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Pharmacology > Fluids And Electrolytes > Flashcards

Fluids And Electrolytes Flashcards

1
Q

What are the causes of hypophasphatemia?PO4 < 2 mg/dL

A

Intestinal malabsorption related to vitamin D deficiency, magnesium/aluminum containing antacids, chronic alcohol misuse, malabsorption syndromes, respiratory alkalosis, increased renal excretion associated with hyperparathyroidism

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2
Q

What is the primary cation in the extracellular fluid?

A

Sodium

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3
Q

What does angiotensin 2 do in the body? (3 things)

A
  1. Vasoconstriction
  2. Stimulates renal tubules to reabsorb sodium and water.
  3. Stimulates the adrenal cortex to release aldosterone
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4
Q

What does the ascending portion of the Frank Starling curve represent?

A

Preload dependence

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5
Q

What area of the adrenal cortex releases aldosterone?

A

Zona glomerulosa

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6
Q

What causes hypovolemic hypotonic hyponatremia?

A

Diuretics, ketonuria, Addison’s disease, vomiting, diarrhea, third spacing, excess sweating, salt loss nephropathy

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7
Q

What is the gold standard for direct cardiac function and volume status monitoring?

A

TEE

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8
Q

What can prophylactic fluid replacement on a healthy fasted patient lead to?

A

Disruption of the glycocalyx and fluid overload

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9
Q

In consideration of the glycocalyx, would you administer colloids or crystalloids to increase intravascular volume?

A

Colloids

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10
Q

What is the formula to calculate free water deficit?

A

[(Na/140)-1] x TBW

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11
Q

How can we explain how hypotensive patients actually likely have an appropriate fluid status? (2)

A

Related to impaired cardiac function

Altered vascular tone

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12
Q

What symptoms will we see with magnesium levels of 10?

A

Respiratory paralysis and coma

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13
Q

What hormone maintains serum calcium levels?

A

Parathyroid hormone

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14
Q

What is the most abundant form of calcium?

A

Ionized and physiologically active 50%
Bound to proteins 40%
Bound to anions 10%

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15
Q

How do you calculate the estimated deficit?

A

Maintenance requirement (from 4-2-1) x fasting hours

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16
Q

What is the gold standard for direct cardiac function and volume status monitoring?

A

TEE

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17
Q

What is isotonic hyponatremia (pseudohyponatremia) serum osmolality 270-300 caused by?

A

Hyperlipidemia, hyperproteinemia, multiple myeloma, excess isotonic nonelectrolyte solutions

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18
Q

A patient is considered fluid responsive if their pulse contour analysis value is what?

A

Greater than 13-15%

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19
Q

What hormone maintains serum calcium levels?

A

Parathyroid hormone

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20
Q

At sodium levels of 129-125 what are patients signs and symptoms?

A

Nausea, malaise

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21
Q

What does parathyroid hormone insufficiency do to calcium levels?

A

Cause hypocalcemia

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22
Q

What are benefits of crystalloids? (3)

A

Lack allergic potential
Easily metabolized and cleared
Preserve electrolyte balance

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23
Q

If you notice biochemical evidence of Hyperkalemia and no ECG changes what is your interventions, their onset and mechanism?

A

K binding resins in the GI tract, onset 1-2 hours, GI excretion of potassium

Promotion of renal K excretion, Lasix 40mg, onset 15-30 minutes, renal excretion of potassium

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24
Q

Which solution would you give to a patient with active blood loss that needs fluid but not a transfusion?

A

Albumin

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25
Q

What are the traditional nonspecific indicators of fluid balance?

A

MAP, CVP, and urine output

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26
Q

What substances are unable to freely move between the vascular and interstitial space?

A

Proteins like albumin and globulins

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27
Q

What happens to contractility for people with a normal Frank Starling curve, that are given fluids?

A

Contractility increases.

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28
Q

When potassium reaches >8 QRS widening can lead to what?

A

Sine waves, V fib and cardiac arrest

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29
Q

What is the value of sodium in the extracellular fluid?

A

142 mEq/L

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30
Q

Which electrolyte condition can make it difficult for the kidney to conserve potassium?

A

Hypochloridemia

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31
Q

The Frank Starling Mechanism is the relationship between which two variables?

A

LVEDV and myocardial contractility

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32
Q

What is the value of calcium in the extracellular fluid?

A

5 mEq/L

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33
Q

Why can you administer plasmalyte, isolyte, and normosol with blood products?

A

They do not contain calcium

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34
Q

What are treatment options for hypercalcemia?

