Fiser ABSITE Ch. 9 Fluids

Question 1

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

Answer 1

2/3, infants, women

Question 2

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

Answer 2

intracellular (mostly muscle), extracellular

Question 3

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

Answer 3

interstitial, plasma

Question 4

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

Answer 4

proteins, Na

Question 5

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

Answer 5

iatrogenic, weight gain

Question 6

What is the meqs in 0.9% NS?

Answer 6

Na 154 and Cl 154

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

280-295

Question 9

How to estimate volume replacement in cc/kg/hr

Answer 9

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)

Question 10

What is the best indicator for adequate volume replacement?

Answer 10

urine output

Question 11

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

Answer 11

0.5-1.0 L/hr

Question 12

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

Answer 12

500

Question 13

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

Answer 13

10

Question 14

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

Answer 14

LR

D5 1/2 NS with 20 mEq K

Question 15

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

Answer 15

525

Question 16

Stomach secretes ___ L/day

Answer 16

1-2

Question 17

Biliary system secretes ___ mL/day

Answer 17

500-1000

Question 18

Pancreas secretes ___ mL/day

Answer 18

500-1000

Question 19

Duodenum secretes ____ mL/day

Answer 19

500-1000

Question 20

Normal K+ requirement is ___ mEq/kg/day

Answer 20

0.5-1.0

Question 21

Normal Na+ requirement is ___ mEq/kg/day

Answer 21

1-2

Question 22

Which bodily fluid has the highest concentration of K+

Answer 22

saliva

Question 23

Primary electrolyte(s) lost in the:
Stomach?
Pancreas?
Bile?
Small Intestine?
Large Intestine?

Answer 23

Stomach H+, Cl-
Pancreas HCO3-
Bile HCO3-
Small intestine HCO3-, K+
Large intestine K+

Question 24

Gastric losses should be replaced with which fluid?

Answer 24

D5 1/2 NS with 20 mEq K+

Question 25

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

Answer 25

LR with HCO3-

Question 26

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

Answer 26

LR with K+

Question 27

GI losses should generally be replaced ___ ?

Answer 27

cc/cc

Question 28

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

Answer 28

0.5

Question 29

Normal range of K+

Answer 29

3.5-5.0

Question 30

Initial finding of hyperkalemia on EKG?

Answer 30

peaked T waves

Question 31

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

Answer 31

``` Calcium gluconate Bicarb 10 U insulin and 1 ampule of 50% dextrose Kayexalete Dialysis ```

Question 32

EKG with hypokalemia?

Answer 32

t waves disappear

Question 33

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

Answer 33

Mg+

Question 34

Normal range of sodium?

Answer 34

135-145

Question 35

What are the sx of hypernatremia?

Answer 35

restlessness, irritibility, ataxia, seizures

Question 36

Correct hypernatremia with ___ slowly to avoid ___

Answer 36

D5W, brain swelling

Question 37

Formula for total body water?

Answer 37

0.6 x patient's weight

Question 38

Formula for total free water deficit

Answer 38

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

Question 39

Formula for water requirement in hypernatremia

Answer 39

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

Question 40

In hypernatremia change Na at ____ mEq/h

Answer 40

0.7

Question 41

Sx of hyponatremia

Answer 41

headaches, delirium, seizures, nausea, vomiting

Question 42

Formula for Na deficit in hyponatremia

Answer 42

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

Question 43

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

Answer 43

water restriction, diuresis, NaCl replacement

Question 44

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

Answer 44

avoid central pontine myelinosis, 1 mEq/h

Question 45

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

Answer 45

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

Question 46

What is the normal Ca range?

Answer 46

8.5-10.0

Question 47

Most common malignant cause of hypercalcemia?

Answer 47

breast CA

Question 48

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

Answer 48

thiazides (also LR contains Ca2+)

Question 49

What is the tx for hypercalcemia? | For malignant disease?

Answer 49

NS at 200-300 cc/hr, Lasix mithramycin, calcitonin, alendronic acid, dialysis

Question 50

Main sx of hypercalcemia?

Answer 50

lethargic state

Question 51

Sx of hypocalcemia?

Answer 51

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

Question 52

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

Answer 52

Mg

Question 53

Protein adjustment for Ca

Answer 53

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

Question 54

Normal range of Mg

Answer 54

2.0-2.7

Question 55

Sx of hypermagnesemia? What type of pts?

Answer 55

lethargic state | burn, trauma and dialysis pts

Question 56

Tx for hypermagnesmia

Answer 56

Ca

Question 57

Signs and sx of hypomagnesmia are similar to what?

Answer 57

hypocalcemia

Question 58

Formula for anion gap and normal range

Answer 58

Na - (HCO3 + Cl) | Less than 10-15

Question 59

Mnemonic for anion gap acidosis

Answer 59

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

Question 60

Normal gap acidosis usually due to loss of ____/____ | Seen with?

Answer 60

Na/HCO3 | ileostomies, small bowel fistulas

Question 61

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

Answer 61

7.20, myocardial contractility

Question 62

Metabolic alkalosis is usually the result of ____

Answer 62

contraction alkalosis

Question 63

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

Answer 63

hypocholoremic, hypokalemic, metabolic alkalosis | paradoxical aciduria

Question 64

Why is there hypokalemia in nasogastric suction? | and why is there paradoxical aciduria?

Answer 64

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+

Question 65

Henderson-Hesselbach equation

Answer 65

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

Question 66

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

Answer 66

20:1

Question 67

What is the best test for azotemia?

Answer 67

FeNa

Question 68

What is the formula for FeNa

Answer 68

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

Question 69

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

Answer 69

FeNa less than 1%, urine Na less than 20, BUN/Cr >20 | urine osmolality >500 mOsm

Question 70

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

Answer 70

volume expansion, HCO3-, N-acetylcysteine gtt

Question 71

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

Answer 71

ferrihemate, alkalinize urine

Question 72

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

Answer 72

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

Question 73

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

Answer 73

Insulin

Question 74

Which bodily fluid has the highest concentration of Cl-

Answer 74

Stomach

Question 75

Which bodily fluid has the highest concentration of HCO3

Answer 75

Pancreas

Question 76

IVF of choice for patients with closed head injuries

Answer 76

Hypertonic saline

Question 77

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

Answer 77

70%