FLUID VOLUME AND ELECTROLYTES

Question 1

The most common cause of hyponatremic hyperosmolality?

Answer 1

Hyperglycemia

Question 2

What method should you use to treat hyponatremia related to SIADH?

Answer 2

3% hypertonic saline, calculated

Question 3

What is a potential cause of hyperkalemia?

Answer 3

NSAIDS

Question 4

Your patient has a Na of 128 and was treated with colloids 3 days ago. What is the treatment?

Answer 4

Restrict free water

Question 5

A 68-year-old pt had Sx three days ago to repair an AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFTS are normal, no s/s CHF. The patient’s laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0.8 mg/dL, PaCO2 of 37 mmHg. Which is the most appropriate method to deliver nutrition?

Answer 5

enteral feeding to the duodenum via a nasogastric small-bore tube (NG tube)

Question 6

Your patient has a serum osmolality of 268 mOsm/kg and a serum sodium of 134 mEq/L. His urine has Na+ less than 10 mEq/L. You know that all of the following are possible explanations except:

Answer 6

Diuretics (Na<10 is nonrenal cause. Diuretics are associated with renal cause, Urine Na >20)

Question 7

A 61 yr old F c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating “abnormally” and she has been experiencing muscle spasms on occasion. You order and EKG and find decreased amplitude and broad T waves. Occasionally you also note prominent U waves. Of the following, which is the most likely Dx?

Answer 7

Hypokalemia

Question 8

Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except

Answer 8

GI Bleed (this is enteral complication)

Question 9

65 yo M with c/o N/V/constipation x several days and a 6 # wt loss. Pt s/p TKR several weeks ago and reports not getting off the couch. What electrolyte is altered?

Answer 9

Hypercalcemia secondary to immobility

Question 10

Pt with s/s of ABD distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the pt has a fluid and electrolyte problem. Which of the following is he most likely experiencing?

Answer 10

Hyperkalemia

Question 11

ABG reads high HC03 and pCO2 55mmhg. What electrolyte abnormality is most likely associated with these values?

Answer 11

Hypokalemia r/t metabolic alkalosis

Question 12

Pt has a fever and tachycardia, and Hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status

Answer 12

extracellular dehydration deficit

Question 13

Low serum Na and high serum osmolality:

Answer 13

hyperglycemia (Probably HHNK)

Question 14

A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give

Answer 14

Normal saline

Question 15

Low protein =

Answer 15

low BUN=hypoosmolar hyponatremia (probably edematous, expect edema in Albumin < 2.7)

Question 16

A pt. who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The initial treatment is to:

Answer 16

replenish volume by infusing a 0.9% sodium chloride solution

Question 17

Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse pt?

Answer 17

Hyponatremia

Question 18

What electrolyte should be monitored prior to administering succinylcholine?

Answer 18

K+

Question 19

ASA overdose: which electrolyte to monitor

Answer 19

K (if low, will prevent the alkalinization of urine, which is the mainstay of Tx)

Question 20

What sx is associated with hepatotoxicity s/p acetaminophen toxicity?

Answer 20

Delirium

Question 21

Pt at highest risk for hyperkalemia

Answer 21

NSAIDs then ACEi

Question 22

Tube feed side effects

Answer 22

Decrease the osmolality of the Tube feeding

Question 23

What pt requires labs to be monitored closely after initiating TF?

Answer 23

Alcoholic with decreased intake over the past 2-3 weeks