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Clin Med - II (Surgery) > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Fluid movement - Pressures

A

Hydrostatic pressure

Osmotic pressure

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2
Q

Hydrostatic pressure

A

increased pressures forces fluid out

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3
Q

Osmotic pressure

A

Water moves from low solute to higher solute

In blood, large molecules (ie Albumin) helps keep fluid in

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4
Q

67yo M, nephrotic syndrome, with bilateral LE edema.

What pressure is at work?

A

Osmotic Pressure

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5
Q

52 yo F with CHF and pulmonary edema.

What pressure is at work?

A

Hydrostatic pressure

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6
Q

Ascites in a cirrhotic.

What pressure is at work?

A

Hydrostatic pressure

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7
Q

Types of fluids

A

Colloids

Cystalloids

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8
Q

Colloids - in general

A

Protein or complex carb/starch

“theoretically help keep fluid in blood stream

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9
Q

Colloids - Examples

A

Albumin (protein)
Hespan / Hetastarch (starch derivative)
Dextran (Complex branched polysaccharide)

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10
Q

Crystalloids - In general

A

Most widely used type of fluid

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11
Q

Crystalloids - examples

A

Isotonic
Hypotonic
Hypertonic

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12
Q

Crystalloids - Isotonic

A

0.9% NaCl (NS)
Lactated Ringer’s solution (LR)
D5W

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13
Q

Crystalloids - Hypotonic

A

1/2 NS (Half the Na+ / Cl- content of the NS)

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14
Q

Crystalloids - Hypertonic

A

3% NaCl

D10 NS

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15
Q

Extracellular Fluid - Components

A 
Na - 142
K - 4
Ca - 5
Mg - 3
Cl - 103
HCO3 - 27
Osmolality - 280
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16
Q

Ringers Lactate - Components

A 
Na - 130
K - 4
Ca - 3
Cl - 109
HCO3 - 28
Osmolality - 278
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17
Q

0.9% NaCl - Components

A

Na - 154
Cl - 154
Osmolality - 308

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18
Q

NS

A

154 mEq/L of Na and Cl

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19
Q

LR

A 
130 mEq/L of Na
109 mEq/L of Cl
28 mEq/L of lactate
4 mEq/L of K
3 mEq/L of Ca
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20
Q

D5

A

50g Dextrose /L

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21
Q

Which solution has potassium?

A

LR

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22
Q

Which solution has more Cl than plasma?

A

NS

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23
Q

T or F

NS and LR both have bicarb.

A

False

Neither has bicarb

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24
Q

Maintenance Rate

A

Based on sensible and insensible losses for a healthy person

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25
Q

Healthy person - sensible losses

A

Can be measured for visualized

Urine, feces

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26
Q

Healthy person - insensible losses

A

Cannot be measured or visualized

Sweat / skin, lungs

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27
Q

Hospital pts - sensible / insensible losses

A 
\+/-
Wounds
Vomiting
Diarrhea
Bile, etc
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28
Q

Fluids not taken into account by maintenance rate

A 
Wounds
Vomiting
Diarrhea
Bile
Ostomies, etc
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29
Q

Maintenance rate 4-2-1 rule

A

First 10kg –> 4 ml/kg/hr
Second 10kg –> 2 ml/kg/hr
Each kg >20kg –> 1 ml/kg/hr

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30
Q

Saliva - components

A 
Volume ml/day - 1500
Na - 10
K - 26
Cl - 10
HCO3 - 30
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31
Q

Stomach - components

A

Volume ml/day - 1500
Na - 60
K - 10
Cl - 130

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32
Q

Duodenum - components

A

Volume ml/day - 100-2000
Na - 140
K - 5
Cl - 80

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33
Q

Pancreas - components

A 
Volume ml/day - 100-800
Na - 140
K - 5
Cl - 75
HCO3 - 115
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34
Q

Bile - components

A 
Volume ml/day - 50-800
Na - 145
K - 5
Cl - 100
HCO3 - 35
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35
Q

Ileum - components

A 
Volume ml/day - 3000
Na - 140
K - 5
Cl - 104
HCO3 - 30
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36
Q

Colon - components

A

Na - 60
K - 30
Cl - 40

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37
Q

Excess fluid losses

A 
In addition to maintenance rate
\+/- Additional fluids
\+/- bicarb
\+/- potassium
Importance of "Strict I and O's"
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38
Q

Fluid in burns

A

Parkland formula
4 cc * kg * % (20 or 30)

Half in the first 8h
Half in remaining 16h

39
Q

Fluid in trauma - What fluid to you give

A

Blood

40
Q

Why would you not give excessive IV fluid in a bleeding pt?

