Fluid And Electrolytes

Question 1

Is k higher inside or outside the cell

Answer 1

Inside

Question 2

Is Na higher inside or outside the cell

Answer 2

Outside

Question 3

Holliday Segar Rule

Answer 3

3-10kg 100 ml/kg/day
10-20kg 1000ml + 50ml/kg
20-70kg 1500ml + 20ml/kg

Question 4

4-2-1 rule

Answer 4

3-10kg 4ml/kg/hr
10-20 kg 40ml/hr + 2ml/kg/hr
21+ 60ml/kg/hr +1ml/kg for additional kg

Question 5

Dose of hypertonic saline

Answer 5

3-5 ml/kg

Question 6

How fast to correct hyponatremia

Answer 6

O.5 mEq/L/hr

Question 7

Causes of kyperkalemia

Answer 7

Excess intake
Decreased excretion- renal failure beta blockers acidosis
Tumor lysis or rhabdo
Hemolyzed sample

Question 8

Signs of hyperkalemia

Answer 8

Peaked T, depressed ST, wide QRS, absent P

Question 9

Hyperkalemia management

Answer 9

Stabilize myocardium with CaCl or CaGluconate
Enhance movement of K into cells with NaHcO3 or glucose+insulin
Remove K with kayexelate diuretics or dialysis

Question 10

Causes of hypocalcemia

Answer 10

Hypoparathyroid, digeorge vit D deficiency, renal insufficiency, massive transfusion, rhabdo, tumor lysis, ethylene glycol ingestion

Question 11

Signs of hypocalcemia

Answer 11

Seizures, tetany, myocardial irritability, long QT, paresthesia

Question 12

Causes of metabolic alkalosis

Answer 12

Diuretics, vomiting, gastric suctioning, corticosteroid therapy, severe k depletion

Question 13

Causes of metabolic acidosis

Answer 13

CAT MUDPILES

Diarrhea, adrenal insufficiency, chronic kidney, hypoaldosteenoism, spironolactone administration

Question 14

MUDPILES

Answer 14

Metabolic acidosis 
Methanol
Uremia
Dka 
Paraldehyde
Iron
Lactic acidosis
Ethanol
Salicylates 
CAT
carbon monoxide aminiglycosides theophyline

Question 15

Electrolytes you vomit

Answer 15

Chloride, potassium, sodium, bicarb

Question 16

Electrolytes list in diarrhea

Answer 16

Sodium potassium magnesium

Question 17

Anion gap calculation

Answer 17

Sodium -(Chloride + bicarb)

Question 18

Macronutrients

Answer 18

Protein glucose fat

Question 19

Micronutrients

Answer 19

Electrolytes minerals vitamins

Question 20

Long term effects of parenteral nutrition

Answer 20

Venous thrombosis thrombus formation infection cholecystitis bone disease liver disease and activity impairment

Question 21

Complication of anorexia

Answer 21

Metabolic acidosis, cardiac arrhythmias, severe bradycardia

Question 22

Hallmark lab findings of ftt

Answer 22

***Hypophosphatemia, hypomagnesemia, hypokalemia

Question 23

What’s released during times of stress

Answer 23

Catacholamines cytokines glucocorticoids and glucagon

Question 24

Nutrition stress response

Answer 24

Hyperglycemia catabolism dyslipidemia and hypermetabolic state leading to high cortisol and free fatty acid depletion

Question 25

DKA presentation

Answer 25

Abdominal pain, vomiting, polyuria, hyperglycemia, ketonuria, lethargy, mental status changes

Question 26

DKA lab findings

Answer 26

Hyperglycemia, low ph, low bicarb, ketonuria, +serum ketones

Question 27

DKA Management

Answer 27

Crystalloid bolus with slow replacement over 24-48 hours at 1.5-2x maintenance
Insulin infusion at .1units/kg/hr
Add glucose to fluids once dexi is 250-300

Question 28

Critical complications of DKA

Answer 28

Cerebral Edema- altered mental status, confusion, seizures, headache

Question 29

Cerebral edema tx

Answer 29

Mannitol 0.5-1 Gm/kg or 3% hypertonic saline

Fluid to manage shock but not in excess just normalize, increase HOB and consider CT