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A Cut Above the Rest (ABSITE) > Fluid and Electrolyte Management of the Surgical Patient > Flashcards

Fluid and Electrolyte Management of the Surgical Patient Flashcards

1
Q

Causes ofMetabolic acidosis with a normal anion Gap

A
  • GI losses (loss of bicarbonate)
    • diarrhea
    • fistulas
  • Acid administrion (HCL or NH4)
  • Renal loss

the bicarbonate loss is accompanied by gain of chloride thus the AG remains unchanged

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2
Q

Possible causes of Postoperative hyponatremia

A
  • Excess infusion of normal saline intraoperatively
  • Administraion of antipsychotic medication
  • Excess oral water intake

ADH can be released transiently postoperatively or less frequently in syndrome of inappropriate ADH secretion

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3
Q

Possible causes of pseudohyponatremia in laboratory testing

A
  • High serum glucose, lipid or protein levels
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4
Q

ECG findings in Hyperkalemia

A
  • Peaked T waves (early change)
  • Flattened P wave
  • Prolonged PR interval
  • widened QRS
  • Sine wave formation
  • Ventricular fibrillation
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5
Q

Hypocalcemia may cause ______

A
  • Congestive heart failure (decreased cardiac contractility)
  • muscle cramping
  • paresthesias
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6
Q

ECG changes of hypocalcemia

A
  • prolonged QT interval
  • T wave inversion
  • heart block
  • Ventricular fibrillaion
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7
Q

Causes hypocalcemia

A
  • hypoparathyroidism
  • severe pancreatitis
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8
Q

Causes of metabolic acidosis with increased anion Gap

A
  • Exogenous acid production
  • Endogenous acid production (B-hydroxybutyrate and acetoacetate, lactate
  • Renal insufficiency (organic acids)
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9
Q

Hypertonic saline

A
  • 7.5%
  • treatment modality in patients with closed head injuries
  • should not be used for initial resucitation
  • Arteriolar vasodilator and may increase bleeding
  • Increases cerebral perfusion
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10
Q

Normal saline

A
  • 154 mEq NaCl/L
  • 154 mEq of chloride
  • Mildy hypertonic
  • used in correcting volume deficits associated wit
    • hyponatremia
    • hypochloremia
    • metabolic alkalosis
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11
Q

Albumin for fluid resuscitation

A
  • Can cause pulmonary edema
  • Available as
    • 5% (300 mOSm/L)
    • 25% (1500 mOsm/L)
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12
Q

Solutions associated withh postoperative bleeding in cardiac and neurosurgery patients

A

Hydroxyethyl starch solutions

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13
Q

Water constitutes ____ percentage of total body weight

A

50-60%

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14
Q

Highest percentaage of TBW is found _______

A

newborns (80%)

Decreases to 65 % by 1 year

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15
Q

Serum Osmolality

A

2 sodium + glucose/18 + BUN/2.8

  • Absite question: if glucose increased by 180 = serum osmolality will increase by 10
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16
Q

Effect of pH to potassium

A

Potassium decreases by 0.3 mEq/L for every 0.1 increase in pH above normal

  • Absite question:
    • pH 7.8
    • K: 2.2
    • answer K: 3.4
17
Q

Free water deficit

A

Water Deficit (L) = (serum sodium-140)/140 x TBW

  • TBW
    • 50% in men
    • 40% in women

Absite question:

  • 70kg
  • sodium is 154
  • answer: 7L
18
Q

Corrected Calcium

A

Adjust total serum calcium down by 0.8 mg/dl for every 1 g/dL decrease in albumin

Absite question:

  • corrected calcium : 6.8
  • albumin : 1.2
  • total calcium : 9.2
19
Q

treatment for hyperkalemia that doesnt reduce serum K level

A

Calcium

  • Calcium chloride or calcum gluconate (5-10 ml of 10% solution) should be administed immediately to counteract myocardial effects of hyperkalemia
  • glucose and bicarbonate shift potassium intracellularlarly
  • Kayexalate is cation exchane resin that binds potassium
20
Q