A 
Infusion of NS to increase secretion
Loop diuretics
Bisphosphonates
Mithramycin
Calcitonin
Glucocorticoids
Phosphate salts
Hemodialysis for life threatening hypercalcemia
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35
Q

What is the goal Potassium range before surgery?

A

Potassium > 4

Potassium < 5.5

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36
Q

Which medication will facilitate redistribution of potassium into the intracellular space

A

Insulin

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37
Q

What is the most consequential effect of hyponatremia?

A

Cerebral edema, cells swell. There is limited diffusion of solutes across the BBB, preventing equilibrium.

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38
Q

What is the goal Potassium range before surgery?

A

Potassium > 4

Potassium < 5.5

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39
Q

What causes transcellular shifts leading to hyperkalemia?

A

Acidosis (due to hydrogen ions), hypertonicity, insulin deficiency, beta blockers, digitalis, succinylcholine, exercise, hyperkalemia periodic paralysis

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40
Q

What is one likely explanation for a normovolumic patient having low urine output?

A

High levels of ADH. They are retaining fluid.

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41
Q

What mechanisms control phosphate balance? (3)

A

Parathyroid hormone
Vitamin D
Calcitonin

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42
Q

What is interstitial hydrostatic pressure?

A

Hydrostatic pressure of interstitial fluid. (Pushes fluid into the capillary)

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43
Q

What is the effect on contractility for people with decreased cardiac function who are given fluids?

A

They can only respond to small volumes without compromise.

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44
Q

What are the two functions of ADH?

A
  1. Cause aquaphorin channels in the kidney to reabsorb water

2. Potent arterial vasoconstrictor

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45
Q

Which medications cause hypomagnesium?

A

Aminoglycosides, amphotericin, beta-agonists, cisplatin, cyclosporine, diuretics, foscarnet, pentamidine, PPI, theophylline

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46
Q

What measures global tissue oxygen balance by comparing blood gases with oxygen consumption and delivery?

A

Measures of tissue oxygenation

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47
Q

What is the osmolality, tonicity and pH of Plasmalyte?

A

294 mOsm
Isotonic
PH 7.4
Contains potassium, magnesium, acetate, and gloconate

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48
Q

For infants 0-10kg what is the 4-2-1 fluid replacement?

A

4mL/kg/hr

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49
Q

Concentration of phosphate in the plasma is inversely proportional to which electrolyte?

A

Calcium

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50
Q

What are the GI signs of hypercalcemia?

A

Nausea vomiting, anorexia, peptic ulcers, pancreatitis, constipation/ileus

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51
Q

What electrolytes are in the intracellular fluid?

A

Potassium, magnesium, calcium, phosphate

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52
Q

What arrhythmias are causes by a serum potassium < 3.5

A

1st and 2nd degree blocks, atrial or ventricular fibrillation, asystole

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53
Q

Which hormone stimulates the excretion of potassium?

A

Aldosterone

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54
Q

What are the cardiovascular signs of hypercalcemia?

A

HTN, St segment elevation, sinus bradycardia/arrest, AV block, short Qt, BBB, ventricular dysrhythmias, potentiation of digoxin toxicity

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55
Q

What are the 6 complications of under resuscitation?

A 
Hypovolemia
Decreased perfusion/O2 delivery
PONV
Renal Dysfunction
Myocardial ischemia
Hemoconcentration/thrombotic events
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56
Q

Hypokalemia caused by renal losses is due to what?

A

Diuretics, drugs, steroids, metabolic acidosis, hyper aldosterone, renal tubular acidosis, DKA, alcohol consumption

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57
Q

What is the value of magnesium in the extracellular fluid?

A

3 mEq/L

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58
Q

The increased sodium load of Normal Saline causes what effects on the vascular space and bowel? (3)

A

Water retention
Hemodilution
Interstitial edema
Decreased bowel motility

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59
Q

How does the glycocalyx impact administration of crystalloids?

A

Crystalloids are able to freely cross the glycocalyx

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60
Q

What is the treatment of hyponatremia?

A

Fluid restriction, diuresis

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61
Q

What mechanism causes laparoscopic surgery to stimulate ANP?

A

Mechanical suppression of splanchnic blood flow and ischemia which also predisposes to reperfusion injury, shunts blood to the thorax -> increasing CVP.

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62
Q

How do we correcting hypernatremia over 24 hours?

A

Hypotonic solutions, 1-2mEq/hr

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63
Q

For adults > 20kg what is the 4-2-1 fluid replacement?

