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Coexisting Disease/Comprehensive Exam - PPT Questions > Fluid and Electrolyte Disturbances > Flashcards

Fluid and Electrolyte Disturbances Flashcards

1
Q

Body water is distributed between 2 major fluid compartments separated by cell membranes: _____ and _____.

A

ICF and ECF

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2
Q

ECF can be divided into what compartments?

A

intravascular and interstitial

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3
Q

The insterstitium includes what?

A

All fluid that is both outside cells and outside the vascular endothelium

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4
Q

What is used to exchange Na for K?

A

membrane-bound adenosine triphosphate (ATP) dependent pump

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5
Q

What is the ratio Na is exchanged for K?

A

3:2

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6
Q

Where is potassium concentrated intracellularly or extracellulary?

A

Intracellular

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7
Q

Where is sodium concentrated intracellularly or extracellulary?

A

extracellularly

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8
Q

What is the most important determinant of intracellular osmotic pressure?

A

Potassium

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9
Q

What is the most important determinant of extracellular osmotic pressure?

A

Sodium

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10
Q

Interference with the Na-K-ATPase activity occurs during ____ or ____. WHat does it cause?

A

ischemia or hypoxia; progressive swelling of cells

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11
Q

Intravascular volume is ECF or ICF?

A

ECF

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12
Q

Why are changes in ECF volume related to changes in total body sodium content?

A

Sodium is a major determinant of extracellular oxsmotic pressure and volume

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13
Q

T/F: Interstitial fluid is in teh form of free fluid.

A

false - very little interstitial fluid is normally in teh form of free fluid

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14
Q

Interstitial water is in a chemical association with extracellular ____-, forming a ___.

A

proteoglycans; gel

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15
Q

Is interstitial fluid pressure positive or negative?

A

Negative

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16
Q

What happens when interstitial pressure rises due to interstitial volume increase?

A

It becomes positive - and free fluid in teh interstitial gel matrix increases rapidly and the result is expansion only of the interstitial fluid compartment

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17
Q

Why is the protein content of interstitial fluid low?

A

only small quantities of plasma proteins can normally cross capillary clefts

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18
Q

How is protein that enters the interstitial space returned to the vascular system?

A

the lymphatic system

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19
Q

______ fluid is commonly referred to as plasma.

A

Intravascular fluid

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20
Q

Most electrolytes can freely pass between ___ and ____.

A

(intravascular) plasma; interstitium

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21
Q

____ is the random movement of molecules due to their kinetic energy and is responsible for the majority of fluid and solute exchange between compartments.

A

Diffusion

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22
Q

Rate of diffusion depends on what 4 things?

A
  1. Permeability of that substance
  2. concentration difference between 2 sides
  3. pressure difference between either side (pressure imparts greater kinetic energy)
  4. electrical potential across membrane
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23
Q

___,___, ____, and ____ can penetrate the cell membrane directly.

A

O2, CO2, water, and lipid-soluble molecules

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24
Q

T/F: Cations such as Na, K, and CA penetrate the lipid membrane poorly and can diffuse only through channels.

A

True

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25
Q

___ and ___- diffuse with the help of membrane-bound carrier proteins.

A

Glucose and amino acids

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26
Q

What is the normal adult daily water intake?

A

2500 mL

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27
Q

What is daily water loss average of the adult?

A

2500 mL

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28
Q

___ mL lost in urine

A

1500 mL

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29
Q

____ mL in respiratory tract evaportion

A

400 mL

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30
Q

___ mL in skin evaporation

A

400 mL

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31
Q

___ mL in sweat

A

100 mL

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32
Q

____ ml in feces

A

100 mL

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33
Q

Evaporative loss accounts for what percentage of heat loss?

A

20-25%

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34
Q

How is sodium serum concentration maintained between 136 and 145?

A

by the aciton of vasopressin on water and osmolal hemoestasis

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35
Q

What are early signs of hyponatremia?

A

anorexia, nausea, malaise

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36
Q

What are late signs of hyponatremia?

A

seizures, brain herniation

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37
Q

How do you treat hypovolemic, hyponatremia?

A

Volume resusciation wtih NS

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38
Q

How do you treat euvolemic or hypervolemic hyponatremia?

A

Withhold free water and encourage free water excertion with loop diuretic

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39
Q

Do you correct acute symptomatic hyponatremia quickly or slowly?

A

Quickly

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40
Q

Do you correct chronic symptomatic hyponatremia quickly or slowly?

A

Slowly

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41
Q

Why do you correct chronic symptomatic hyponatremia slowing?