Magnesium correction

A

magnesium deficit = Desired - Actual

  • target Mg is usually 1 for patients with cardiac disease otherwise target is 0.8
  • 1g MgSO4 is given per 0.1 mmol/L Mg
    • MgSO4 drip in D5W
21
Q

Causes of hypomagnesemia

A
  • Poor intake
  • alcoholism
  • prologed use of IV fluids and total parenteral solution
  • GI losses
  • Malabsortiop
  • Acute pancreatitis
  • DKA
  • primary aldosteronism
22
Q

Daily maintenace fluids

A

Holliday segar

  • First 10 kg = 100 ml/kg/day
  • next 10-20 kg = 50 ml/kg/day
  • each kg >20 kg = 20 ml/kd/ay (15 if elederly or with cardiac disease)

ml/kg/hr: 4/2/1

absite question:

  • 60kg
  • answer 2100
23
Q

Signs of hypocalcemia

A
  • Trosseau sign ( spams resulting from pressure applied to the nerves and vessels on the upper extremity)
  • Chvostek sign ( spasm resulting from tapping over the facial nerve)
24
Q

Asymptomatic hypocalcemia

A

Asymptomatic hypocalcemia may occur with hypoprotenemia

Symptoms do not occur until the ionized fraction falls below 2.5 mg/dL

25
Q

Corrected Anion Gap

A

Corrected = actual + [2.5(4.5-albumin)]

Absite question:

  • Na 133
  • K 4
  • Cl 101
  • HCO3 22
  • Albumin 2.5
  • ANSWER: 15
26
Q

Effective osmotic pressure between plasma and intestitial fluid compartments is controlled primarily by

A

Protein

27
Q

The metabolic derrangement most commonly seen in patients with profuse vomiting

A

Hypochloremic, hypokalemic metabolic acidosis

  • isolated loss of gastric contents in infants with pyloric stenosis or in adults with duodenal ulcer disease = metabolic alkalosis
28
Q

Symptoms and signs of extracellular fluid volume deficit

A

Anorexia

Apathy

Decreased body temperature

tachycardia

orthostasis/hypotension

oliguria

ileus

azotemia

  • EXCESS ECF
    • High pulse pressure
    • Weight gain
    • Edema
    • Increased CO
    • Increased central venous pressure
    • Distended neck veins
    • murmur
    • bowel edema
    • Pulmonary edema
29
Q

A low urinary NH4 with a hyperchloremic acidosis indicates what cause?

A

Renal tubular acidosis

30
Q

When lactic acid is produced in response to injury, the body minimizes pH change by ________

A

Excreting carbon dioxide through the lungs

  • Lactic acid reacts with base bicarbonate to produce carbonic acid - . broken down into water and cO2 - > lungs
31
Q

Predicted Changes in Acid-Base disorders

A
32
Q

Characteristic findings of acute renal failure

A
  • Hyperkalemia
  • Severe acidosis
  • Uremic pericarditis
  • Uremic encephalopathy

Elevation of BUN is commonly seen as well but is not itself an indication for dialysis

33
Q

Relationship of glucose and sodium

A

For each 100mg/dL rise in blood glucose above the normal, serum sodium falls aprroximately 3 meq/L

and vice versa

34
Q

Excessibe administration of normal saline for fluid resuscitation can lead to what metabolic derangement?

A

Metabolic Acidosis

35
Q

The first step in the management of acute hypercalcemia

A

Correction of deficit of extracellular fluid volume

36
Q

In patients suffering from hemorrhagic shock and metabolic acidosis. this fluid is recommended

A

Lactated ringers

  • Balanced salt solution
  • Restore perfusion
  • Correct metabolic acidosis by ending anerobic metabolism
37
Q

Refeeding syndrome

A

Shift in metabolism from fat to carbohydrate substrate stimulates insuin release, which results in the cellular uptakeof electrolytes particuarly phosphate, AMgnesium, Potassium, and calcium

A Cut Above the Rest (ABSITE) (48 decks)

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