Fluid

Question 1

Hypoalbuminemia is a wake acid and can cause metabolic…

Answer 1

Alkalosis

Question 2

Water constitutes … % of total body weight in adults.

2/3 (40%) of it is …
1/2 (20%) is … and extracellular composer of …

Answer 2

60 %

Intracellular is 40/60 % more then extracellular 20/60 % (5% intravascular + 15% interstitial)

Question 3

20% albumin is hyperoncotic and expands the …. compartment the most.

Answer 3

Extravascular

Question 4

5% dextrose distribution … compartment. Where NS remains in extracellular.

Answer 4

2/3 intracellular and 1/3 extracellular

Question 5

Distribution of normal saline?

Answer 5

All of it remains extracellular

75% in interstitial
25% remains intravascular space.

Question 6

Causes of hyperchloremic metabolic acidosis

Answer 6

• Acetazolamide
• Biliary/pancreatic fistula

Below causes for hyperchloremic and non ion met acidosis:

• Diarrhea
• Bilateral urethras implant into ilial conduit
• Massive 0.9% NS

Non-ion metabolic acidosis only:
- RTA

Question 7

What explains a normal anion gap in presence of lactic acidosis.

Answer 7

Hypoalbuminemia

Because albumin constitutes 3/4 of the anion gap.

Corrected calculation anion gap = measured albumin - normal albumin (4gm/dl) x 2

Question 8

ABG abnormalities expected in alcoholism?

Answer 8

Hypo Mg, K

Respiratory alkalosis

Question 9

Hormones increase/decrease during fluid resuscitation?

Answer 9

ANP -> increases

ADH, Aldo, RAAS -> decreases

Question 10

The recommended volume rate for Hetastarch is … and of higher increases risk for …

Answer 10

20 ml/kg.

Allergic rxn, coagulation abnormalities, and interference with cross matching.

Question 11

The coagulation abnormalities of Herastarch infusion is related to …

Answer 11

Factor 8 activity decreased

Also decreases Von Wilibrand and platelets dysfunction.

Question 12

The antidote for hyper Mg and hyperK?

Answer 12

Calcium

Question 13

Indication for DDAVP?

Answer 13

DI
Von willebrand disease
Bleeding uremic patients with platelet dysfunction

Question 14

Management of patients with autoantibodies to factor 8?

Answer 14

Rituximab

Start prednisone + cyclophosphamide when tigers begin to fall.

Cyclosporine A, vincristine or chlodexyadnosine considered if above failed

Question 15

Factor 5 Leiden deficiency is due to …

Answer 15

Factor 5 resistant to inactivation by protein C and result into increase risk of thrombosis

Question 16

Thromboelastogram

R Time ->

Answer 16

Is the Reaction Time

Measures from zero to beginning of clot formation

Indicator of intrinsic, extrinsic and final pathway.

Normal is 5-10 min

If elevated then it represents clotting factors deficiency-> treated with FFP

Question 17

Thromboelastogram

K time ->

Answer 17

Coagulation time and it’s a measure of speed of clot formation and strengthening

Depends on fibrinogen

Normal is 1-3 min

Elevation represents fibrinogen deficiency and treatment with Cryoprecipitate

Question 18

Thromboelastogram

Alpha angle

Answer 18

A measure of clot formation

Depends on fibrinogen

Normal angle is 53-72 degree

A low value represents deficiency in fibrinogen and treatment is Cryopreceipitate

Question 19

Thromboelastogram

MA -> maximal amplitude

Answer 19

Measure of maximal clot strength

Depends on platelets number and function, fibrin cross linking

(Keyword 2014)

Normal range 50-70 mm

Low value represents deficiency in platelets and treated with -> platelets has

Question 20

Thromboelastogram

LY30 -> lysis time 30 min

Answer 20

It is the % of amplitude reduction 30 min after its maximum

A measure of fibrinolysis

Normal range is ~6%

Higher value indicates excess fibrinolysis and is treated with -> Amicar