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Anesthesia Pharmacology > Fluid Management & Blood Therapy > Flashcards

Fluid Management & Blood Therapy Flashcards

1
Q

Etiology hypokalemia

A

<3.5 mEq/L
Poor intake
GI LOSS: vomitting, diarrhea, NG suction, Kayexalate
Renal loss- dieurtics, metabolic Alkalosis, licorice
Intracellular shift: Beta-2agonist, insulin alkalosis

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2
Q

Etiology hyperkalemia

A 
>5.5 mEq/L
Poor excretion: renal failure, K sparing diuretics
Extracellular Shift: Acidosis
Iatrogenic: Succinylcholine
Misc. Tumor Lysis
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3
Q

Presentation/symptoms Hypokalemia

A

Skeletal muscle cramps=> weakness=> paralysis

Worsens dioxin toxicity

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4
Q

Presentation/symptoms hyperkalemia

A

Cardiac rhythm disturbances

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5
Q

EKG findings Hypokalemia

hint: short long flat

A

PR interval- short
QT interval- Long
T wave- flat
U wave visible

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6
Q

EKG findings Hyperkalemia

A 
Early:
PR=> long
QT=> short
T wave => peaked tall
Middle: 
P wave=> flat
QRS wide
Late:
QRS=>sine wave=> VF
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7
Q

Treatment for Hypokalemia

A

K+ supplementation

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8
Q

Treatment for Hyperkalemia

A 
Calcium (Stabalizes cardiac membrane)
insulin + D50
Hyperventilation
Bicarbonate
Albuterol
Potassium wasting diuretics
Dialysis
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9
Q

Etiology of Hyponatremia

<135mEq

A

May exist in various states of hydration hypovolemic, isovolemic, hypervolemic, so you must evaluate plasma osmolarity and ECF volume to determine cause.
Ex. SIADH, CHF, Cirrhosis, TURP syndrome, Cushing’s

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10
Q

Etiology Hypernatremia >145 mEq/L

A

Hyernatremia may exist in various states of hydration (Hypovolemic, isovolemic, hypervolemic), so you must evaluate plasma osmolarity and ECF volume to determine cause.
Ex: Diabetes inspidus, impaired thirst, NaHCO3 admin

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11
Q

Presentation/ symptoms

Hyponatremia

A

N/V
Skeletal muscle weakness
Mental status changes=> seizures => coma
Cerebral edema cell swelling

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12
Q

Presentation/ symptoms Hypernatremia

A 
Thirst
Mental status changes=> seizures=> coma
Cerebral dehydration (Cell shrinkage)
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13
Q

Treatment for Hyponatremia

A

Treatment depends on specific cause.
The goal is to restore Na+ balance by manipulating serum osmolality fluid balance with H2O restriction IVF selection based on toxicity and diuretics

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14
Q

Treatment for hypernatremia

A

Treatment depends on specific cases.
Gal is to restore balance Na+ by manipulating serum osmolality and fluid balance with Na++ restriction, IVF selection based on tonicity and diuretics

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15
Q

Etiology Hypocalcemia <8.5 mg/dL

A 
Hypoparathyroidism 
Vitamin D deficiency 
Renal Osteodystrophy
Pancreatsis
Sepsis
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16
Q

Hydercalcemia >10.5 mg/dL

A 
Hyperparathyroidism 
Cancer
Thyrotoxicosis
Thiazide diuretics
Immobilization
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17
Q

Presentation/ symptoms Hypocalcemia

A 
Skeletal muscle cramps
Nerve irritability => paresthesia and tetany
Chvostek sign
Trousseau sign
largyospasm
Mental status changss => seizures
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18
Q

Presentation/ symptoms Hypercalcemia

A 
Nausea
abdominal pain
hypertension
psychosis
Mental status changes- seizures
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19
Q

Hypocalemia treatment

A

Calcium Vitamin D

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20
Q

Treatment for Hypercalcemia

A 
0.9 NaCl
Loop diuretic (Furosemide)
21
Q

EKG finding Hypocalcemia

A

QT long

22
Q

EKG finding Hypercalcemia

A

QT interval short

23
Q

Etiology of Hypomagnesemia < 1.3 mEq/L

A 
poor intake
alcohol abuse
diuretics
Critcal illness
common with hypokalemia
24
Q

