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FLUIDS AND ELECTROLYTES Flashcards

1
Q

Symptoms of hypernatremia are usually not evident until Na+ reaches..

A

160 mEq/L

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2
Q

Causes of hypernatremia

A

Insensible losses (fever, hyperventilation, and burns), polyuria associated with excessive renal free water losses (osmotic diuresis, high output renal failure causing inability to concentrate urine) or hypotonic fluid losses due to perspiration or severe diarrhea

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3
Q

If perfusion is adequate, which types of fluids should be used to correct hypernatremia

A

0.5NS or D5W

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4
Q

Plasma Na should not be corrected at a rate faster than

A

0.5 to 1.0 mEq/L

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5
Q

Formula to correct Na

A

Water deficit=TBW x {(Plasma Na) / desired plasma Na) -1

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6
Q

Total intracellular K

A

40-50 mmol/kg body weight

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7
Q

How much potassium in ECF

A

2%

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8
Q

Content of K+ in gastric secretion

A

10 mEq/L

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9
Q

T wave flattening, U waves, prolonged QT, manifests at a plasma K below ..

A

3 mmol/L

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10
Q

Hyperkalemia in the surgical patient is usually due to..

A

Impaired renal excretion of K caused by oliguric renal dysfunction

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11
Q

How much of total body calcium within ECF is free

A

40%

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12
Q

Why do you get hypocalcemia with hyperventilation

A

Acid-base alterations affect calcium binding to albumin. alkalosis increases binding affinity of Ca to albumin, resulting in lower serum ionized calcium levels

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13
Q

Most frequent cause of hypocalcemia

A

Low serum albumin

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14
Q

Alternate causes of hypocalcemia

A

Acute pancreatitis, massive soft tissue infection, small bowel fistula, hypoparathyroidism

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15
Q

Massive blood transfusion effect n calcium

A

Induces hypocalcemia caused by chelation of calcium with citrate (each unit of blood contains approx 3 g of citrate). Liver metabolizes 3g citrate q 5 min.

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16
Q

Once patient is rehydrated, may enhance further calcium excretion by administering..

A

Furosemide

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17
Q

Why is hypophosphatemia common after liver resections

A

Regenerating hepatocytes use a lot of phosphate

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18
Q

Serum [uric acid] depends on

A

purine nucleotide pool size. GI tract is responsible for SECRETION, not resorption.

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19
Q

Urine Na below 10-15 suggests..

>20?

A

10-15: hypovolemia

>20: ATN

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20
Q

How to calculate FeNa

A

(USNa x Pcr/PNa x Ucr) x 100

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21
Q

If FeNa <1%, suggestive of..

A

> 99% of filtered Na has been resorbed. Likely hypovolemic state which enhances reabsorption of Na – > stimulated renin release from JG cells in afferent arterioles which results in production of angiotensin II

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22
Q

Hyper metabolic response seen 5 days after burn injury is associated with increased blood levels of

A

Cortisol. Up to 4 weeks after injury. Inhibits GH release.

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23
Q

How does hyperaldosteronism cause hypokalemia

A

Increased aldosterone leads to sodium retention – both potassium and H+ are excreted in urine in exchange for sodium.

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24
Q

Most common causes of hypoxia resulting in respiratory alkalosis

A

Pulmonary disease, exposure to high altitudes

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25
Q

Total body K

A

50 mEq/kg of body weight or approx 3500 mEq in total body stores

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26
Q

A serum K of 3.0 mEq/L usually represents a total body deficit of ..

A

100 to 200. Each additional 1.0 mEq/L decrease reflects an additional deficit of 200-400 mEq.

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27
Q

Primary cause of hypermagnesemia

A

Renal failure. Because of the ability of the kidneys to excrete large amounts of magnesium, hyperMg rarely occurs if renal function is normal.

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28
Q

Meds that can cause hypomagnesemia.

