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Surgery > Fluid And Electrolytes > Flashcards

Fluid And Electrolytes Flashcards

1
Q

Total body water of young adult male

A

60% of body weight in kilogram

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2
Q

Total body water in young adult female

A

50% of body water weight in kilogram

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3
Q

Lean individual has a greater proportion of water to total weight than

A

Obese person

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4
Q

Total body water decreases steadily and significantly with age in male

A

52%

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5
Q

Total body water decreases steadily and significantly with age in female

A

47%

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6
Q

Highest proportion of total water is found in infant

A

79-80%

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7
Q

At one year of age total body water averages ___ of the body weight

A

65%

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8
Q

Formula for calculating maintenance fluids

For the first 0-10 kg

A

Give 100 ml/kg per day

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9
Q

Formula for calculating maintenance fluids

For the next 10-20 kg

A

Give additional 50 ml/kg per day

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10
Q

Formula for calculating maintenance fluids

For weight >20kg

A

Give 20 ml/kg per day

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11
Q

Fluid within the bodies diverse cell population presents

A

40% of the total body weight in kilogram

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12
Q

The largest proportion of intracellular fluid is found in the

A

Skeletal muscle mass

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13
Q

The principal,intracellular cation is

A

Potassium

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14
Q

The principal intracellular anion is

A

Phosphate and proteins

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15
Q

Extracellular fluid represent approximately

A

20% of the body weight

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16
Q

Two major subdivision of ECF

A

Plasma - 5%

Interstitial - 15%

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17
Q

Non functioning components are

A

1-2 % of body weight

Cerebro spinal fluid and synovial fluid

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18
Q

Total fluid requirements =

A

Basal requirement + correction of abnormal losses

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19
Q

Basal requirements

Adults or >30 kg

A

35ml/kg/day

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20
Q

Basal requirements

Pediatrics or

A

0-10 kg = 100ml/kg
11-20 kg = 100ml + 50ml/kg in excess of 10
21-30kg = 1500 ml + 20 ml/kg in excess of 20

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21
Q

Normal daily losses

GIT

A

100-200 ml lost in stools

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22
Q

Normal daily losses

GUT

A

1000-1500 ml lost in urine

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23
Q

Insensible losses

A

600-800 ml in adults

Lungs 25%
Skin 75%

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24
Q

Abnormal losses

A 
Fever
Tachypnea
Evaporation
Gastrointestinal
Third spaces
Intraoperatives
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25
Q

Volume wherein a specific fluid equilibrates

A

Distribution volume

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26
Q

Distribution volume

Water distributes freely into the ICF and ECF

A

35L in 60kg includes 5% dextrose

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27
Q

Distribution volume

Crystalloid sa with approximately 140meq/L sodium is

A

12L in 60 kg male

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28
Q

Distribution volume

Ex. In resuscitating a 60kg male with a 1liter blood loss

A

Volume to be infused = 1liter x 36 liters / 3 liters

Using NSS/LRS = 1 liter x 12 liters / 3 liters

Using colloids = 1liter x 3 liters / 3 liters

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29
Q

Electrolytes requirements

A 
Na= 10-250 mEq/day
K = 50 - 100 mEq/day
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30
Q

Only patients who need dextrose containing solutions are

A

Infants and those receiving insulin

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31
Q

In jaundice the preferred IVF is

A

NSS

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32
Q

Cations

A

Sodium
Potassium
Calcium
Magnesium

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33
Q

Anions

A 
Chloride
Bicarbonate
Phosphorus
Protein
Organic acid
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34
Q

Connective tissue water

A

Cerebrospinal fluid

Joint fluid

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35
Q

Principal extracellular cation

A

Sodium

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36
Q

Principal extracellular anion

A

Chloride

Bicarbonate

37
Q

The product of the concentration of any pain of diffusible cations and anions on one side of a semi-permeable membrane will equal the product of the same pair of ions on the other side.

A

Gibbs- Donnan Equilibrium equation

38
Q

Osmotic pressure

Physiologic and chemical activity of electrolytes depends on

A

Number of particles
Number of electric change
Number of osmotically active particles

39
Q

Osmotic pressure

Total osmotic pressure of a fluid is

A

The sum of the partial pressures contributed by each of the solutes in that fluid

40
Q

Osmotic pressure

Effective osmotic pressure dependent on those substances

A

That fail to pass through the pores of the semipermeable membrane

41
Q

Osmotic pressures

The dissolve proteins in plasma are primarily responsible for

A

Elective osmotic pressure between the plasma and the interstitial fluid compartments

Colloid oncotic pressure

42
Q

Stable internal fluid environment is maintained by the

A 
Kidneys
Brain
Lungs
Skin
GIT
43
Q

Normal individual consumes an average of water

A

2000-2500 ml/ day

44
Q

Daily water losses

A 
Stool - 250 ml
Urine - 899-1500 ml
Insensible losses - 600 ml
Skin - 75%
Lungs - 25%
45
Q

Normal salt intake

A

50-90 mEq/day 3-5 grams

46
Q

Reduce intake or extra renal losses

A

Sodium excretion is reduced to less than 1meq/day

47
Q

Na losses exceed 200 mEq/ L of urine

A

Salt wasting kidneys

48
Q

Sweat represent a hypotonic loss of fluids

A

Unacclinatized 60meq/L

49
Q

Disorder in fluid balance is classified in 3 general categories

A

Volume
Concentration
Composition

50
Q

If an isotonic salt solution is added to or lost from the body fluids

A

Only the volume of the extracellular fluid is changed

51
Q

Fluid will not be transferred from intracellular space to refill the depleted extracellular space as long as

