Fluid, E- and Acid-base abnormalities

Question 1

Excessive Vomiting;

Vomiting leads to a ?, ? ? ?(as ? ? is lost).
? can also commonly become depleted.
Treatment is with ? to replace the ECF volume, as well as ? (?mmol) to restore ?levels.
The ? ? will self-correct with restoration of fluid and ? balance, but ? should be frequently checked during treatment.

Answer 1

hypochloraemic, hypokalaemic met alk
gastric acid
sodium
saline
kcl 20
K
met alk
pot
u+Es

Question 2

High Volume Pancreatic/ lleal / Jejunal / Bile Fistula;

Pancreatic, bile and small bowel fistulas are likely to contain high ? levels due to their ? nature, and thus fluid and ? replacement is required.
o Bowel contents after the ? of ? are ? in nature
? displaces ? from the cell so ? levels may seem ? when in fact total body potassium is ?

Answer 2

bicarbonate
alkaline
bicarb
ampulla of vater
alkaline
acidosis
potassium
pot
elevated
depleted

Question 3

Diarrhoea;

Acute diarrhoea causes a ? ? ?, with ? if profuse.
Chronic diarrhoea can cause a ? ?
Treatment is ideally with ? rehydration, however if not possible then ? and ?mmol ? should be given

Answer 3

hyperchloraemic metabolic acidosis
hypokalaemia
metabolic alkalosis
oral
saline
20
pot

Question 4

Acute Tubular Necrosis;

Hyper?, hyper?, hyper?.
Hypo?, hypo?.
Metabolic ?(unless prevented by ?).

Answer 4

kalaemia, magnesia, phosphataemia
natraemia, calcaemia
acidosis
vomiting

Question 5

Dehydration;

Most commonly ?, but can be hyponatraemic if ? fluid is being lost, or hypernatraemic if ? fluid is being lost.
- These require specific treatment regimens.
?, ?, ?, ? and ? are essential investigations.

Answer 5

isonatraemic
hypertonic
hypotonic
fbc, u+e, urinalysis, glucose, lactate

Question 6

Congestive Cardiac Failure·

The neurohormonal adaptation process leads to activation of the adrenergic
and RAA systems, leading to ? and water ?.
Patients are at risk of dilutional ? in severe CCF due to dietary ? restriction and the inability to ? water (RAAS over activation).
? can result from prolonged administration of diuretics, or ? can occur in severe heart failure leading to reductions in GFR, particularly if they are on ? ? diuretics/ ?.

Answer 6

salt
retention
hyponatraemia
salt
excrete
hypokalaemia
hyperkalaemia
pot sparing
ACEis

Question 7

Closed Head Injury;
- The general goal in cerebral oedema is to maintain a state of ? to reduce the risk of a secondary brain injury.
If the patient is haemodynamically stable, ? of maintenance with ? solution is recommended. .
? fluids should be avoided as they may decrease serum osmolality, and increase cerebral ?.
? volumes of hypertonic solutions are occasionally used.

Answer 7

euvolaemia
2/3rds
isotonic
hypotonic
oedema
small

Question 8

Syndrome of Inappropriate ADH Secretion (SIADH);

Non-physiologic release of ?, which results in decreased water ? and ? sodium excretion leading to a ? ?.

Investigations show ? with ? urea/ creatinine. There’s increased urinary ? giving an increased specific ? of the urine

Answer 8

adh
excretion
normal
dilutional hyponatraemia
hyponatraemia
normal
sodium
gravity

Question 9

Syndrome of Inappropriate ADH Secretion (SIADH);

Causes;
Malignancy: lung ? cell, ?, ?.
CNS disorders: ?itis, ?, head injury.
Chest disease: ??, pneumonia, ?.
Endocrine disease: ?thyroidism.
Drugs: ?, psychotropics.
Other: major ?, ?, symptomatic ???.

Answer 9

small
prostate
pancreas
meningoencephalitis
haemorrhage
TB
abscess
hypo
opiates
surgery, trauma, HIV