A

To avoid the risk of osmotic demyelination

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42
Q

What is the main risk for induction of maintenance of anesthesia in hypovolemic hyponatremic patients?

A

HYPOTENSION

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43
Q

How is benign prostatic hyperplasia treated?

A

TURP

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44
Q

What does TURP stand for?

A

transurethral resection of the prostate

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45
Q

What is the irrigating fluid used during TURP?

A

a nearly isotonic nonelectrolyte fluid containing glycien or a mix of sorbitol and mannitol

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46
Q

What are the risks of irrigation during TURP?

A

Volume overload and hyponatremia b/c the irrigating fluid can be absorbed rapidly via open venous sinuses in the prostate gland

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47
Q

What 4 things increase the risk of TURP Syndrome?

A
  1. resection >1. hour
  2. irrigating fluid >40cm
  3. hypotonic irrigation fluid
  4. pressure in bladder >15
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48
Q

Resection longer than ____ is associated with increased risk of TURP syndrome.

A

1 hour

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49
Q

Irrigating fluid suspended higher than ____ above the operative field is associated with increased risk of TURP syndrome.

A

40 cm

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50
Q

HYpertonic or hypotonic irrigation fluid is associated with increased risk of TURP syndrome?

A

Hypotonic

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51
Q

Bladder pressure >____ is associated with increased risk for TURP syndrome.

A

15 cmH2O

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52
Q

What are 2 common findings in TURP syndrome?

A

HTN and pulmonary edema

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53
Q

What is the treatment for TURP syndrome?

A

Stop surgery, administer loop diuretics, and hypertonic saline (w/ severe neuro s/s or Na<120)

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54
Q

Hypernatremia induces the movement of water across the cell membrane into teh ___.

A

ECF

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55
Q

What are early S/S of hypernatremia?

A

restlessness, irritability, lethargy

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56
Q

What are late S/S of hypernatremia?

A

muscular twitching, hyperreflexia, tremors, ataxia

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57
Q

S/S of muscle spasitcity, seizures, and death occur with hypernatremia when the osmolaity increases above ___.

A

325

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58
Q

S/S of hypernatremia are more severe with acute or chronic high sodium levels?

A

acute

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59
Q

How is hypovolemic hypernatremia treated?

A

Water deficit is replenished with NS or electrolyte solution

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60
Q

How is hypervolemic hypernatremia treated?

A

Diuresis with loop duretic

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61
Q

How is euvolemic hypernatremia treated?

A

PO water replacement or 5% Dextrose IV

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62
Q

Acute hypernatremia should be corrected over _____.

A

several hours

63
Q

Chronic hypernatremia should be corrected over ____.

A

2-3 days

64
Q

What happens if you correct chronic hypernatremia too quickly?

A

cerebral edema

65
Q

Potassium plays a major role in regulating membrane potential as well as in ___ and ___ synthesis.

A

carbohydrate and protein

66
Q

Renal excretion of potassium can. vary from ___ to ___ mEq/L.

A

5-100

67
Q

Nearly all the potassium filtered in glomeruli is normally reabsorbed in the ____________ and ________.

A

proximal tubule and loop of henle

68
Q

T/F: Plasma potassium concentration typically correlates poorly with the total potassium deficit.

A

True

69
Q

When does hypokalemia due to the intracellular movement of potassium occur?

A

alkalosis, insulin therapy, beta agonists, hypothermia, and hypokalemic periodic paralysis

70
Q

What are renal related causes of hypokalemia?

A

Hypomagnesemia, renal tubular acidosis, ketoacidosis, salt-wasting nephropathies, amphotericin B

71
Q

Why is hypokalemia due to decreased potassium intake not common?

A

B/c of the kidneys ability to decrease urinary potassium excretion to as low as 5-20

72
Q

Most patients are asymptomatic with hypokalemia until K falls below ____.

A

3

73
Q

What are the CV effects of hypokalemia?

A

abnormal EKG, arrhythmias, decreased contractility, liable BP (d/t autonomic dysfunction)

74
Q

What type of IV solutions should be used with hypokalemia and why?

A

Glucose-free; b/c glucose stimulates K+ movement into the cell

75
Q

Hyperventilation or hypoventilation should be avoided with hypokalmia?

A

Hyperventilation

76
Q

There might be an increased sensitivity to ____ drugs with hypokalemia.

A

NMB

77
Q

When does hyperkalemia occur due to extracellular movement of potassium?

