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Barash > Fluids And Electrolytes > Flashcards

Fluids And Electrolytes Flashcards

1
Q

The pathophysiology of metabolic alkalosis is divided into 2 factors

A particularly important maintenance factor is?

A
  1. Generating
  2. Maintenance

Renal response to hypovolemia

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2
Q

Target blood glucose to lower mortality

A

180 mg/dL

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3
Q

Factors that generate metabolic ALKALOSIS are (2)

A
  1. Vomiting

2. Diuretic administration

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4
Q

Treatment of metabolic alkalosis(2)

A
  1. Expansion of intravascular volume

2. Potassium administration

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5
Q

This most rapidly corrects life threatening metabolic alkalosis

A

0.1 N hydrochloric acid

Administered through a central vein to prevent tissue damage

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6
Q

Metabolic acidosis, what anion gap occurs when bicarbonate is lost externally.

A

Normal anion gap (< 13 mEq/L)

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7
Q

Metabolic acidosis, what anion gap occurs because of excess production or decreased excretion of organic acids or ingestion of one of several toxic compounds.

A

High anion gap

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8
Q

How much is ICV of total body weight?

A

60%

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9
Q

How much is ECV of total body weight?

A

20%

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10
Q

The primary mechanism of controlling water intake

A

Thirst

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11
Q

Final osmolality of tubular fluid

A

1200 mOsm/kg

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12
Q

Daily adult requirement for
Na
K

A

75 meqs

40 meqs

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13
Q

Number of osmotically active particles per LITER of solvent

A

Osmolarity

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14
Q

Number of osmotically active particles per KILOGRAM

A

Osmolality

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15
Q

This volume is determined by the rates of capillary filtration and lymphatic drainage.

A

IFV (interstitial fluid volume)

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16
Q

Because of the influence of the glycocalyx, theoretical rates of fluid filtration usually substantially exceed actual filtration rates, a phenomenon termed as

A

Low lymph flow paradox

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17
Q

What is a positive tilt test?

A

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.

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18
Q

How many % of nephrons must be dysfunctional before serum creatinine exceeds the normal range.

A

40 to 50%

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19
Q

Requirement of PPV (4)

A
  1. Direct arterial monitoring
  2. Mechanical ventilation
  3. Vt of 8 mL/kg
  4. No cardiac arrhythmia
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20
Q

In esophageal doppler assessment of iop blood volume

A corrected flow time of 0.35 suggests
A corrected flow time of 0.40 suggests

A

Volume expansion should improve CO

Further volume expansion will be ineffective

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21
Q

In high risk surgical patients, these parameters has been associated with improved outcomes (3)

A
  1. DO2I of 600 mL/m2/min (equivalent to a cardiac index of 3)
  2. Hgb of 14 g/dL
  3. 98% oxyhgb
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22
Q

Disorders of total body sodium are affected by two factors

A
  1. ECV

2. PV

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23
Q

Is the most common electrolyte problem in hospitalized patients

A

Hyponatremia

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24
Q

Plasma sodium DECREASES approximately how much for each 100 mg/dL rise in glucose concentration

A

2.4 mEq/L

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25
Q

The vasopressin-regulated water channel

A

Aquaporin 2

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26
Q

Diagnosis of SIADH (6)

A
  1. Hyponatremia (low plasma osmolality)
  2. Urinary osmolality > plasma osmolality
  3. Renal sodium excretion > 20 mmol/L
  4. Absence of hypotension, hypovolemia & edematous states
  5. Normal renal & adrenal functions
  6. Absence of drugs that affect renal water & sodium handling
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27
Q

Cornerstone of SIADH

A

Free water restriction (0.5 - 1L per day)

Elimination of cause

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28
Q

As long as GFR is above this level, potassium intake can be excreted.

A

8 mL/min

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29
Q

2 most important regulators of potassium excretion

A
  1. Plasma K

2. Aldosterone

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30
Q

Hallmark of hypocalcemis

A

Increased neuronal membrane irritability and tetany

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31
Q

Low or normal phosphate concentrations imply 2 things

A
  1. Vitamin D deficiency

2. Magnesium deficiency

32
Q

High phosphate concentration suggests (2)

A
  1. Renal failure

2. Hypoparathyroidism

33
Q

Enzyme responsible for conversion of calcidiol to calcitriol

A

1a hydroxylase

34
Q

Treatment of hypocalcemia

A

Treat cause

35
Q

Symotomatic hypocalcemia occurs when serum ionized calcium is?

A

Less than 0.7 mM

36
Q

Correction of this electrolyte abnormality without treating hypocalcemia may provoke tetany

A

Hypokalemia

37
Q

Has been called an enogenous calcium antagonist

38
Q

How does Magnesium function in potassium metabolism?

A

Regulating Na K ATPase enzyme especially in potassium depleted states, and controls reabsorption of potassium

39
Q

Absorption of most Mg

A

Thick ascending loop of Henle

40
Q

An electrolyte that may block the NMDA receptor

41
Q

1 gram of magnesium sulfate provides approximately how much mmol, meqs and mg of elemental mg?

A

4 mmol
8 meqs
98 mg

42
Q

Symptomatic hypomagnesemia should be treated with?

