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METABOLIC > FLUIDS > Flashcards

FLUIDS Flashcards

1
Q

What percentage of humans are water?

A

60%

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2
Q

How much fluid does an average human require a day?

A

2-2.5L in 24 hours

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3
Q

Outline the compartment model?

A

2/3rds of our fluids are intracellular and 1/3rd extracellular
Within extracellular we have mostly interstitial fluid, plasma fluid and some trans cellular fluids

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4
Q

Give examples of trans cellular fluids?

A

Optic fluid
CSF
Pleural fluid

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5
Q

What are the main intracellular cations and anions?

A

K+ proteins and PO4-

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6
Q

What are the main extracellular cations and anions

A

Na+, Cl- and HCO3-

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7
Q

What forces are responsible for movement between intracellular and extracellular fluids?

A

Osmotic

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8
Q

What forces are responsible for movement between plasma and interstitial fluids?

A

Starling forces

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9
Q

What is Osmolality?

A

The total number of solute particles ina solvent

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10
Q

How do we calculate osmolality?

A

2(Na+ + K+) + urea + glucose

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11
Q

What is a normal osmolality value?

A

280-295mosmol/kg

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12
Q

What is a transudate?

A

A fluid that results from the disturbance from the pressure gradient or oncotic pressure of the blood

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13
Q

What is an exudate?

A

A fluid resulting from a disturbance in vessel permeability - so protein levels are high

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14
Q

What are examples of transudate? And exudate?

A

Transudates - cardiac failure, liver cirrhosis, hypoalbuminaemia, SVC obstruction
Exudate - malignancy, infection and inflammation (damage vessels and increase permeability)

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15
Q

What are the fluid inputs to our body?

A

Oral
Food
Oxidative water

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16
Q

What are the fluid outputs to our body?

A

Urine
Stool
Skin
Lungs

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17
Q

What are some causes of hypervolaemia?

A 
Increased/inappropriate sodium re-absorption (cardiac failure or nephrotic syndrome)
Reduced excretion (renal failure)
Increased intake - rare
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18
Q

How does hypervolaemia manifest?

A

Pulmonary oedema
Raised JVP
Peripheral pitting oedema

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19
Q

What might cause hypovolaemia?

A

Sepsis or third spacing - I.e. a distribution problem
Excess loss e.g. polyuria, diarrhoea, sweating, blood loss
Inadequate intake

20
Q

How does hypovolaemia manifest?

A

Confusion, coma, cool hands, tachycardia, sunken eyes, dry mouth, prolonged cap refill, reduced BP, reduced JVP, reduces urine output

21
Q

What’s the difference between crystalloids and colloids?

A

Crystalloids are electrolytes within water eg. Saline

Colloids are fluids with high molecular weight molecules e.g. blood

22
Q

Outline basic fluid replacement therapy management?

A

Resuscitate patient - give colloids
Maintenance - 1 bag normal saline and 2 bags 5% dextrose
Replace any ongoing losses

23
Q

What level of Na+ is hyponatraemia?

A

<135mmol/l

24
Q

What is pseudohyponatraemia?

A

spuriously low plasma sodium concentration due to the presence of increased plasma lipid and/or increased plasma protein concentration.

25
Q

What is artefactual hyponatraemia?

A

when the lab tests read low sodium levels but there is no hypotonicity - this may be due to taking blood from an arm with a cannular with saline

26
Q

When you have a patient with sodium changes what’s the first thing to do?

A

Work out their fluid status

27
Q

What’s the likely cause of normovolaemic hyponatraemia?

A

Syndrome of inappropriate ADH secretion

28
Q

What are causes of hypovolaemic hyponatraemia?

A

If urinary Na+ is >20 - renal loss e.g. diuretic excess, Addison’s disease
If urinary Na+ is <20 - bleeding, diarrhoea and vomiting (not kidneys basically!)

29
Q

What can cause hypervolaemic hyponatraemia?

A

If urinary Na+ >20 then think renal - AKI or CKD

If <20 then its not the kidneys - hepatic cirrhosis, congestive HF

30
Q

How do you manage…
Hypovolaemic hyponatraemia?
Hypervolaemic hyponatraemia?
Normovolaemic hyponatraemia?

A

Hypo - normal saline
Hyper- fluid restriction and diuretics
Normovolaemic - fluid restriction

31
Q

What can cause hypernatraemia?

A

Insufficient fluid intake or a large water loss relative to Na+ loss e.g. diabetes insipidus

32
Q

What are normal K+ values?

A

3.5-5.0 mmol/l

33
Q

What causes hypokalaemia?

A

Increased loss - gut losses, kidney losses (d+v, Cushing syndrome)
Cellular uptake e.g. insulin and alkalosis
Reduces intake

34
Q

What can cause hyperkalaemia?

A 
Decreased loss (renal failure, Addison’s disease, K+ sparing diuretics)
Cellular loss - acidosis, severe haemolysis, rhabdomyolysis
Increased intake
35
Q

How do we treat hyperkalaemia?

A

stabilise myocardium 10ml 10% calcium gluconate. Drive K+ into cells with 10u insulin + 50ml 50% dextrose, and give salbutamol (beta agonist). Mop up K+ using calcium resonium and you may have to give haemofiltration.

36
Q

What’s important to remember about the calcium concentration in the blood?

A

That 50% is bound to albumin and 50% is not (active form)

37
Q

What are some causes of hypocalcaemia?

A

Parathyroid removal
Renal disease
Vit D deficiency

38
Q

What are clinical features of hypocalcaemia?

A 
Peri-oral paraethesia 
Trousseaus sign
Chvosteks sign
QT interval elongation on ECG
Cataracts - chronic
39
Q

What is Trousseaus sign?

A

When you inflate the blood pressure cuff and muscles go into spasm

40
Q

What is chvosteks sign?

A

When you tap over the division point of the facial nerve (over parotid) and the face violently twitches

41
Q

How do you treat hypocalcaemia?

A 
Calcium supplements
(If they have kidney disease then you will have to give alpha-calcidol which is the activated form)
42
Q

What can cause Hypercalcaemia?

A

Hyperparathyroidism
Bone malignancy, bony mets
Granulomatous disease
Vit D excess

43
Q

What are the clinical features of Hypercalcaemia?

A

Bones - osteitis fibrosis cystica
Stones - renal stones
Groans - abdominal symptoms
Psychic moans - weakness, fatigue, confusion

44
Q

How do you treat Hypercalcaemia?

A

Fluids to promote diuresis, bisphosphonates to inhibit further bone resorption
Treat cause

45
Q

At what point is Hypercalcaemia a medical emergency?

A

> 3.5mmol/l

METABOLIC (43 decks)

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