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Z.Fiser > Fiser.09.FluidsElectrolytes > Flashcards

Fiser.09.FluidsElectrolytes Flashcards

1
Q

What proportion of an adult male’s body is water?

A

2/3

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2
Q

How does the proportion of TBW in men compare to women and infants?

A

Women have less TBW, infants have more TBW

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3
Q

What proportion of water weight is intracellular (which cells) versus extracellular?

A

2/3 intracellular (mostly muscle) and 1/3 extracellular

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4
Q

What is the breakdown of the extracellular water?

A

2/3 interstitial, 1/3 plasma

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5
Q

Which compartment osmotic pressures are determined by protein?

A

Determines plasma / interstitial compartment osmotic pressures

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6
Q

Which osmotic pressures are determined by Na?

A

Intracellular / extracellular osmotic pressure

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7
Q

What is the MCC of volume overload?

A

Iatrogenic

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8
Q

What is the first sign of volume overload?

A

Weight gain

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9
Q

What molecule is released in significant amounts with cellular catabolism?

A

water

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10
Q

How many mEq/L of sodium is in NS?

A

154 mEq/L

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11
Q

How many mEq/L of sodium is in LR?

A

130 mEq/L

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12
Q

How many mEq/L of sodium is in plasmalyte?

A

140 mEq/L

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13
Q

what is the pH of plasmalyte?

A

7.4

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14
Q

How many mEq/L of potassium is in LR?

A

4 mEq/L

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15
Q

How many mEq/L of potassium is in plasmalyte?

A

5 mEq/L

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16
Q

How many mEq/L of potassium is in NS?

A

0 mEq/L

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17
Q

How many mEq/L of calcium is in NS?

A

0 mEq/L

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18
Q

How many mEq/L of calcium is in LR?

A

3 mEq/L

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19
Q

How many mEq/L of calcium is in plasmalyte?

A

0 mEq/L

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20
Q

How many mEq/L of Magnesium is in NS?

A

0 mEq/L

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21
Q

How many mEq/L of Magnesium is in LR?

A

0 mEq/L

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22
Q

How many mEq/L of Magnesium is in plasmalyte?

A

3 mEq/L

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23
Q

How many mEq/L of chloride is in NS?

A

154 mEq/L

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24
Q

How many mEq/L of chloride is in LR?

A

109 mEq/L

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25
Q

How many mEq/L of chloride is in plasmalyte?

A

98 mEq/L

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26
Q

How many mEq/L of lactate is in NS?

A

0 mEq/L

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27
Q

How many mEq/L of lactate is in LR?

A

28 mEq/L

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28
Q

How many mEq/L of lactate is in plasmalyte?

A

0 mEq/L

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29
Q

How many mEq/L of gluconate is in NS?

A

0 mEq/L

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30
Q

How many mEq/L of gluconate is in LR?

A

0 mEq/L

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31
Q

How many mEq/L of gluconate is in plasmalyte?

A

23 mEq/L

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32
Q

How many mEq/L of acetate is in NS?

A

0 mEq/L

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33
Q

How many mEq/L of acetate is in LR?

A

0 mEq/L

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34
Q

How many mEq/L of acetate is in plasmalyte?

A

27 mEq/L

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35
Q

What is the osmolarity in mOsm/L of NS?

A

308 mOsm/L

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36
Q

What is the osmolarity in mOsm/L of LR?

A

275 mOsm/L

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37
Q

What is the osmolarity in mOsm/L of plasmalyte?

A

294 mOsm/L

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38
Q

What is the pH of NS?

A

5.50

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39
Q

What is the pH of LR?

A

6.75

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40
Q

What percentage of insensible losses come from which organ system? (2)

A

75% skin, 25% respiratory

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41
Q

What fluid is lost through insensible losses?

A

pure water

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42
Q

Which crystalloid should be used intraop and 24 hours postop after major adult GI surgery?

A

LR

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43
Q

Which crystalloid should be used at > 24hours postop after major adult GI surgery and why?

