Fluids And Electrolytes Flashcards
The pathophysiology of metabolic alkalosis is divided into 2 factors
A particularly important maintenance factor is?
- Generating
- Maintenance
Renal response to hypovolemia
Target blood glucose to lower mortality
180 mg/dL
Factors that generate metabolic ALKALOSIS are (2)
- Vomiting
2. Diuretic administration
Treatment of metabolic alkalosis(2)
- Expansion of intravascular volume
2. Potassium administration
This most rapidly corrects life threatening metabolic alkalosis
0.1 N hydrochloric acid
Administered through a central vein to prevent tissue damage
Metabolic acidosis, what anion gap occurs when bicarbonate is lost externally.
Normal anion gap (< 13 mEq/L)
Metabolic acidosis, what anion gap occurs because of excess production or decreased excretion of organic acids or ingestion of one of several toxic compounds.
High anion gap
How much is ICV of total body weight?
60%
How much is ECV of total body weight?
20%
The primary mechanism of controlling water intake
Thirst
Final osmolality of tubular fluid
1200 mOsm/kg
Daily adult requirement for
Na
K
75 meqs
40 meqs
Number of osmotically active particles per LITER of solvent
Osmolarity
Number of osmotically active particles per KILOGRAM
Osmolality
This volume is determined by the rates of capillary filtration and lymphatic drainage.
IFV (interstitial fluid volume)
Because of the influence of the glycocalyx, theoretical rates of fluid filtration usually substantially exceed actual filtration rates, a phenomenon termed as
Low lymph flow paradox
What is a positive tilt test?
A positive tilt test defined as an increase in heart rate of at least 20 beats per minute and a decrease in systolic blood pressure of 20 mmHg or more when the subject assumes the upright position.
How many % of nephrons must be dysfunctional before serum creatinine exceeds the normal range.
40 to 50%
Requirement of PPV (4)
- Direct arterial monitoring
- Mechanical ventilation
- Vt of 8 mL/kg
- No cardiac arrhythmia
In esophageal doppler assessment of iop blood volume
A corrected flow time of 0.35 suggests
A corrected flow time of 0.40 suggests
Volume expansion should improve CO
Further volume expansion will be ineffective
In high risk surgical patients, these parameters has been associated with improved outcomes (3)
- DO2I of 600 mL/m2/min (equivalent to a cardiac index of 3)
- Hgb of 14 g/dL
- 98% oxyhgb
Disorders of total body sodium are affected by two factors
- ECV
2. PV
Is the most common electrolyte problem in hospitalized patients
Hyponatremia
Plasma sodium DECREASES approximately how much for each 100 mg/dL rise in glucose concentration
2.4 mEq/L
The vasopressin-regulated water channel
Aquaporin 2
Diagnosis of SIADH (6)
- Hyponatremia (low plasma osmolality)
- Urinary osmolality > plasma osmolality
- Renal sodium excretion > 20 mmol/L
- Absence of hypotension, hypovolemia & edematous states
- Normal renal & adrenal functions
- Absence of drugs that affect renal water & sodium handling
Cornerstone of SIADH
Free water restriction (0.5 - 1L per day)
Elimination of cause
As long as GFR is above this level, potassium intake can be excreted.
8 mL/min
2 most important regulators of potassium excretion
- Plasma K
2. Aldosterone
Hallmark of hypocalcemis
Increased neuronal membrane irritability and tetany