A

MgSO4 1 to 2 grams IV for 1 hour
Then 2 to 4 meqs/hr infusion

Infusion should not exceed 1 meq/min

43
Q

Most cases of hypermagnesemia are due to?

A

Iatrogenic causes

44
Q

Criteria for SIADH (6)

A
  1. Hyponatremia, low plasma osmolality
  2. Urinary greater than plasma osmolality
  3. Renal sodium excretion > 20 mmol/L
  4. No hypotension, hypovolemia & edema
  5. Normal renal & adrenal functions
  6. Absence of drugs affecting renal & sodium handling
45
Q

Is a class of drugs that inhibit the action of AVP

A

Vassopressin receptor blocking agents

46
Q

Is a vassopressin receptor blocking agent that inhibits both V1a and V1b. However, there are potential decreases of blood pressure when V1a is blocked.

A

Conivaptan

47
Q

This drug only blocks the V2 receptor

48
Q

This is indicated for hyponatremic patients who experience seizures

A

Hypertonic 3% saline (1 to 2 mL/kg/hr or 1 to 2 meqs/L/hr)

NO MORE THAN 4 to 8 meqs/L/day

49
Q

Principal determinants of neurological injury in Na replacement therapy (2)

A
  1. Severity & chronicity of hyponatremia

2. Rate of correction

50
Q

Osmotic demyelination is more common if hyponatremia persisted for how many hours

51
Q

Rate of hyponatremia should be at?

It should not exceed for how much rate?

A

Above 1 to 2 meqs/L in an hour

No more than 8 meqs/L/day

52
Q

Why are geriatric patients at risk for hypernatremia

A

Because of decreased renal concentrating ability

53
Q

Criteria diagnostic of DI (3)

A
  1. Hypertonicity
  2. Polyuria
  3. Hypotonic urine (<150 mOsm/kg)
54
Q

Central DI drug treatment (2)

A
  1. Desmopressin (DDAVP), 10-20 ug intranasally, 2-4 ug SC
  2. Aqueous vasopressin (5 U q2-4H IM or SC)

DDAVP: longer duration without VASOCONSTRICTOR EFFECTS

55
Q

TBW deficit is the first step in treating hypernatremia

What is the formula.

A

TBW deficit = 0.6 x body weight x [(Na - 140)/140)]

Water deficit should be replaced over 24 to 48 hours

Should not exceed 1 to 2 meq/L/hr

If present for 2 days, no more than 10 meqs/L/day

56
Q

Is a drug that potentiates the renal effects of vasopressin, ang carbamazepine, which enhances vasopressin excretion.

A

Chlorpropramide

57
Q

Potassium concentration

  1. Intracellular?
  2. Extracellular?
A

150 meqs/L

3.5 to 5 meqs/L

58
Q

As long as GFR is above this rate, potassium can be excreted

59
Q

Major site at which potassium excretion is regulated

60
Q

Two most important regulators of potassium

A
  1. Plasma K

2. Aldosterone

61
Q

As a general rule, a chronic decrement of 1 meq/L in plasma potassium corresponds to a total body deficit of how much?

A

200 to 300 meqs

62
Q

Read

A

Cardiac rhythm disturbances are among the most dangerous complications of potassium deficiency. Acute hypokalemia causes HYPERPOLARIZATION of the cardiac cell and may lead to ventricular escape activity, re-entrant phenomena, ectopic tachycardias, and delayed conduction.

63
Q

This drug increases its binding capacity into the myocardium if associated with hypokalemia

64
Q

Aldosterone primarily controls this electrolyte reabsorption and not potassium excretion.

A

Sodium reabsorption

65
Q

Read

A

Potassium is usually replaced as the chloride salt because coexisting chloride deficiency may limit the ability of the kidney to conserve potassium.

66
Q

Ascending muscle weakness appears when plasma K is?

67
Q

If hyponatremia exists with hypokalemia what organ should be evaluated?

68
Q

Drugs that may contribute to hyperkalemia (5)

A
  1. NSAIDs
  2. ACEi
  3. Cyclosporine
  4. Potassium-sparing diuretics
  5. Triamterene
69
Q

Salbutamol decreases potassium acutely by how much?

70
Q

What are the two most important regulators of calcium?

A

PTH

Calcitriol

71
Q

Hallmark of hypocalcemia is?

A

Increased neuronal membrane irritability and tetany

72
Q

Read

A

In renal insufficiency, reduced phosphorus excretion results in hyperphosphatemia, which downregulates the 1a hydroxylase responsible for the conversion of calcidiol to calcitriol.

73
Q

Symptomatic hypocalcemia usually occurs when ionized calcium is less than?

74
Q

What 2 electrolyte abnormalities potentiate hyocalcemic induced cardiac and neuromuscular irritability?

A
  1. Hyperkalemia
  2. Hypomagnesemia

Therefore correction of hypokalemia without correction of hypocalcemia may provoke tetany.

75
Q

Oral calcium can be substituted once serum calcium is at what level?

A

4 to 5 mg/dL

76
Q

In hypoalbuminemic patients, total serum calcium can be estimated by assuming an increase of how much?

A

0.8 mg/dL for every 1 g/dL of albumin concentration below 4 g/dL

Barash (16 decks)

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