A

D5 1/2NS + 20K. Dextrose stimulates insulin release, resulting in amino acid uptake and protein synthesis. Also prevents protein catabolism

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44
Q

How much glucose and calories are provided every 24 hours by D5-1/2NS + 20K @125cc/hr?

A

150g glucose / 525 kcal

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45
Q

How much fluid does the stomach produce per day?

A

1-2L / day

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46
Q

How much fluid does the biliary system produce per day?

A

500-1000cc/day

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47
Q

500-1000cc/day How much fluid does the pancreas produce per day?

A

500-1000cc/day

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48
Q

How much fluid does the duodenum produce per day?

A

500-1000cc/day

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49
Q

What is the normal K+ requirement in mEq/kg/day?

A

0.5-1.0 mEq/kg/day

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50
Q

What is the normal Na+ requirement in mEq/kg/day?

A

1-2mEq/kg/day

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51
Q

What is the [Na] in sweat

A

Hypotonic, [Na] = 35-65

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52
Q

What body fluid has the highest [K+] in the body?

A

Saliva

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53
Q

What electrolytes are in stomach fluid?

A

H+ and Cl-

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54
Q

What electrolytes are in bile?

A

bicarb

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55
Q

Which electrolytes are in small intestine secretions?

A

Bicarb, K+

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56
Q

Which electrolytes are in colonic secretions?

A

K+

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57
Q

Which crystalloid should you use to replace gastric losses?

A

D5-1/2NS + 20K

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58
Q

Which crystalloid should you use to replace pancreatic losses?

A

LR with bicarb

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59
Q

Which crystalloid should you use to replace biliary losses?

A

LR with bicarb

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60
Q

Which crystalloid should you use to replace small intestine losses?

A

LR with bicarb

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61
Q

Which crystalloid should you use to replace large intestine losses?

A

LR with K+

62
Q

What ratio should you use to replace GI losses?

A

1:1 ratio (cc for cc)

63
Q

What crystalloid should you use to resuscitate for dehydration?

A

NS

64
Q

What is the minimal goal UOP? Should it be replaced?

A

0.5cc/kg/hr, no please do not replace

65
Q

What is a normal serum concentration value for K+

A

3.5-5.0

66
Q

How does hyperkalemia present on EKG?

A

Peaked T waves

67
Q

What is the MC comorbidity with hyperkalemia

A

Renal failure

68
Q

What are the four meds to treat hyperkalemia and what do they do?

A

Calcium gluconate (stabilizes cardiac membrane); sodium bicarb (alkalinity helps K go intracellular); 10U insulin (glucose + K into cells); 1 ampule D50 (prevents hyperglycemia); kayexelate (poo out K+)

69
Q

What does calcium gluconate do to treat hyperkalemia?

A

Cardiac membrane stabilizer

70
Q

What does sodium bicarb do treat hyperkalemia?

A

Causes alkalosis, then K enters the cell in exchange for H

71
Q

What does the 10U insulin + 1 ampule D50 do for hyperkalemia

A

Insulin allows K to be driven into cells with glucose

72
Q

What is the treatment for refractory hyperkalemia?

A

dialysis

73
Q

What are the EKG findings in hypokalemia

A

T waves disappear

74
Q

What is the MCC of hypokalemia?

A

overdiuresis

75
Q

Which electrolyte do you usually have to replace in hypokalemia before you can correct K+?

A

Mg

76
Q

What is the normal range for Na?

A

135-145

77
Q

What is the MCC of hypernatremia?

A

dehydration

78
Q

Name 3 symptoms of hypernatremia

A

Restlessness, irritablity, seizures

79
Q

Which crystalloid do you use to correct hypernatremia?

A

D5W

80
Q

Why do you need to correct hypernatremia slowly?

A

to prevent brain swelling

81
Q

What is the MCC of hyponatremia?

A

fluid overload

82
Q

Name 4 symptoms of hyponatremia

A

HA, N, V, seizures

83
Q

How do you treat hyponatremia (first and second-line)

A

First-line: free water restriction; Second-line: diuretics

84
Q

Why do you need to correct Na slowly?