Etiology of Hypermagnesemia >2.5 mEq

A

Excessive administration
Renal failure
Adrenal insufficiency

25
Q

Presentation/ symptoms of hypomag

A

Skeletal muscle weakness

Arrhythmias torsades de pointes

26
Q

Presentation/ symptoms of hypermag

A

Loss of deep tendon reflex 4-6.5 mEq/L or 10-12 mg/dL
Respiratory depression
6.5-7.5 mEq/L or 18mg/dL
cardiac arrest >10 mEq/L or > 25 mg/dL

Potentiation of neuromuscular blockade (succ & NDNMB

27
Q

EKG findings with Hypomagnesium

A

Not significant unless very low-

long QT

28
Q

EKG findings with hypermagnesium

A

Not significant unless very high heart block

29
Q

Treatment for hypomag

A

give magnesium

30
Q

Treatment for hypermag

A

calcium chloride

31
Q

Influences Fluid Dynamics
Renin-angiotensin-aldosterone-system
Antidiuretic hormone (ADH)
Atrial natriuretic peptide

A
  1. Reabsorption of sodium (and water)
  2. Reabsorption of water
  3. Stimulated by stretch receptors in the atria
    - -Stimulates kidneys to release sodium and water, thereby reducing intravascular volume
    - -Inhibits renin and ADH
32
Q

Assessment of Fluid Volume Status
Preop evaluation
Assessing for fluid volume status

A
  1. Skin turgor, mucous membrane, peripheral edema
  2. Lung sounds
    Vital signs
    Urine output
    HCT
    Urine specific gravity
    BUN/Creatinine
    Acid-base balance (ABG)
33
Q

Acidosis and cardiac effects

A

Increased P50(Right=release)
Decreased contractility
Increased risk of dysrthymias

34
Q

Alkalosis and cardiac effects

A

Decreased 50 left=love
Decrease coronary blood flow
increase dysrthymias

35
Q

Acidosis CNS effects

A

Increase cerebral blood flow

Increase ICP

36
Q

Alkalosis CNS effects

A

Decrease cerebral blood flow

Decreased ICP

37
Q

Acidosis pulmonary effects

A

Increase pulmonary vascular resistance

38
Q

Acidosis pulmonary effects

A

Decreased pulmonary vacuolar resistance

39
Q

Acidosis on electrolyte

A

causes hyperkalemia

40
Q

Alkalosis on electrolyte

A

Hypokelemia

Decreased ionized calcium

41
Q

Intravenous fluid therapy: Crystalloids Hypotonic solutions uses and examples

A

Replaces water loss
called maintenance fluids
examples: D5W

42
Q

Intravenous fluid therapy Isotonic solutions (Normal Osmolarity 285-295 mOsm/L) uses and examples

A

Replaces water and electrolyte loss
called replacement fluids
examples: LR, NS

43
Q

Intravenous fluid therapy Hypertonic solutions uses and examples

A

For hyponatremia or shock

examples: D5 1/2NS (405 mOsm/L), 3% NS (1026 mOsm/L)

44
Q

Examples of hypotonic solution

A

d5w, 0.45% NaCl

cell swells

45
Q

Examples of Isotonic solutions

A

LR
0.9 Nacl
plasmalyte A

Colloids:
5% albumin
Voluven6%
Hespen 6%

46
Q

Examples of hypertonic solutions

A

D5LR
3% NaCl
cell will shrink

Colloids
Dextran 10%

47
Q

Describe Normal saline and its ingredients

A

0.9% NaCl in Water
Isotonic solution (~308 Mosm/L)
Typical solution for diluting PRBCs (cannot use Ca++ containing crystalloids)

48
Q

In large volumes, NaCl produces high Cl- content, which leads to

A

dilutional hyperchloremic acidosis

49
Q

The primary role of NS in modern anesthetic practice is in the administration of small volumes to neurosurgical patients. As a result of its mild hyperosmolality, 0.9% saline is the preferred fluid for patients at risk for cerebral edema. NS may also be indicated in fluid management of patients with anuria and end-stage renal disease who cannot excrete the potassium content of more balanced crystalloid solutions.

A

The primary role of NS in modern anesthetic practice is in the administration of small volumes to neurosurgical patients. As a result of its mild hyperosmolality, 0.9% saline is the preferred fluid for patients at risk for cerebral edema. NS may also be indicated in fluid management of patients with anuria and end-stage renal disease who cannot excrete the potassium content of more balanced crystalloid solutions.

Anesthesia Pharmacology (7 decks)

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