A

4mL/kg/hr for the first 10kg
2mL/kg/hr for the next 10kg
1mL/kg/hr for every kg > 20kg

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64
Q

What is the osmolality, tonicity and pH of NS?

A

308 mOsm
Isotonic
PH 5

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65
Q

What is the treatment suggestions of hyponatremia?

A

Correct 1-2mEq/L/hr with 3% saline at 1-2mL/kg/hr and not raised more than 10-15mmol/L in 24 hours.

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66
Q

What Utilizes individualized hemodynamics end points monitored by hemodynamics modalities to support oxygen transport balance, minimize oxygen demand, optimize CO, tissue oxygenation, capillary and micro vascular flow, oxygen/nutrient delivery and end organ perfusion?

A

Goal directed fluid therapy

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67
Q

What is the order of EKG changes related to hyperkalemia?

A

T wave changes, P wave and PR interval, QRS changes.

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68
Q

What does the ascending portion of the Frank Starling curve represent?

A

Preloads dependence

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69
Q

Explain the Renin-Angiotensin Aldosterone System response to hypotension. (4 steps)

A
  1. Hypotension detected by baroreceptors
  2. Sympathetic Nervous System stimulation of juxtaglomerular cells of the kidney to release renin.
  3. Renin interacts with angiotensinogen creating angiotensin 1
  4. Angiotensin Converting Enzyme converts angiotensin 1 to angiotensin 2
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70
Q

As preload increases, contractility…. according to the Frank Starling Law

A

Increases, up to a point

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71
Q

Hypernatremia with an serum osmolality of 401-430 will cause what signs and symptoms?

A

Hyperreflexia, muscle twitching/spasm

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72
Q

Which medication will facilitate redistribution of potassium into the intracellular space

A

Insulin

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73
Q

What maintains the osmotic equilibrium between ECV and ICV?

A

The cell membranes permeability to water

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74
Q

Why is magnesium used in the treatment of pheochromocytoma?

A

Reduces catecholamine release and dilates vasculature

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75
Q

What is the function of ANP?

A
  1. Stimulate removal of sodium and water by the kidneys
  2. Increase GFR
  3. Inhibits release of renin and ADH
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76
Q

What are some miscellaneous causes of hypomagnesmia?

A

Pregnancy, excessive alcohol intake, citrate binding with blood administration

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77
Q

What patients should you avoid giving hydroxyethyl starches to?

A

Preexisting renal injury, sepsis, neurological injury, organ donors, CABG with CPB.

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78
Q

What are symptoms of a serum potassium < 2.5 mEq/L?

A

Parasthesia, depressed deep tendon reflexes, fasciculations, weakness, altered level of consciousness

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79
Q

What is the value of sulfate in the extracellular fluid?

A

1 mEq/L

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80
Q

What is the value of sulfate in the intracellular fluid?

A

2 mEq/L

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81
Q

What are the cardiovascular signs of hypocalcemia?

A

Bradycardia, angina, hypotension, CHF, cardiac arrest, digitalis insensitivity, Qt prolongation

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82
Q

Where is magnesium regulated?

A

Intestines and kidneys

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83
Q

What is the value of phosphates in the extracellular fluid?

A

4 mEq/L

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84
Q

How do you replace blood loss with colloids?

A

1:1 ratio

1mL of colloid for every 1mL of blood loss

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85
Q

Hypokalemia as a result of decreased intake is due to what?

A

Ethanol, malnutrition

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86
Q

What causes increased K intake/absorption leading to hyperkalemia?

A

K supplements, salt substitutes, stored blood, K containing medications

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87
Q

What solution contains macromolecules suspended in electrolyte solutions that promote volume expansion by directly increasing plasma oncotic pressure.

A

Colloids- hydroxyethyl starches

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88
Q

What is the dilution technique?

A

Administration of a fixed volume of injectate into the vascular space and measurement of CO based on area under a time-temperature or concentration-time curve.

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89
Q

What are the manifestations of hyphosphatemia? PO4<2mg/dL

A

Decreased oxygen transport and ATP creation, platelet dysfunction, bone reabsorption, altered nerve and muscle function, confusion, coma, seizures, muscle weakness, respiratory failure, cardiomyopathy

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90
Q

What can rapid correction of hyponatremia cause?

A

Neurological complications like central pontine myelinolysis.

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91
Q

Hypernatremia with an serum osmolality of 350-375 will cause what signs and symptoms?