A

To prevent central pontine myelinosis

85
Q

What rate should you correct hyponatremia?

A

No more than 1meq/hr

86
Q

How does hyperglycemia affect sodium measurements?

A

Hyperglycemia can cause pseudohyponatremia

87
Q

How do you correct for hypergycemia causing pseudohyponatremia (formula)?

A

For each 100 increment of glucose above normal, add 2 points to Na value

88
Q

How does SIADH affect Na concentrations?

A

Causes hyponatremia

89
Q

What is the normal range for calcium?

A

8.5 – 10.0

90
Q

What is the normal range for ionized calcium?

A

4.4-5.5

91
Q

How high does Ca/iCa need to be to cause hypercalcemic symptoms?

A

Ca > 13 or iCa>6-7

92
Q

What are the symptoms of hypercalcemia?

A

Lethargy

93
Q

What is the MC malignant cause of hypercalcemia?

A

Breast CA

94
Q

What is the MC benign cause of hypercalcemia?

A

Hyperparathyroidism

95
Q

Which crystalloid is CI in hypercalcemia and why?

A

LR b/c it contains Ca2+

96
Q

Which diuretic is contraindicated in hypercalcemia and why?

A

Thiazide diuretics b/c they cause Ca retention

97
Q

What is the treatment for benign hypercalcemia?

A

NS @ 200-300cc/hr and Lasix

98
Q

What is the treatment for malignant hypercalcemia (4)?

A

Mithramycin (antineoplastic drug), calcitonin, alendronic acid (bisphosphonate), dialysis

99
Q

What are the Ca/iCa measurements for symptomatic hypocalcemia?

A

Ca < 8 or iCa <4

100
Q

Name 5 S/Sx a/w hypocalcemia

A

Hyperreflexia; Chvostek’s sign (tapping on face produces twitching); Perioral tingling and numbness; Trousseau’s sign (carpopedal spasm); Prolonged QT interval

101
Q

Which surgery can cause hypocalcemia postop?

A

parathyroidectomy

102
Q

Which electrolyte may you have to replace prior to replacing Ca?

A

Mag

103
Q

How do you adjust calcium for albumin levels?

A

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

104
Q

What are normal levels for magnesium

A

2.0 – 2.7

105
Q

What are the symptoms of hypermagnesemia?

A

lethargy

106
Q

What is the MC comorbidity a/w hypermagnesemia?

A

Renal failure patients taking Mg-containing products

107
Q

What is the treatment for hypermagnesemia?

A

Calcium

108
Q

Name three causes of hypomagnesemia

A

Massive diuresis; chronic TPN without mineral replacement; EtOH abuse

109
Q

What are the S/Sx of hypomagnesemia (5)?

A

Hyperreflexia; Chvostek’s sign (tapping on face produces twitching); Perioral tingling and numbness; Trousseau’s sign (carpopedal spasm); Prolonged QT interval

110
Q

How do you calculate anion gap?

A

Na – (HCO3 + Cl)

111
Q

What is a normal anion gap?

A

<10-15

112
Q

Name 8 causes of high anion gap acidosis

A

MUDPILES: methanol, uremia, DKA, paraldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates

113
Q

What are two causes of normal anion gap acidosis

A

Loss of Na/HCO3- (ileostomies, small bowel fistulas)

114
Q

What is the treatment of metabolic acidosis?

A

Treat underlying cause; keep pH > 7.20 with bicarb b/c acidosis can affect myocardial contractility

115
Q

What is the MCC of metabolic alkalosis?

A

Contraction alkalosis (activation of RAA system causes angiotensin II to increase bicarb reabsorption and aldosterone causes increased H+ secretion)

116
Q

What metabolic disturbance is caused by NG suction?

A

Hypochloremic, hypokalemic, metabolic alkalosis with paradoxical aciduria

117
Q

What causes the hypochloremia and alkalosis a/w NG suction?

A

Loss of Cl- and H+ from the stomach

118
Q

What causes the hypokalemia a/w NG suction?

A

Loss of water causes kidney to reabsorb Na in exchange for K+ (Na/K ATPase) causing loss of K+

119
Q

What causes the paradoxical aciduria a/w NG suction?