A

acidosis, cell lysis following chemo, hemolysis, rhabdo, massive tissue trauma, hyperosmolality, digitalis OD, hyperkalemic periodid paralysis, Sux, BB, and arginine hydrochloride

78
Q

When does hyperkalemia due to decreased renal excretion of potassium occur? (3)

A
  1. reduced GFR
  2. Decreased aldosterone activity
  3. defect in K+ secretion in the distal nephron
79
Q

Skeletal muscle weakness with hyperkalemia is generally not seen until K+ is >____

A

8

80
Q

Cardiac manifestations of hyperkalemia are due to ______.

A

delayed depolarization

81
Q

Cardiac manifestations are consistently present when plasma K+ level is >_____

A

7

82
Q

Because of its lethal potential, hyperkalemia exceeding ___ should always be corrected.

A

6

83
Q

Which is stronger Calcium chloride or gluconate?

A

chloride

84
Q

What is the dose of calcium gluconate for hyperkalemia?

A

5-10 mL of 10% calcium gluconate

85
Q

What is the dose of calcium chloride for hyperkalemia?

A

3-5 mL of 10% calcium chloride

86
Q

_______ partially antagonizes the cardiac effects of hyperkalemia and is useful in symptomatic patients with marked hyperkalemia.

A

Calcium

87
Q

What potentiates Digoxin toxicity?

A

Calcium

88
Q

Only ___% of total body calcium is present in ECF. Where is the rest stored?

A

1; bone

89
Q

What calcium is physiologically active?

A

ionized calicum in the extracellular space

90
Q

Ionized calcium concentrations are affected by _____ concentration and ___.

A

albumin; pH of plasma

91
Q

What 3 hormones regulate calcium metabolism?

A
  1. parathyroid
  2. calcitonin
  3. vitamin D
92
Q

How does parathyroid hormone regulate calcium?

A

increases bone reabsorption and renal tubular reabsorption of calcium

93
Q

How does calcitonin regulate calcium?

A

inhibitis bone resorption

94
Q

How does vitamin D regulate calcium?

A

augments intestinal absorption of calcium

95
Q

_____ reduceds the iCa concentration, so therefore, iCa may be significantly reduced after _______ administration.

A

alkalosis; bicarbonate

96
Q

Significantly reduced iCa may be seen with hyperventilation or hypoventilation?

A

hyperventilation

97
Q

What are S/S of hypocalcemia?

A

Paresthesias, irritability, seizures, hypotension, myocardial depression

98
Q

What is an electrolyte concern in the post-op period following thyroid or parathyroid resection?

A

Hypocalcemia-induced laryngospasm

99
Q

How do you treat acute symptomatic hypocalcemia (seizures, tetany, CV depression)?

A

IV calcium

100
Q

Treatment of hypocalcemia in teh presence of ____ is ineffective.

A

hypomagnesmia
(Mg must also be replenished)

101
Q

If acidosis is present with hypocalcemia, what should be corrected first?

A

Calcium level (b/c correcting acidosis w/ bicarb or hyperventilation will exacerbate hypocalcemia)

102
Q

What is normal iCa level?

A

1.1-1.2

103
Q

At what iCa level should you treat hypocalcemia?

A

0.8 or less

104
Q

At an iCa of ____ S/S will occur.

A

0.7

105
Q

Sudden decreases in iCa level may be seen in early post-op period after ___ or _____ surgery. What can this cuase?

A

thyroidectomy or parathyroidectomy; laryngospasm

106
Q

A decrease in iCa levels should always be considered during MTP of blood containing ____.

A

citrate

107
Q

When does hypercalcemia occur?

A
  1. increased GI absorption
  2. decreased renal excretion
  3. increased bone resorption
108
Q

When does increased calcium absorption from teh GI tract occur?

A
  1. milk-alkali syndrome
  2. vitD intoxication
  3. granulomatous disease such as sarcoidosis
109
Q

When does increased bone resorption of calcium occur?

A

primary or secondary hyperparathyroidism
hyperthyroidism
immobilization

110
Q

What are S/S of hypercalcemia?

A

confusion, hypotonia, depressed DTR, lethargy, abdominal pain, N/V

111
Q

Hypercalcemia is frequently associated wtih hyper or hypovolemia? This is secondary to _____.

A

hypovolemia; poluria

112
Q

What is the anesthetic management for emergency surgery in the patient with hypercalcemia?

A

Restoring intravascular volume before induction and increase urinary excretion of calcium with loop diuretics

113
Q

What type of diuretic should be avoided wtih hypercalcemia?

A

Thiazide (b/c it increases renal tubular reabsorption of calcium)

114
Q

Where is magnesium predominantly found?

A

intracellularly and in mineralized bone

115
Q

Renal reabsorption and excretion of magnesium is ____.

