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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
What is artefactual hyponatraemia?
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
When you have a patient with sodium changes what’s the first thing to do?
Work out their fluid status
27
What’s the likely cause of normovolaemic hyponatraemia?
Syndrome of inappropriate ADH secretion
28
What are causes of hypovolaemic hyponatraemia?
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
What can cause hypervolaemic hyponatraemia?
If urinary Na+ >20 then think renal - AKI or CKD | If <20 then its not the kidneys - hepatic cirrhosis, congestive HF
30
How do you manage… Hypovolaemic hyponatraemia? Hypervolaemic hyponatraemia? Normovolaemic hyponatraemia?
Hypo - normal saline Hyper- fluid restriction and diuretics Normovolaemic - fluid restriction
31
What can cause hypernatraemia?
Insufficient fluid intake or a large water loss relative to Na+ loss e.g. diabetes insipidus
32
What are normal K+ values?
3.5-5.0 mmol/l
33
What causes hypokalaemia?
Increased loss - gut losses, kidney losses (d+v, Cushing syndrome) Cellular uptake e.g. insulin and alkalosis Reduces intake
34
What can cause hyperkalaemia?
``` Decreased loss (renal failure, Addison’s disease, K+ sparing diuretics) Cellular loss - acidosis, severe haemolysis, rhabdomyolysis Increased intake ```
35
How do we treat hyperkalaemia?
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
What’s important to remember about the calcium concentration in the blood?
That 50% is bound to albumin and 50% is not (active form)
37
What are some causes of hypocalcaemia?
Parathyroid removal Renal disease Vit D deficiency
38
What are clinical features of hypocalcaemia?
``` Peri-oral paraethesia Trousseaus sign Chvosteks sign QT interval elongation on ECG Cataracts - chronic ```
39
What is Trousseaus sign?
When you inflate the blood pressure cuff and muscles go into spasm
40
What is chvosteks sign?
When you tap over the division point of the facial nerve (over parotid) and the face violently twitches
41
How do you treat hypocalcaemia?
``` Calcium supplements (If they have kidney disease then you will have to give alpha-calcidol which is the activated form) ```
42
What can cause Hypercalcaemia?
Hyperparathyroidism Bone malignancy, bony mets Granulomatous disease Vit D excess
43
What are the clinical features of Hypercalcaemia?
Bones - osteitis fibrosis cystica Stones - renal stones Groans - abdominal symptoms Psychic moans - weakness, fatigue, confusion
44
How do you treat Hypercalcaemia?
Fluids to promote diuresis, bisphosphonates to inhibit further bone resorption Treat cause
45
At what point is Hypercalcaemia a medical emergency?
>3.5mmol/l

METABOLIC (43 decks)

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