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Principles in Practice > Fluid and Electrolyte Management > Flashcards

Fluid and Electrolyte Management Flashcards

1
Q

Different signs of Hypovolemia

5%, 10%, 15%

Mucus

LOC

Orthostatic [HR, BP]

UOP

PULSE RATE

A
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2
Q

Laboratory/ Monitoring evaluation for Hypervolemia

A
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3
Q

Where do you start your Fluid challenge?

A

you can always give more, never less

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4
Q

What are the most common electolyte that you will be giving?

A

Sodium

Potassium

Calcium

Magnesium

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5
Q

Percent of Intracellular and Extracellular

Fluid in the body

A

Intracellular is so much bigger than extracellular fluid

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6
Q

What electrolyte does NS have?

A

Na 154

Cl 154

Ph 4.2

mOsm/L: 308

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7
Q

What is the composition of LR

A

Na: 130

Cl: 110

K: 4

Ca: 3

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8
Q

What is the composition of Plyte?

A

Na: 140

Cl: 98

K: 5

Mg: 3

ph: 7.4

mOsm/L: 294

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9
Q

What is the goal of Hyponatremia?

What is causing the electrolyte disturbance?

A
  1. Na and water deficit
  2. Water excess
  3. Na and water excess
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10
Q

What is the level of Hyponatremia you should be worried about and you may see seizure

A

<110

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11
Q

What is the tx of hyponatremia

A
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12
Q

can you rapidly correct hyponatremia?

What is safe for GA?

A

NO!

may cause central pontine myelinolysis

>130

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13
Q

What is the goal for correction of Hyponatremia?

A

6-8 meq / l

*key is slow correction and checking your sodium levels

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14
Q

What is an EKG change that you can see for hypokalemia

A

U waves, T wave flattening, ST- segment changes

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15
Q
A
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16
Q

What are the TX of hypokalemia

A

Remember that NDMB should be reduced 25-50% since hypokalemia causes increased sensitivity.

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17
Q

What are Hyperkalamia EKG changes?

A

numbness tingling on extremities

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18
Q

What is the presentation of Hypercalcemia?

A
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19
Q

Hypocalcemia EKG changes

A

prolonged Qt

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20
Q

What is the TX OF HYPOCALCEMIA?

what other electrolyte you should follow?

A

– follow Mg

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21
Q

EKG changes for hypocalcemia and hypercalcemia

A
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22
Q

Hypercalcemia Causes

A
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23
Q

Tx of Hypomagnesemia

A
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24
Q

Hypermagnesemia

Causes

Clinical Management

25
Q

What are the tx of hypermagnesemia

26
Q

How to calculate your NPO hours?

27
Q

What are the EBV for

Neonates:

Premature:

Full term

28
Q

EBV for Infantd

A

Infants 3-12 months

80 ml/kg

29
Q

Adults

Males

Females

30
Q

What can NaCl cause?

A

Hyperchloremic, hypernatremic metabolic acidosis if >3-4 L given

31
Q

How do you calculate Hct?

32
Q

How to replace blood loss?

LR/NS/Plyte:

Colloids:

PRBC:

33
Q

What is the EBV formula?

34
Q

Blood Component Therapy

Why do you need whole blood for?

What is the Hct?

What does it contain?

How much does it raise Hct?

A
  • massive infusion therapy
  • 40% HCT
35
Q

PRBC

what is HCT?

How much does it increase Hct?

What is the volume?

A

Tubing should contain 170-230 mm fliter

Warm it - Hypothermic effects and lower level of 2,3 DPG in stored blood cause leftward shift of oxyHgb dissociation curve

Infuse NS

36
Q

Know banked blood preservatives

what does the different additives do?

37
Q

What happens to older blood?

A

The older the blood the more acidotic it gets

38
Q

When can you not give O+

A

pregnant women

39
Q

What are the two things that the TEG are looking at?

what does it require?

A

Coagulation

Fibrinolysis

frequent calibrations.

40
Q

Initiation

A

Time of latency from start of test to initial fribrin formation

41
Q

Amplification

A

Time taken to achieve a certain level of clot strength

42
Q

Alpha

A
  • angle (slope between R and K); measures the speed at which fibrin build up and cross linking takes place, hence assesses the rate of clot formation
43
Q

Definition: TMA

MA?

A

time to maximum amplitude

Maximum amplitude - represents the ultimate strength of the fibrin clot; i.e overall stability of the clot

44
Q

Important TEG patterns

45
Q

Important TEG form and treatment

46
Q

Citrate Intoxication

A

Complications of massive blood transfusion therapy
Ø Citrate intoxication: from the addition of CPD as
preservative for stored blood; can occur with
rapid transfusion (>150ml/min)
l Citrate metabolized by liver; if rate of transfusion
exceeds 1 unit of blood per minute in an adult,
decreased calcium may result (binds calcium and
magnesium) l Due to accumulation of citrate chelating serum
calcium l Pediatric patients and those with liver disease more
likely to become intoxicated

47
Q

Symptoms of Citrate Intoxication

and

Treatment

A

S ymptoms of citrate intoxication
Ø Hypocalcemia

Ø Hypotension

Ø Increased LVEDP

Ø Increased CVP

Ø Prolonged QT interval

Ø Hypomagnesemia
l Tachyarrhythmias, TdP, refractory V Fib

Treatment:

Ø Calcium or magnesium

Ø Citrate will be metabolized quickly in
Kreb’s cycle so symptoms may abate
before treatment needed

48
Q

when do you see Dilutional coagulopathy

A

Ø Seen with massive transfusions > 1 EBV

Ø Microvascular bleeding

Ø Hematuria

Ø Bleeding at IV sites

Clinically oozing

Ø Increased PT/PTT

Ø Decreased platelets

(>10 units)

49
Q

What is the tx of Dilutional coagulopathy

A

Treatment for dilutional coagulopathy
Ø Surgically control the bleeding

Ø Keep patient warm

Ø Maintain perfusion and euvolemia

Ø Don’t overhydrate and dilute patient

Ø Consider FFP, platelets

Ø Consider Vitamin K, DDAVP (enhances
platelet adhesiveness)

50
Q

Citrate combines to?

51
Q

really common complication of blood transfusion

52
Q

most commonly transfused virus in blood transfusion

A

CMV virus

  • if patient is a transplant you have to ask for it to be CMV negative and irradiated blood.
53
Q

FFP indications?

what does it contain?

54
Q

How long can you store FFP?

A

can be stored for a year

55
Q

When do you give platelets?

A

1 unit of platelet per 10 kg of bodyweight

it has 6-7 donor units and will raise count 5 - 10

57
Q

What is the normal platelet count?

what is the trigger?

58
Q

When do yo give Cryo?

Principles in Practice (19 decks)

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