A

Confusion, restlessness, agitation, headache

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92
Q

What are the manifestations of hyperphosphatemia? PO4 > 4.7 mg/dL

A

Symptoms related to hypocalcemia

chronic calcification of soft tissues (joints, lungs, kidneys)

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93
Q

How is fluid in the interstitial space returned to the circulation?

A

Via lymph

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94
Q

What is the value of sodium in the intracellular fluid?

A

10 mEq/L

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95
Q

What is the value of chloride in the extracellular fluid?

A

103 mEq/L

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96
Q

Why do hydroxyethyl starches carry a black box warning?

A

Renal injury

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97
Q

What is normal total serum calcium?

A

8.5-10.5 mg/dL

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98
Q

How does the hypothalamus respond to increased serum osmolality?

A
  1. Osmoreceptors in the hypothalamus detect the increased osmolality
  2. Stimulate thirst
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99
Q

What is the value of phosphates in the intracellular fluid?

A

75 mEq/L

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100
Q

What affects do magnesium have on dysrhythmias?

A

Blocks calcium influx decreasing SA node activity and prolonging AV conduction time

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101
Q

What causes hypertonic hyponatremia (serum osmolality > 300)?

A

Hyperglycemia, mannitol excess glycerol therapy

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102
Q

What are the neurological signs of hypercalcemia?

A

Fatigue, weakness, confusion, lethargy, seizures, coma, hypotonia, diminished deep tendon reflexes

103
Q

Which electrolyte condition can make it difficult for the kidney to conserve potassium?

A

Hypochloridemia

104
Q

What is the most prominent protein in the body? The primary force of osmotic pressures.

A

Albumin

105
Q

Which crystalloids are the most isotonic of the salt solutions?

A

Plasmalyte, normosol R, isolyte S

106
Q

What isotonic solution is the least similar to physiologic fluid?

A

Normal Saline

107
Q

Hydroxyethyl starches can cause severe non histamine related pruritis and nephrotoxicity due to what?

A

Interstitial colloid deposits

108
Q

What is the value of potassium in the extracellular fluid?

A

4 mEq/L

109
Q

What is the primary determinant of serum osmolality and water transport?

A

Sodium

110
Q

What does the intracellular phosphate do?

A

Component of ATP, and 2,3 DPG

Acts as a buffer in acid base balance

111
Q

How can we explain how hypotensive patients actually likely have an appropriate fluid status? (2)

A

Related to impaired cardiac function

Altered vascular tone

112
Q

Hypokalemia caused by renal losses is due to what?

A

Diuretics, steroids, metabolic acidosis, hyper aldosterone, renal tubular acidosis, DKA, alcohol consumption

113
Q

What electrolyte is responsible for the majority of osmotic activity in the ECF and effects ECV and ICV osmolality

A

Sodium

114
Q

Is Normal Saline or Lactated Ringers more effecting at preserving intravascular volume?

A

Lactated Ringers

115
Q

How does hyponatremia affect the movement of water between the ECV and ICV?

A

(Sodium is extracellular) ECV is hypo-osmolar, so water moves into the ICV. Cells swell.

116
Q

What is the principle electrolyte in the ICV

A

Potassium

117
Q

What is an antagonist for hypermagnesmia?

A

Calcium gluconate 10-15mg/kg

118
Q

What are the 9 complications of over-resuscitation?

A 
Vascular overload
Micro vascular congestion/ decreased O2 delivery
Endothelial glycocalyx damage
Hypo-coagulation
Anemia, thrombocytopenia
Poor wound healing
Decreased organ perfusion and congestion
Pulmonary edema
Compartment syndrome
119
Q

Which hormone is stimulated during hypervolemia?

A

ANP

120
Q

What most likely causes hypocalcemia inter-op?

A

Hyperventilation, and rapid massive blood transfusion

121
Q

How does the body maintain sodium balance?

A

Restrict or expand water volume

Supplement or eliminate sodium

122
Q

What is the primary anion in the extracellular fluid?

A

Chloride

123
Q

What are some negative effects of hydroxyethyl starches?

A

Dose dependent coagulopathy from hemodilution
binding of clotting factors
Interference with platelet adhesion
Alterations in plasma viscosity

124
Q

What is the bodies response to increased osmolality? (4 steps)

A
  1. Posterior pituitary secretes ADH
  2. ADH causes aquaphorin channels in the kidney to reabsorb water
  3. Circulating volume increases
  4. Urine osmolality and concentration increases
125
Q

What is the normal range of magnesium?

A

1.5-3 mEq/L

126
Q

A patient is considered fluid responsive if their pulse contour analysis value is what?