A

Na/H exchanger is activated to reabsorb water and K, causes release of H+ and paradoxical aciduria

120
Q

What is the treatment for the metabolic derangements a/w NG suction?

A

NS helps treat the Cl- deficit

121
Q

what are the pH, CO2, and HCO3 derangements seen with respiratory acidosis?

A

low pH < 7.4, elevated CO2 > 40, elevated HCO3 > 24

122
Q

what are the pH, CO2, and HCO3 derangements seen with respiratory alkalosis?

A

elevated pH > 7.4; low CO2 < 40; low bicarb < 24

123
Q

what are the pH, CO2, and HCO3 derangements seen with metabolic acidosis?

A

low pH < 7.4; low CO2 < 40; low bicarb < 24

124
Q

what are the pH, CO2, and HCO3 derangements seen with metabolic alkalosis?

A

elevated pH > 7.4; elevated CO2 > 40; elevated bicarb > 24

125
Q

Define respiratory compensation for acid/base balance

A

CO2 regulation for acidosis/alkalosis

126
Q

How much time does respiratory compensation take?

A

Minutes

127
Q

Define renal compensation for acid/base balance

A

HCO3- regulation for acidosis / alkalosis

128
Q

How much time does renal compensation take?

A

Hours to days

129
Q

What is the best test for azotemia?

A

Fractional excretion of sodium

130
Q

What is the formula for FeNa?

A

[(Urine Na*Plasma Cr) / (Urine Cr*Plasma Na)]

131
Q

What percent of renal mass may be damaged before you see elevated BUN and Cr?

A

70%

132
Q

What is the FeNa value for prerenal disease?

A

< 1%

133
Q

What is the urine Na for prerenal disease?

A

< 20

134
Q

What is the BUN/Cr ratio for prerenal disease?

A

> 20

135
Q

What is the Urine osmolality for prerenal disease?

A

>500 mOsm

136
Q

What is the best way to prevent contrast-induced renal damage?

A

Prehydration is the best, bicarb and N-acetylcysteine

137
Q

What does myoglobin convert to in an acidic environment?

A

Ferrihemate in an acidic environment

138
Q

What happens to renal cells when exposed to myoglobin

A

Myoglobin becomes ferrihemate, toxic to renal cells

139
Q

How do you treat myoglobinemia and prevent renal damage?

A

Alaklanize urine

140
Q

Define tumor lysis syndrome and what chemicals are released

A

Metabolic abnormalities that occur as a complication of cancer treatment, when tumor cells lyse and release their contents into the bloodstream. Releases purines, pyrimidines leading to increased PO4, increased uric acid, and decreased Ca

141
Q

What are the renal effects of tumor lysis syndrome?

A

Increased BUN / Cr from renal damage

142
Q

What are the cardiac effects of tumor lysis syndrome?

A

EKG changes

143
Q

What are the five treatments for tumor lysis syndrome

A

Hydration is the best treatment; Rasburicase, allopurinol, diuretics, alkalanization of urine

144
Q

What is the MOA of rasburicase

A

Converts uric acid to inactive metabolite allantoin

145
Q

What is the MOA of allopurinol

A

Reduces uric acid production

146
Q

What is the conjugation reaction of vitamin D in the skin

A

UV sunlight converts 7 dehydrocholesterol to cholecalciferol

147
Q

What two reactions occur after conjugation of vitamin D in the skin?

A

Liver for 25-OH and then kidney for 1-OH to create active form of Vitamin D

148
Q

What does the active form of vitamin D do?

A

Increases calcium-binding protein leading to increased intestinal calcium absorption

149
Q

What happens to the vitamin D balance and Ca balance in the body with CRF?

A

Reduced active vitamin D b/c reduced 1-OH hydroxylation

150
Q

Why does anemia result from CRF?

A

Reduced erythropoeitin

151
Q

What is the function of transferrin?

A

Transporter of iron

152
Q

What is ferritin?

A

Storage form of iron

Z.Fiser (22 decks)

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