A

passive

116
Q

Hypomagnesium S/S are similar to S/S of _____

A

hypocalcemia

117
Q

What are the S/S of hypomagnesemia?

A

dysrhythmias, weakness, muscle twitching, tetatny, apathy, seizures

118
Q

Hypomagesemia is most commonly due to what 2 things?

A

reduced GI uptake or to renal wasitng of mg

119
Q

How can you determine which is causing hypomagnesemia - decreased GI uptake or renal wasting?

A

by measuring urinary Mg excretion rate

120
Q

With hypomagnesemia, if cardiac dysrhythmias or seizures are present what is the treatment? Include dose.

A

IV bolus of 2 grams Mg Sulfate

121
Q

2 grams of Mg Sulfate = ____ mEq of Mg

A

8

122
Q

What is a potential s/e of the treatment of hypomagnesemia?

A

hypermagnesemia

123
Q

What is the anesthesia management for patients with hypomagnesemia?

A

attention to S/S, Mg supplementation, and treatment of refractory hypokalemia or hypocalcemia

124
Q

____magnesium can enhance digitalis toxicity.

A

hypo

125
Q

Magnesium >___ is considered hypermagnesemia

A

2.5

126
Q

When is Mg given?

A

Torsades

127
Q

T/F: Mg can be briskly excreted if renal function is normal, so hypermagnesemia is much less common.

A

True

128
Q

Magnesium infusion is sometimes done during what procedure?

A

Pheochromocytoma surgery

129
Q

What are first S/S of hypermagnesemia?

A

lethargy, N/V, facial flushing

130
Q

When do the S/S of lethargy, N/V, facial flushing begin with hypermagnesemia?

A

At levels of 4-5

131
Q

For hypermagnesemia, At levels >___, loss of DTR and hypotension occur.

A

6

132
Q

At Mg levels >6, ____ and ___ occur.

A

loss of DTR and hypotension

133
Q

What are 2 meds (besides IV Mg Sulfate) that could cause high Mg?

A

antacids and Mg-based enemas or cathartics

134
Q

How can life-threatening signs of hypermagenesmia be temporarliy treated?

A

IV Calicum

135
Q

How can mild forms of hypermagnesemia be treated?

A

Loop diuretics and diuresis with salien

136
Q

_____ exacerbates hypermagnesemia so careful attention must be paid to ventilation and arterail pH.

A

Acidosis

137
Q

Does acidosis or alklaosis exacerbate hypermagnesemia?

A

Acidosis

138
Q

Phosphorus is required for the synthesis of what 3 things?

A
  1. phospholipids and phosphoproteins in cell membranes
  2. phosphonucleotides involved in protein synthesis and reproduction
  3. ATP used for storage of energy
139
Q

Hyperphosphatemia may be seen with ____ syndrome.

A

tumor lysis

140
Q

What are examples of increased phosphorus intake associated with hyperphosphaemia?

A

abuse of phosphate laxatives or excessive admin of potssium phosphate

141
Q

Significant hyperphosphatemia may produce ____ (other electrolyte imbalance).

A

hypocalcemia

142
Q

How does hyperphosphatemia produce hypocalcemia?

A

Via phosphate chelation with plasma Ca2+

143
Q

Hyperphosphatemia may produce _____ via parenchymal and tubular deposits of calcium-phosphate sats.

A

AKI

144
Q

How do you treat hyperphosphatemia?

A

Phosphate-binding antacids

145
Q

What are the two phosphate-binding antacids?

A

Aluminum hydroxide or aluminum carbonate

146
Q

what can cause severe hypophophatemia?

A
  1. Large doses of aluminum or Mg containing antacids
  2. severe burns
  3. insufficient Phos supplementation durign TPN
  4. DKA
  5. Alcohol withdrawal
  6. prolonged respiratory alklaosis
147
Q

____ mg/dL is considered mild to moderate hypophosphatemia

A

1.5-2.5

148
Q

T/F: Mild to moderate hypophosphatemia is generally asymptomatic.

A

True

149
Q

Severe hypophosphatemia is considered a phosphorus level <___.

A

1.0 mg/dL

150
Q

Sever hypophophatemia is associated with increased ______ in critically ill.

A

morbidity and mortality

151
Q

Is PO or parenteral phosphorus replacemetn preferred?

A

PO

152
Q

Why is PO phosphorus preferred over parenteral?

A

B/c of the increased risk of phosphate precipitation w/ Ca

153
Q

What is a post-op concern wtih severe hypophosphatemia?

A

Some pts may require mechanical ventilation b/c of muscle weakness

Coexisting Disease/Comprehensive Exam - PPT Questions (6 decks)

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