A

Greater than 13-15%

127
Q

How is water balance regulated?

A

Antidiuretic Hormone

128
Q

What is the normal range of ionized calcium?

A

2-2.5 mEq/L

129
Q

Based on traditional guidelines for fluid replacement, what is the preferred combination of replacement of 500mL of blood loss?

A

750mL LR and 250mL albumin

500 of blood to replace
750mL of LR replaces half of the blood loss; 3 x 500 = 1500/2 = 750
Still need to replace 50% of the blood loss. So if colloids replace blood at a 1:1 ratio, giving 250mL of albumin would replace the other half of the blood.

130
Q

What is pulse contour analysis?

A

Measure preload responsiveness by quantifying change in arterial, capo graphs, or pulse oximetry waveform

131
Q

If using negative base excess as a guide to Normal Saline fluid replacement what is the risk?

A

Fluid overload

132
Q

How does parathyroid hormone resistance states affects calcium levels

A

Cause hypocalcemia

133
Q

Which hormone is inhibited during hypervolemia?

A

ADH

134
Q

What are the 3 forms of hypotonic Hyponatremia with a serum osmolality < 270?

A

Hypovolemic hypotonic hyponatremia
Isovolemic hypotonic hyponatremia
Hypervolemic hypotonic hyponatremia

135
Q

Which fluid pressures favor absorption/retention of fluid within the vascular space?

A

Interstitial hydrostatic pressure

Capillary oncotic pressure

136
Q

What syndromes causes hypercalcemia?

A

Primary hyperparathyroidism, granulomatous disorders, nonparathyroid endocrine disorders, immobilization, idiopathic hypocalcemia of infancy

137
Q

Which two pressures favor absorption of fluid into the interstitial space?

A

Interstitial oncotic pressure

Capillary hydrostatic pressure

138
Q

What causes renal loss of magnesium?

A

Renal failure, postobstructive diuresis, tubular necrosis, glomerulonephritis, interstitial nephropathy, transplant

139
Q

What are the psychiatric signs of hypocalcemia?

A

Anxiety, depression, irritability, confusion, psychosis, dementia

140
Q

How is a serum sodium osmolality of 270-300 classified.

A

Isotonic hyponatremia (pseudohyponatremia)

141
Q

What modalities help us monitor goal directed fluid therapy?

A

Dilution techniques, pursue contour analysis, echocardiogram, esophageal Doppler, tissue oxygenation monitoring.

142
Q

What is capillary oncotic pressure?

A

Osmotic force of proteins within the vascular space. (Pulls fluid into the capillary)

143
Q

What is the value of magnesium in the intracellular fluid?

A

58 mEq/L

144
Q

What are the benefits of buffered solutions like plasmalyte, normosol, and isolyte?

A

Less acid base alterations

Require less blood product infusions

145
Q

Which form of calcium replacement provides the most rapid correction?

A 
Calcium chloride (272 mg elemental calcium)
But can cause tissue necrosis and venous irritation

Calcium gluconate: 10 mL (93mg of elemental Calcium)

146
Q

What does the plateau portion of the Frank Starling curve represent?

A

Preload independence

147
Q

What endocrine disorders causes hypomagnesium?

A

DM, hyperaldosteronism, hyperthyroidism, hyperparathyroidism, acute poryphyria

148
Q

What is the osmolality, tonicity and pH of D5NS?

A

560 mOsm
Hypertonic
PH 4
Contains glucose

149
Q

What is the effect on contractility for people with decreased cardiac function who are given fluids?

A

They can only respond to small volumes without compromise.

150
Q

What is the osmolality, tonicity and pH of LR?

A

273 mOsm
Isotonic
PH 6.5
Contains potassium, calcium, and lactate

151
Q

How is hyperphosphatemia treated? What does it do?

A

Aluminum hydroxide which binds phosphate in the GI tract

152
Q

What are causes of GI loss of magnesium?

A

Chronic diarrhea, NG suction, short bowel syndrome, protein calorie deficit, bowel fistula, TPN, pancreatitis

153
Q

Do not infuse LR with what type of infusion products due to risk of coagulation

A

Citrated.

Do not use with blood products

154
Q

How do we classify a serum sodium osmolality > 300?

A

Hypertonic hyponatremia

155
Q

What is pulse contour analysis?

A

Measure preload responsiveness by quantifying change in arterial, capo graphs, or pulse oximetry waveform

156
Q

Why should you avoid infusing large volumes of LR in diabetics?