A

The osmolarity remains the same in the two compartments

52
Q

If water alone is added to or lost from the extracellular fluid,

A

The concentration of osmotically active particles will change

53
Q

If the extracellular fluid is depleted of Na,

A

Water will pass into the intracellular space until the osmolarity is again equal in two compartments

54
Q

Volume deficit

Occurs early with acute rapid lose

A

CNS

CVS

55
Q

Volume deficit

Tissue signs maybe absent until the deficit has existed for

A

Al least 24hours

56
Q

Volume deficit

Secondary to renal hypo-perfusion (pre renal azotemia)

A

Oliguria

57
Q

Volume deficit

Potassium containing solutions are avoided in TH

A

First 24 hours post OP to avoid hyperkalemia

58
Q

Volume deficit

Suggested IVF

A

1st 24 hours = LRS or NSS

2nd day = D5W + NSS

59
Q

Most common fluid disorder in surgical patients

Water and electrolytes lost in the same proportion

A

Hypovolemia

60
Q

Degree of hypovolemia

Total body water lost

A

Mild 4%
Moderate 6%
Severe 8%
Shock >8%

61
Q

Degree of hypovolemia

Blood volume lost

A

Mild 15%
Moderate 15-30%
Severe 30-40%
Shock > 40%

62
Q

Volume excess may generally be due to

A

Latrogenic
Renal insufficiencliver cirrhosis
CHF

63
Q

Volume excess

A

Both plasma and interstitial fluid volumes are increased

64
Q

Used to estimate the total body fluid osmolality

A

Sodium

65
Q

Sodium and water go together and since ECF and ICF are separated of semipermeable membrane only,

A

The ECF and ICF osmolality are considered equal

66
Q

Hyponatremia

Loss of isotonic fluids or resuscitation with inadequate volume of hypotonic fluids eg. 0.3% NaCL

A

Hypovolemic hypotonic Hyponatremia

67
Q

Hyponatremia

Iatrogenic free water loading, SIADH, hypokalemia (kidney sensitized to ADH )

A

Isovolemic hypotonic Hyponatremia

68
Q

Hyponatremia

Fluid retention as in CHF, CRD, liver failure, malnutrition

A

Hypervolemic hypotonic Hyponatremia

69
Q

Hyponatremia

Pseudohponatremia, hyperproteinemia

A

Isotonic Hyponatremia

70
Q

Hyponatremia

In glucose or mannitol infusion, fluid flows from ICF to ECF, hence diluting the sodium

A

Hypertonic Hyponatremia

71
Q

Hyponatremia

Na deficit =

A

.6 x kg body weight x 120

72
Q

Hypernatremia

Loss of hypotonic fluids like sweat
Increase insensible loss
Each 3 mEq decrease of Na = 1 liter free water loss

A

Hypovolemic hypernatremia

73
Q

Hypernatremia

Actually sub clinical hypovolemia as in diabetes insipidus

A

Isovolemic hypernatremia

74
Q

Usually iatrogenic as an parenteral bicarbonate, some antibiotics with Na as its base, Cushing’s syndrome, conn’s disease, CAH, steroids

A

Hypervolemic hypernatremia

75
Q

Hypernatremia

Treatment

A

Treat underlying disorder
Infuse free water
D5W

76
Q

SS Hyponatremia

A 
Headache
Lethargy
Confusion
Waekness
Seizures
Coma
Death
77
Q

SS of hypernatremia

A 
Lethargy
Irritability
Thirst
Hyper reflexia
Seizures
Coma
 Death
78
Q

Mixed volume and concentration abnormalities

Produced by individual who continue to drink water while losing large volume of GIT fluids

A

Extracellular fluid deficit and Hyponatremia

79
Q

Mixed volume and concentration abnormalities

Produced by the loss of a large amount of hypotonic salt solution such as sweet in the absence of fluid intake

A

Extra cellular volume deficit and hypernatremia

80
Q

Mixed volume and concentration abnormalities

Prolonged administration of excessive quantities of sodium salts with restricted water intake

A

Extracellular volume excess and hypernatremia

81
Q

Excessive administration of water or hypotonic salt solution to pt with oliguria renal failure.

A

Extracellular fluid excess Hyponatremia

82
Q

Sign and symptoms of hypokalemia

A 
Nausea
Vomiting
Weakness
Constipation
Ileus
Paralysis
Respiratory insufficiency
Tachydysrhythmias
83
Q

SS hyperkalemia

A 
Cramping
Paralysis
Nausea
Vomiting
Tachydysrhythmias
Cardiac arrest
84
Q

ECG changes in hyperkalemia

A

Flattened P waves
Widened QRS
Prolonged PR interval
Peaked T waves

85
Q

ECG changes in hypokalemia

A

U wave
T wave flattening
ST segment changes
Arrhythmias

86
Q

Potassium removal

A

Kayexalate

Dialysis

87
Q

Glucose 1 ampule of D50

A

Shift potassium

88
Q

Calciumgluconate 5-10 ml of 10% solution

A

Counteract Cardiac Effects

89
Q

Water constitute between ___ to ___ of total body weight

A

50-70%

Surgery (7 decks)

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