A

Excessive IV fluid in bleeding can cause hemodilution of remaining blood products

41
Q

What does hemodilution lead to?

A

Worsening coagulopathy
Acidosis
Morbidity

42
Q

End goals of resuscitation

A 
Vitals 
Urine Output
Lactic acid
Weight
CVP
CO
43
Q

What is considered adequate urine output?

A

0.5 cc / kg / hr

44
Q

Elective Sx on inguinal hernia on a 24yo healthy M.

What kind of IV fluids do you order pre-op?

A

NS
D5
LR

45
Q

AV graft placement for dialysis on a 65yo F.

What kind of IV fluids do you order pre-op?

A

NS

D5

46
Q

40yo M, 100kg, 3rd degree burns to 20% of his body.
What kind of IV fluids do you order?
How much total fluid?
What rate?

A

NS or LR

4 * 100 * 20 = 8,000 ml total fluid

For the first 8h –> 500 ml/h
For the next 16h –> 250 ml/h

47
Q

40yo M, 100kg, 3rd degree burns to 20% of his body. He has been given fluids properly for the first 24h. He is now producing 30 ml/h urine in 3h.
What do you do?

A

Should be 50 ml/h

Increase fluids

48
Q

76 yo M who has CHF, renal failure, lymphedema among other health problems. GSW to the leg. He is hypotensive in the trauma bay with a SBP 85.
What do you do?

A

Give blood

49
Q

You’re massively resuscitating a pt in profound septic shock. Despite stabilized vitals, good urine output and good CO, he remains acidotic.
Why?

A

B/c of the Cl in the NS he received

50
Q

Post-op pt now has a bile leak from a duodenal stump blowout.
What fluids should you use?

A

One that contains bicarb

51
Q

You did a subtotal colectomy with end ileostomy for fulminant colitis due to C.diff.
What should you watch for?

A

Dehydration
Fluid loss
Electrolyte losses

52
Q

Sodium

A

Most abundant particle in extracellular fluid

Regulated by various mechanisms (ADH, kidneys, and aldosterone)

53
Q

Hyponatremia - S/S

A

Neurological symptoms

  • Ha
  • Fatigue
  • Confusion
  • Lethargy
54
Q

SIADH

A

Excess ADH (trauma, brain tumors, certain meds)
Excess water reabsorption
Dilutional / hypervolemic hyponatremia

55
Q

Hyponatremia - Tx

A

Assess volume status
+/- fluid restrict
Correct underlying condition
Replace Na (NS)

56
Q

Hyponatremia - Rate of correction and why

A

Slow

Rapid correction can result in Central Pontine Myelinolysis

57
Q

Hyponatremia - calculations

A

Na Deficit = (total body water) * (desired Na - Actual Na)

58
Q

Hypernatremia - In general

A

Usually due to water deficit

S/s similar to hyponatremia (weakness, lethargy, neuro s/s)

59
Q

Hypernatremia - Tx

A

Assess volume status
Calculate water deficit
Replace fluid

60
Q

Calculation of water deficit

A

Water deficit = TBW * [(serum Na -140) / 140]

61
Q

At what speed should the rate of correction for hypernatremia be and why?

A

Slow

Rapid correction can result in cerebral edema

62
Q

Potassium - in general

A

97-98% found intracellularly
Normal - 3.5-5.0 mEq/L
80% taken in is excreted by kidneys

63
Q

Factors that affect potassium

A

GI absorption
Renal regulation
pH level
Insulin

64
Q

Hypokalemia - s/s

A 
Weakness
Fatigue
Muscle cramps
Decreased bowel sounds
Constipation
Ileus, etc.
65
Q

Hypokalemia - In general

A 
Often associated with hypomagnesemia
EKG changes (flattened T waves, prominent U waves)
66
Q

Hypokalemia - Tx

A

PO or IV replacement
Monitor VS, EKG, serum K+ levels
Correct underlying cause
Replace magnesium deficiency (if any)

67
Q

Hyperkalemia - Causes

A

Increased intake - diet; meds; blood products
Decreased excretion - renal failure
Leak out of cells - burns; crush injury; tumor lysis

68
Q

Hyperkalemia - S/s

A

Often asymptomatic
Arrhythmias / asystole
EKG changes - peaked T waves

69
Q

Hyperkalemia - Tx

A

EKG / cardiac monitoring

Give calcium to stabilize the heart

70
Q

Additional factors that can affect potassium levels

A

Decrease gut absorption (Kayexalate)
Increase urination (diuretics)
Shift from extracellular to intracellular (insulin, bicarb)
Hemodialysis