A

Metabolic byproduct lactate causes gluconeogenesis

157
Q

What does the plateau portion of the Frank Starling curve represent?

A

Preload independence

158
Q

What impact does hyperkalemia have on aldosterone?

A

Increases synthesis and release of aldosterone

159
Q

What impact does the glycocalyx have on colloids?

A

Colloids are unable to cross the glycocalyx. Increasing intravascular volume.

160
Q

How do you replace blood loss with crystalloids?

A

3:1

3mL for every 1 mL of blood loss

161
Q

If you notice ECG evident of Potassium excess (peaked T waves), what medications do you give, their dose, onset, and mechanism?

A

Glucose and insulin infusion: 50mL of D50, 10 units insulin, onset 30 minutes, shifts K intracellular

Immediate hemodialysis

162
Q

Why are crystalloids preferred for correcting dehydration?

A

Contribute to hydration of the entire extracellular volume

163
Q

What symptoms will we see with magnesium levels 4-5?

A

Decreased deep tendon reflexes

164
Q

The Frank Starling Mechanism is the relationship between which two variables?

A

LVEDV and myocardial contractility

165
Q

Rapidly occurring hypernatremia leads to what?

A

Shrinking of the brain and traction on intercranial veins/venous sinuses, leading to intercranial hemorrhage

166
Q

Which hormone is stimulated during hypovolemia?

A

ADH

167
Q

What causes impaired renal excretion of potassium leading to hyperkalemia?

A

Renal failure, tubular defects, nephropathy, obstructive jeopardy, nephritis, pyelonephritis, K-sparing diuretics, hypoaldosteronism, SLE, addisons, adrenal hyperplasia, drugs

168
Q

Which solution should you avoid in TBI and neurovascular insults because it promotes cerebral edema and hypo-osmolality.

A

Lactated Ringers

169
Q

Hypernatremia with an serum osmolality of 376-400 will cause what signs and symptoms?

A

Ataxia, tremors, weakness

170
Q

What causes hypokalemia in the form of increased nonrenal loss?

A

Sweating, diarrhea, vomiting, laxatives

171
Q

What affect does acidemia and alkalemia have on calcium?

A

Acidemia decreases protein bound calcium and increases ionized
Alkalemia increases proteins bound calcium and decreases ionized

172
Q

What is one likely explanation for a normovolumic patient having low urine output?

A

High levels of ADH. They are retaining fluid.

173
Q

Surgical trauma/tissue injury promotes endothelial release of inflammatory mediators which contribute to what?

A

Hyperthermia
Increase O2 demands
Altered microcirculatory flow

174
Q

What causes intracellular shifts leading to hypokalemia?

A

Hyperventilation, metabolic alkalosis, beta adrenergic agonists, theophylline

175
Q

If you notice ECG evidence of impending arrest (loss of P wave, QRS widening) what are the medications you give, their dose, onset and mechanism?

A

10mL of 10% CaCl or CaGluc over 10 minutes, onset is 1-3 minutes, membrane stabilization

50-100 mEq of HCO3- over 10-20 minutes, onset 5-10 min, shifts intracellular potassium

176
Q

What does hypermagnesmia do to nondepolarizing neuromuscular blockers?

A

Potentiates their action

177
Q

What causes endocrinopathy leading to hypokalemia?

A

Cushing disease, bartter syndrome, insulin therapy

178
Q

Is hyperkalemia or hypokalemia more common?

A

Hypokalemia

179
Q

Hypernatremia with an serum osmolality of >430 will cause what signs and symptoms?

A

Coma, seizures, death

180
Q

What is the most abundant form of calcium?

A

Ionized and physiologically active 50%
Bound to proteins 40%
Bound to anions 10%

181
Q

What does vitamin D insufficiency do to calcium levels

A

Cause hypocalcemia

182
Q

Hypocalcemia most likely stimulates which action?
A decrease in PTH release
Increased renal reabsorption of calcium
Decreased intestinal absorption of calcium
Activity of osteoblasts

A

*Increased renal absorption of calcium

Activity of osteoclasts

183
Q

What signs and symptoms will be see with sodium levels < 115?

A

Seizures, coma, respiratory arrest, cerebral herniation

184
Q

What happens to contractility for people with a normal Frank Starling curve, that are given fluids?

A

Contractility increases.

185
Q

What is the value of calcium in the intracellular fluid?

A

<1 mEq/L

186
Q

The high chloride load of Normal Saline has what effects on the kidney? (2)

A

Decreased GRF

Impaired renal handling of HCO3

187
Q

What symptoms will we see with magnesium levels 10-20?

