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ABSITE > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

What percentage of body weight is water?

A

2/3 (Infants have more body water); women have less body water

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2
Q

Among total body water, what percentage is IC vs. EC?

A

IC: 2/3 (Muscle)
EC: 1/3

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3
Q

Among the water that is EC, what percentage is intravascular vs. interstitial

A

1/4 intravascular

3/4 interstitial

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4
Q

Most common cause of volume overload?

A

Iatrogenic: first sign is weight gain

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5
Q

Na and Cl contents of NS

A

154, 154

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6
Q

Ionic composition of LR

A

Na: 130, K 4, Ca 2.7, Cl 109, lactate/bicarb 28

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7
Q

Calculation of plasma osmolarity

A

2xNa + glucose/18 + bun/2.8

Normal 280-295

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8
Q

mIVF calculation rate

A

4/2/1 (10, 10, 1)

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9
Q

IV maintenance fluid after major GI surgery

A

Intraop, 24 hrs: LR; then switch to D5 1/2 NS with 20 K

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10
Q

Why D5 in mIVF?

A

5% dextrose will stimulate insulin release; resulting in AA uptake and protein synthesis (prevents protein catabolism)

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11
Q

D5 1/2 @ 125 provides how much glucose per day?

A

150 g; 525 kcal/day

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12
Q

During open abdominal operations, what is approximate fluid loss?

A

0.5-1L / hr unless there are measurable blood losses

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13
Q

At what point do you have to replace blood loss intraoperatively?

A

500 cc

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14
Q

Best indicator of adequate volume replacement

A

Urine output (0.5 cc/kg/hr; should not be replaced – a sign of good post-op diruesis)

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15
Q

Insensible fluid losses

A

10 cc/kg/day; 75% skin, 25% respiratory (pure water)

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16
Q

Fluid resuscitation for significant dehydration

A 
Sweat: NS
Gastric fluid: NS
HPB: LR
Sm/Lg bowerl: LR
GI losses cc/cc
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17
Q

Should GI losses be replaced CC/CC?

A

Yes

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18
Q

GI fluid secretion per day: stomach, biliary, panc, duodenum

A

Stomach: 1-2 L/day
Biliary: 500cc-1 L/day
Panc: 500 cc-1L/day
Duodenum: 500 cc-1L/day

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19
Q

GI Electrolyte Losses: sweat

A

Hypotonic (Na 35-65)

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20
Q

GI Electrolyte Losses: saliva

A

K+ / highest concentration of K in the body

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21
Q

GI Electrolyte Losses: stomach

A

H+, Cl-

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22
Q

GI Electrolyte Losses: pancreas

A

HCO3

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23
Q

GI Electrolyte Losses: bile

A

HCO3

24
Q

GI Electrolyte Losses: small intestine

A

HCO3, K

25
Q

GI Electrolyte Losses: large intestine

A

K

26
Q

What electrolytes can dialysis remove?

A

K, Ca, Mg, PO4, urea, Scr

27
Q

Normal body K+ requirement per day

A

0.5-1 mEq/kg/day

28
Q

Normal body Na+ requirement per day

A

1-2 mEq/kg/day

29
Q

Hypokalemia usually occurs in this setting

A

Over diuresis; may need to replace the Mg

30
Q

When treating hypokalemia, you may need to replete this electrolyte

A

Mg

31
Q

Hypernatremia usually results from

A

Poor PO intake; restlessness, irritability, seizures; correct with D5W slowly to avoid brain swelling

32
Q

Hyponatremia is ususally 2/2

A

Fluid overload; HA, n/v/seizure

  • Water restruction, diresus
  • Correct slowly to avoid CPM (1 meQ/hr)
33
Q

Can hyperglycemia cause pseudohyponatremia?

A

Yes – for each 100 increment of glucose over normal, add 2 points to the Na value

34
Q

DI can occur with EtOH or head injury

A

True: Decreased ADH; increased urine output, decreased spec grav, increase serum Na, increased osmolarity

35
Q

Treatment of DI

A

Free water; DDAVP

36
Q

SIADH can occur with head injury

A

True: decreased u/p; concentrated urine; hyponatremia; decreased osmolarity

37
Q

Treatment of SIADH

A

Fluid restriction; diuresis; conivaptain, tolvaptan

38
Q

Most common malignant cause of hypercalcemia

A

Breast cancer

39
Q

How high does Ca have to get for symptoms

A

Lethargy, n/v, hypotension (>13)

40
Q

MCC overall and benign cause of hypercalcemia

A

Hyperparathyroidism

41
Q

MCC hypercalcemic crissi

A

Undiagnosed hyperparathyroidism with stressor, i.e. surgery

42
Q

What fluid/diuretic to avoid in hypercalcemia?

A

LR; thiazide diuretics

43
Q

Treatment of hypercalcemic crisis

A

NS @ 200-300 cc/hr and Lasix

44
Q

Malignant hypercalcemia treatment

A

Calcitonin, alendronic acid, bisphosphonates, dialysis

45
Q

Hypocalcemia symptoms at what level

A

< 8; < 4 ionized; perioral tingling and numbness; hyperreflexia, Chovstek’s sign, Trousseau’s sign; prolonged QT

46
Q

What electrolyte might you need to replace before treating hypocalcemia?

A

Mg

47
Q

What is the protein adjustment for calcium?

A

For every 1 g decrease in protein, add 0.8 to Ca

48
Q

MCC of hypocalcemia

A

Thyroidectomy

49
Q

HyperMg treatment: Ca

A

Lethargy; occurs in renal failure; Mg containing laxitives, antacids
Treatment: Ca

50
Q

HypoMg

A

Irritability, confusion, hyperreflexia, seizures

- Occurs with massive diuresis, chronic TPN without Mg replacement, ETOH (similar signs to hypocalcemia)

51
Q

Hyperphosphotemia a/w

A

renal failure

Tx: Sevelamer hydrochloride (Renagel); low-phosphate diet, dialysis

52
Q

Hypophosphatemia most often a/w

A

Refeeding syndrome; usually from phosphate shift from EC to IC
- Sx: failure to vent wean; muscle weakness

53
Q

Treatment of hypo-phos

A

K phos

54
Q

Best test for azotemia

A

Urine Na/Cr / Serum Na/Cr

55
Q

RF for tumor lysis syndromes

A

Leukemia, lymphoma: Increase BUN/Cr, EKG changes; PO4, K, uric acid; decreased Ca
Tx: hydration; rasburicase; allopurinol; diuretics

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