10.0

47
Q

Most common malignant cause of hypercalcemia?

A

breast CA

48
Q

What drug causes retention of Ca2+ and should not be given to patient with hypercalcemia?

A

thiazides (also LR contains Ca2+)

49
Q

What is the tx for hypercalcemia?

For malignant disease?

A

NS at 200-300 cc/hr, Lasix

mithramycin, calcitonin, alendronic acid, dialysis

50
Q

Main sx of hypercalcemia?

A

lethargic state

51
Q

Sx of hypocalcemia?

A

hyperreflexia, Chvotstek’s sign (tapping on face produces twitching), perioral tingling and numbness, Trousseau’s sign (carpopedal spasm), prolonged QT

52
Q

In hypocalcemia, may need to correct ___ before being able to correct Ca

A

Mg

53
Q

Protein adjustment for Ca

A

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

54
Q

Normal range of Mg

A

2.0-2.7

55
Q

Sx of hypermagnesemia? What type of pts?

A

lethargic state

burn, trauma and dialysis pts

56
Q

Tx for hypermagnesmia

A

Ca

57
Q

Signs and sx of hypomagnesmia are similar to what?

A

hypocalcemia

58
Q

Formula for anion gap and normal range

A

Na - (HCO3 + Cl)

Less than 10-15

59
Q

Mnemonic for anion gap acidosis

A

MUDPILES

methanol, uremia, diabetic ketoacidosis, paraldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates

60
Q

Normal gap acidosis usually due to loss of ____/____

Seen with?

A

Na/HCO3

ileostomies, small bowel fistulas

61
Q

Tx for metabolic acidosis is underlying cause; keep pH > ___ with bacarbonate; severely decreased pH can affect ____

A

7.20, myocardial contractility

62
Q

Metabolic alkalosis is usually the result of ____

A

contraction alkalosis

63
Q

Nasogastric suction results in what electrolyte abnormality and what is the urine?

A

hypocholoremic, hypokalemic, metabolic alkalosis

paradoxical aciduria

64
Q

Why is there hypokalemia in nasogastric suction?

and why is there paradoxical aciduria?

A

Loss of water causes kidney to resorb Na in exchange for K (Na/K ATPase)

Na+/H- exchange activated in an effort to absorb water along with K+/H- exchanger in an effort to resorb K+

65
Q

Henderson-Hesselbach equation

A

pH = pK + log [HCO3-]/[CO2]

66
Q

A pH of 7.4 has a ratio of base to acid (HCO3- to CO2) of ____

A

20:1

67
Q

What is the best test for azotemia?

A

FeNa

68
Q

What is the formula for FeNa

A

(urine Na/Cr)/(plasma Na/Cr)

69
Q

In Pre renal failure. What is the FeNa? urine Na? BUN/Cr ratio? urine osmolality?

A

FeNa less than 1%, urine Na less than 20, BUN/Cr >20

urine osmolality >500 mOsm

70
Q

In contrast dye induced ARF: What best prevents renal damage? What are 2 others?

A

volume expansion, HCO3-, N-acetylcysteine gtt

71
Q

Myoglobin is converted to ____ in acidic environment which is toxic to renal cells. Tx?

A

ferrihemate, alkalinize urine

72
Q

In tumor lysis syndrome there is increased ___ and ___ and decreased Ca. This can result in increased BUN and Cr, EKG changes. Tx?

A

phosphate and uric acid

hydration, allopurinol (decreased uric acid production), diuretics, alkalinization of urine

73
Q

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

A

Insulin

74
Q

Which bodily fluid has the highest concentration of Cl-

A

Stomach

75
Q

Which bodily fluid has the highest concentration of HCO3

A

Pancreas

76
Q

IVF of choice for patients with closed head injuries

A

Hypertonic saline

77
Q

% renal mass damage to result in an increase in creatinine and BUN

A

70%

Surgery (33 decks)

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