A

Heart block and cardiac arrest

188
Q

What causes hypokalemia in the form of increased nonrenal loss?

A

Sweating, diarrhea, vomiting, laxatives

189
Q

What electrolyte disturbance is usually the result of impaired water intake?

A

Hypernatremia

190
Q

What is the goal Potassium range before surgery?

A

Potassium > 4

Potassium < 5.5

191
Q

What are the pulmonary signs of hypocalcemia?

A

Bronchospasm, laryngospasm

192
Q

How does SNS stimulated release of catecholamines affect fluid status?

A

Release ADH

Excretion of potassium and reabsorption of water

193
Q

At sodium levels of 135-150 what are the signs and symptoms we will see?

A

Little or no symptoms, may see mild neurologic signs

194
Q

Vomiting, diarrhea, continuous GI suctioning, and osmotic diuresis causes what type of hypernatremia?

A

Hypernatremia with dehydration and low total body sodium

195
Q

What does magnesium for preeclampsia do to the fetus?

A

It crosses the placenta and can cause neonatal lethargy, hypotension, and respiratory depression

196
Q

What functions does magnesium have?

A

Enzymatic processes, Na/K pump, protein synthesis, and neuromuscular excitability

197
Q

What are symptoms of a serum potassium < 3.5

A

Palpitations, skeletal muscle weakness and pain

198
Q

How are sodium levels maintained?

A

GI tract absorption, renal excretion and reabsorption

199
Q

How does the body maintain sodium balance?

A

Restrict or expand water volume

Supplement or eliminate sodium

200
Q

What is the primary anion in the intracellular fluid?

A

Phosphate

201
Q

What is the value of potassium in the intracellular fluid?

A

140 mEq/L

202
Q

Which direction does water move in an attempt to maintain equilibrium?

A

Areas of low solute concentration to areas of higher solute concentration

203
Q

What does rapid administration of free water used to treat hypernatremia lead to?

A

Cerebral edema

204
Q

What is interstitial oncotic pressure?

A

Osmotic force of proteins within the interstitial space. (Pulls fluid out of the capillary)

205
Q

What are symptoms of hypomagnesium?

A

Inhibits Na/P pump decreasing ICV potassium, N/V, tetany, flat T wave, U wave, prolonged Qt, wide QRS, arrhythmia

206
Q

What are the neuromuscular signs of hypocalcemia?

A

Paresthesia, muscle weakness, muscle spasm, tetany, Chvosteks sign (facial/eye muscle twitching) trousseau’s sign (carpopedal spasm), hyperreflexia, seizures

207
Q

What are the EKG changes noted in hyperkalemia?

A

Tall peaked T wave, depressed ST segment, wide QRS, prolonged PR, decreased R wave

208
Q

What maintains the resting membrane gradient?

A

Na/P ATPase pump

209
Q

What value of potassium in the ICF and ECF?

A

ICF 150-160 mEq/L

ECF 3.5-5 mEq/L

210
Q

What is the osmolality, tonicity and pH of D5 .45% NS?

A

406 mOsm
Hypertonic
PH 4
Contains glucose

211
Q

Which solution has a pH closest to physiologic pH?

A

Plasmalyte

212
Q

What does plasmalyte, normosol, and isolyte do better than NS?

A

Preserves renal function

213
Q

What types of cell injury lead to hyperkalemia?

A

Rhabdomyolysis, severe intravascular hemolysis, acute tumor lysis syndrome, burns and crushing injuries.

214
Q

What are the alkalizing buffers in plasmalyte, normosol, and isolyte? (2)

A

Sodium gluconate and sodium acetate

215
Q

Which type of solution has the risk of allergic potential? Why?

A

Hydroxyethyl starches.

Made from starchy plants

216
Q

What is the value of HCO3 in the extracellular fluid?

A

28 mEq/L

217
Q

Diabetes, neurogenic, renal disease, sick cell disease and aminoglycosides cause which type of hypernatremia?

A

Hypernatremia with low total body water and normal total body sodium

218
Q

What causes hypervolemic hypotonic hyponatremia

A

Nephrotic syndrome, cirrhosis, CHF, renal failure

219
Q

What is the osmolality of the extracellular fluid?

A

281 mOsm/L

220
Q

What is capillary hydrostatic pressure?

A

Intravascular blood pressure driven by CO and impacted by vascular tone. (Pushes fluid out of the capillary)

221
Q

What is the value of HCO3 in the intracellular fluid?