71
Q

Hypomagnesemia - s/s

A

Neuromuscular excitability

  • Hyperreflexia
  • Positive Chvostek sign
  • Trmors
  • Nystagmus
  • Muscle cramps
  • Arrhythmias
  • Confusion
  • Disorientation
72
Q

Hypomagnesemia - Tx

A

Replace magnesium (PO or IV)

73
Q

Hypermagnesemia - in general

A

Rare in sx pts
Occurs with renal failure and excessive intake

Example - magnesium therapy for pre-eclampsia

74
Q

Hypermagnesemia - s/s

A 
Muscle weakness
Hyperreflexia
Mental obtundation and confusion
Flaccid paralysis
Ileus
Urinary retention
Hypotension
Eventually respiratory muscle paralysis and cardiac arrest
75
Q

Hypermagnesemia - Tx

A

Stop giving magnesium!
IV saline to dilute
Dialysis in renal failure

76
Q

Hypocalcemia - Causes

A 
Hypoparathyroidism
Hypomagnesemia
Severe pancreatitis
CRF
Poor GI absorption
77
Q

Hypocalcemia - Clincally

A 
Neuromuscular hyperactivity
Chvostek sign
Muscle and abdominal cramps
Carpopedal spasm (Trousseau's sign)
Convulsions
Paresthesias
Diarrhea
Dry or brittle nails, hair, and bones
Decreased CO
78
Q

Hypocalcemia - Tx

A

Check corrected Ca levels
Asymptomatic / mild - PO
Symptomatic - IV
Check for hypomagnesemia

79
Q

Hypercalcemia - causes

A

Primary Hyperparathyroidism

Malignancy

80
Q

Hypocalcemia - S/s

A 
Constipation
N/V
Fatigability
Confusion
Lethargy
Muscle weakness
Depression anorexia
Hyporeflexia
Arrhythmias
Stupor
Coma
81
Q

Hypocalcemia - Tx

A

Isotonic saline - expand ECF; dilute Ca; increase urine flow
Furosemide - Increase excretion of Ca
Bisphosphonates - Prevent bone resorption
Calcitonin - prevent bone and kidney resorption
Corticosteroids - prevent action of Vit D

82
Q

Refeeding Syndrome - in general

A

If someone has been starving for a long time, their cells are also starving.
When you feed them, the nutrients goes straight to the cells and suck it up.
This causes hypo- everything

83
Q

Tumor Lysis Syndrome

A

Cell dies and leaks out everything
Hyperkalemia
Hyperuricemia
Hyperphospatemia

84
Q

80 yo F with renal failure with planned operation tomorrow. K = 8.1
What are you first steps?
How do you manage this?

A

First steps - Do an EKG, looking for peaked T waves. The K level is chronic so their body is probably used to it

Management - Give Ca (IV); Dialysis or decreased with Kayexalate until she can have dialysis

85
Q

76 yo M referred for hypercalcemia secondary to a parathyroid adenoma has a Ca=14.2
How do you manage this?

A

NS and Furosemide
Definitive management
- sx excision of adenoma

86
Q

Severely, chronically, malnourished pt, POW, held for years, finally relased and is able to eat for the first time in years.
What are you worried about?
How do you prevent it?

A

Refeeding syndrome

Replace electrolytes and check hourly

87
Q

67 yo M who just did a colectomy for colon cancer is receiving chemo, with good tumor response.
What do you have to be mindful of?
How do you recognize it?

A

Tumor lysis syndrome

Check labs for electrolyte changes (hyper)

88
Q

44yo M with hyperaslosteronism is weak and irritable.

Why?

A

Hypernatremia

89
Q

59yo M with Addison’s dz is acidotic.

Why?

A

Adrenal insufficiency

Acidotic b/c Hyper-K

90
Q

Despite trying to correct a low potassium level, it just wont correct.
Why?

A

Magnesium

91
Q

30yo F with pre-eclampsia. She is being tx with IV magnesium.
How do you clinically monitor for hypermagnesemia?

A

Decrease in neuromuscular excitability

Decreased DTR

92
Q

65yo M s/p severe head trauma, now weak, lethargic.

Why?

A

Head trauma can cause DI

93
Q

75yo M. Successfully did CPR for his V fib. Now he is lethargic and confused.
Why?

A

Fluids are wide open

People loose track of how much fluid the pt has received

Clin Med - II (Surgery) (10 decks)

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