A

long term use of loop diuretics, cyclosporine, or ahminoglycosides

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29
Q

Primary causes of decreased urinary K excretion

A

hypovolemia, hypoaldosteronism, renal failure, and drugs like spironolactone or NSAIDs

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30
Q

Purines are broken down into

A

Ammonia and uric acid. Uric acid is notably poorly soluble in water and may form uric acid crystals.

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31
Q

How many kcal in 1 gram Nitrogen

A

150

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32
Q

How many grams protein per gram nitrogen

A

6.25

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33
Q

Amino acids utilized for energy yield approx how many kcal per gram

A

4

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34
Q

Dextrose provides approx how many kcal/g

A

3.4

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35
Q

Complete oxidation of lipid yields how many kcal/g

36
Q

Principal intracellular cations

37
Q

Principal intracellular anions

A

Proteins, phosphates

38
Q

Principle extraceullar anions

A

Chloride, Bicarb

39
Q

What is responsible for effective osmotic pressure between plasma and ISF compartment?

A

Non-permeable proteins

40
Q

Effective osmotic pressure between ECF and ICF is due mainly to..

41
Q

Plasma fluid constitutes how much of ECF?

42
Q

Interstitial fluid constitutes how much of ECF?

43
Q

Which intravascular factor causes arterial vasodilation but does NOT increase microvascular membrane permeability?

A

Nitric Oxide

44
Q

Earliest sign of volume excess post-operatively

A

Weight gain

45
Q

MOA of Loop diuretics

A

Potent inhibitors of Na-K-Cl co transporter. Compete for the Cl-binding site at the thick ascending limb of the loop of Henle. This results in inhibition of Na reabsorption – > diuresis. Mg, K, and Ca will likewise be excreted. Additionally, thye increase blood flow to kidneys by stimulating vasodilatory prostaglandins and increase venous capacitance.

46
Q

Avg individual has intake of how much water per day

A

2000-2500 (1500 orally, remainder from PO food)

47
Q

How much water is lost daily in stool?

48
Q

How much water is lost daily in urine?

A

800-1500 mL

49
Q

How much water is lost as insensible losses?

A

600 mL. 75% via skin, 25% lungs.

50
Q

In febrile patients, insensible losses through skin may increase to…

A

250 mL/day for each degree of fever.

51
Q

In a patient who has a trach and is being ventilated with unhumidified air, insensible losses from lungs may increase to..

A

1500 mL/day.

52
Q

Avg daily salt intake

A

50-90 mEq NaCl

53
Q

Avg [Na] in sweat

A

30-50 mEq/L

54
Q

Pancreatic secretions [bicarb]

A

70-90 mEq/dL

55
Q

K+ in sweat

56
Q

H+ in sweat

57
Q

Na in gastric secretions

58
Q

H+ in gastric secretions

59
Q

Cl- in gastric secretions

60
Q

Na in Biliary secretions

61
Q

K in Biliary secretions

62
Q

Cl in biliary secretions

63
Q

HCO3 in biliary secretions

64
Q

Na in pancreatic secretions

65
Q

K in pancreatic secretions

66
Q

Cl in pancreatic secretions

67
Q

HCO3 in pancreatic secretions

68
Q

Na in ileostomy secretions

69
Q

K in ileostomy secretions

70
Q

Cl in ileostomy secretions

71
Q

HCO3 in ileostomy secretions

72
Q

Na in diarrhea

73
Q

K in diarrhea

74
Q

Cl in diarrhea

75
Q

HCO3 in diarrhea

76
Q

What electrolyte is high in saliva?

77
Q

LR contains how much sodium?

78
Q

LR contains how much Cl

79
Q

LR contains how much K

80
Q

LR contains how much Ca

81
Q

LR contains how much lactate

82
Q

How much Na and Cl is contained in 0.9% NS

83
Q

How much Na and Cl in3% hypertonic

84
Q

How does hyperglycemia lead to hypernatremia (sometimes)?

A

If it causes glycosuria/excess osmotic diuresis

85
Q

Electrolyte abnormalities in tumor lysis syndrome

A

HyperK+
Hyperphosphatemia
Hyperuricemia
– > Renal failure

SURG (17 decks)

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