A

10 mEq/L

222
Q

What causes isovolemic hypotonic hyponatremia?

A

SIADH, renal failure, hypothyroidism, drugs, water intoxication, porphyria, pain, stress, PPV

223
Q

How does pseudo hyperkalemia occur?

A

Hemolysis of the sample, leukocytosis, thrombosis, clinching of the fist during law draw

224
Q

What medications can be used to treat hyponatremia?

A

Vasopressin antagonists like tolvaptan and conivaptan

225
Q

What are the primary causes of hypercalcemia?

A

Primary hyperparathyroidism
Granulomatous disorders
Nonparathyroid endocrine disorders

226
Q

Which crystalloids have the most favorable acid base profile?

A

Plasmalyte, normosol R, isolyte S

227
Q

What is the value of chloride in the intracellular fluid?

A

4 mEq/L

228
Q

What signs and symptoms will we see at sodium levels of 124-115?

A

Headache, lethargy, altered LOC

229
Q

What symptoms will we see with magnesium levels 5-7?

A

Hypotension

230
Q

What electrolyte is responsible for the majority of osmotic activity in the ECF and effects ECV and ICV osmolality

A

Sodium

231
Q

What is the osmolality, tonicity and pH of D5 LR?

A

525 mOsm
Hypertonic
PH 4.9
Contains potassium, calcium, glucose, and lactate

232
Q

How does hyponatremia affect the movement of water between the ECV and ICV?

A

(Sodium is extracellular) ECV is hypo-osmolar, so water moves into the ICV. Cells swell.

233
Q

Crystalloids, being low molecular weight favor loss of 80% of the interstitial space through which mechanisms? (3)

A

Hemodilution of plasma proteins
Loss of capillary oncotic pressure
Increase in capillary hydrostatic pressure

234
Q

How is a serum sodium osmolality of 270-300 classified.

A

Isotonic hyponatremia (pseudohyponatremia)

235
Q

What causes hypertonic hyponatremia (serum osmolality > 300)?

A

Hyperglycemia, mannitol excess glycerol therapy

236
Q

What are the renal signs of hypercalcemia?

A

Polyuria, polydipsia, dehydration, loss of electrolytes, prerenal azotemia, nephrolithiasis, nephrocalcinosis

237
Q

What are the causes of hyperphosphatemia? PO4> 4.7 mg/dL

A

Metastatic Disease
Acute/chronic renal failure, treatment of metastatic tumor, long-term use of laxatives/enemas containing phosphates, hypoparathyroidism

238
Q

What affect does acidemia and alkalemia have on calcium?

A

Acidemia decreases protein bound calcium and increases ionized
Alkalemia increases proteins bound calcium and decreases ionized

239
Q

What are other uses for magnesium?

A

Relieve bronchospasm, arrhythmia, decrease post-op pain

240
Q

What is normal total serum calcium?

A

8.5-10.5 mg/dL

241
Q

What electrolytes does the extracellular fluid contain?

A

Sodium and chloride

242
Q

Why does LR contribute to cerebral edema and hypo-osmolality?

A

It is slightly hypotonic

243
Q

What is the primary cation in the intracellular fluid?

A

Potassium

244
Q

What measures global tissue oxygen balance by comparing blood gases with oxygen consumption and delivery?

A

Measures of tissue oxygenation

245
Q

Which direction does water move in an attempt to maintain equilibrium?

A

Areas of low solute concentration to areas of higher solute concentration

246
Q

Total calcium is largely dependent on concentration of what?

A

Albumin

247
Q

What is the dilution technique?

A

Administration of a fixed volume of injectate into the vascular space and measurement of CO based on area under a time-temperature or concentration-time curve.

248
Q

How does hyperglycemia affect the vasculature and fluid volume?

A

It disrupts the glycocalyx, allowing crystalloids and colloids to freely move out of the intravascular space.

249
Q

Due to the large chloride load of normal saline, what are some concerns?

A

Hyperchloremic metabolic acidosis

Alterations in base excess

250
Q

Hypertonic saline infusion, Cushing syndrome, conn syndrome and hemodialysis causes which type of hypernatremia?

A

Hypernatremia with increased total body sodium

251
Q

What is the osmolality of the intracellular fluid?

A

281 mOms/L

252
Q

For toddlers 11-20kg what is the 4-2-1 fluid replacement?

A

4mL/kg/hr for the first 10kg

2mL/kg/hr for every kg > 10

253
Q

Which hormone is inhibited during hypovolemia?

A

ANP

Pharmacology (6 decks)

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