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Section I, Surgical Recall Sixth Edition > Fluids and Electrolytes Chapter18 P107-123 > Flashcards

Fluids and Electrolytes Chapter18 P107-123 Flashcards

1
Q

What are the two major body fluid compartments?

P107

A
  1. Intracellular

2. Extracellular

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2
Q

What are the two subcompartments of extracellular fluid?

P107

A
  1. Interstitial fluid (in between cells)

2. Intravascular fluid (plasma)

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3
Q

What percentage of body weight is in fluid?

P107 (picture)

A

60%

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4
Q

What percentage of body fluid is intracellular?

P108

A

66%

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5
Q

What percentage of body fluid is extracellular?

P108

A

33%

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6
Q

What is the composition of body fluid?

P108

A

Fluids = 60% total body weight:
Intracellular = 40% total body weight
Extracellular = 20% total body weight
(Think: 60, 40, 20)

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7
Q

How can body fluid distribution by weight be remembered?

P108

A

“TIE”:
T = Total body fluid = 60% of body weight
I = Intracellular = 40% of body weight
E = Extracellular = 20% of body weight

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8
Q

On average, what percentage of body weight does blood
account for in adults?
P108

A

≈7%

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9
Q

How many liters of blood
are in a 70-kg man?
P108

A

0.07 x 70 = 5 liters

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10
Q

What are the fluid requirements every 24 hours for each of the following substances:
1. Water
P108

A

≈30 to 35 mL/kg

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11
Q

What are the fluid requirements every 24 hours for each of the following substances:
2. Potassium
P108

A

≈1 mEq/kg

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12
Q

What are the fluid requirements every 24 hours for each of the following substances:
3. Chloride
P108

A

≈1.5 mEq/kg

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13
Q

What are the fluid requirements every 24 hours for each of the following substances:
4. Sodium
P108

A

≈1–2 mEq/kg

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14
Q

What are the levels and sources of normal daily water loss?

P108

A

Urine—1200 to 1500 mL (25–30 mL/kg)
Sweat—200 to 400 mL
Respiratory losses—500 to 700 mL
Feces—100 to 200 mL

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15
Q

What are the levels and sources of normal daily electrolyte loss?
P108

A

Sodium and potassium = 100 mEq

Chloride = 150 mEq

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16
Q

What are the levels of sodium and chloride in sweat?

P109

A

≈40 mEq/L

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17
Q

What is the major electrolyte in colonic feculent fluid?

P109

A

Potassium—65 mEq/L

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18
Q

What is the physiologic response to hypovolemia?

P109

A

Sodium/H2O retention via renin → aldosterone, water retention via ADH, vasoconstriction via angiotensin II and
sympathetics, low urine output and tachycardia (early), hypotension (late)

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19
Q

THIRD SPACING
What is it?
P109

A

Fluid accumulation in the interstitium of tissues, as in edema, e.g., loss of fluid into the interstitium and lumen of a paralytic bowel following surgery (think of the intravascular and intracellular spaces as the first two spaces)

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20
Q

THIRD SPACING
When does “third-spacing” occur postoperatively?
P109

A

Third-spaced fluid tends to mobilize back into the intravascular space around POD #3 (Note: Beware of fluid overload once the fluid begins to return to the intravascular
space); switch to hypotonic fluid and decrease IV rate

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21
Q

THIRD SPACING
What are the classic signs of third spacing?
P109

A

Tachycardia

Decreased urine output

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22
Q

THIRD SPACING
What is the treatment?
P109

A

IV hydration with isotonic fluids

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23
Q

THIRD SPACING
What are the surgical causes of the following conditions:
Metabolic acidosis
P109

A
  • Loss of bicarbonate: diarrhea, ileus, fistula, high-output ileostomy, carbonic anhydrase inhibitors
  • Increase in acids: lactic acidosis (ischemia), ketoacidosis, renal failure, necrotic tissue
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24
Q

THIRD SPACING
What are the surgical causes of the following conditions:
Hypochloremic alkalosis
P109

A

NGT suction, loss of gastric HCl through vomiting/NGT

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25
Q

THIRD SPACING
What are the surgical causes of the following conditions:
Metabolic alkalosis
P110

A

Vomiting, NG suction, diuretics, alkali ingestion, mineralocorticoid excess

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26
Q

THIRD SPACING
What are the surgical causes of the following conditions:
Respiratory acidosis
P110

A

Hypoventilation (e.g., CNS depression), drugs (e.g., morphine), PTX, pleural effusion, parenchymal lung disease,
acute airway obstruction

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27
Q

THIRD SPACING
What are the surgical causes of the following conditions:
Respiratory alkalosis
P110

A

Hyperventilation (e.g., anxiety, pain, fever, wrong ventilator settings)

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28
Q

THIRD SPACING
What is the “classic” acidbase finding with significant
vomiting or NGT suctioning?
P110

A

Hypokalemic hypochloremic metabolic alkalosis

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29
Q

THIRD SPACING
Why hypokalemia with NGT suctioning?
P110

A

Loss in gastric fluid—loss of HCl causes

alkalosis, driving K⁺ into cells

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30
Q

THIRD SPACING
What is the treatment for hypokalemic hypochloremic
metabolic alkalosis?
P110

A

IVF, Cl⁻/K⁺ replacement

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31
Q

THIRD SPACING
What is paradoxic alkalotic aciduria?
P110

A

Seen in severe hypokalemic, hypovolemic, hypochloremic metabolic alkalosis with paradoxic metabolic alkalosis of serum and acidic urine

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32
Q

THIRD SPACING
How does paradoxic alkalotic aciduria occur?
P110

A

H⁺ is lost in the urine in exchange for Na⁺ in an attempt to restore volume

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33
Q

THIRD SPACING
With paradoxic alkalotic aciduria, why is H⁺ preferentially lost?
P110

A

H⁺ is exchanged preferentially into the
urine instead of K⁺ because of the low
concentration of K⁺

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34
Q

THIRD SPACING
What can be followed to assess fluid status?
P110

A

Urine output, base deficit, lactic acid, vital signs, weight changes, skin turgor, jugular venous distention (JVD), mucosal membranes, rales (crackles), central venous
pressure, PCWP, chest x-ray findings

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35
Q

THIRD SPACING
With hypovolemia, what changes occur in vital signs?
P110

A

Tachycardia, tachypnea, initial rise in diastolic blood pressure because of clamping down (peripheral vasoconstriction) with subsequent decrease in both
systolic and diastolic blood pressures

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36
Q

THIRD SPACING
What are the insensible fluid losses?
P111

A

Loss of fluid not measured:
a) Feces—100 to 200 mL/24 hours
b) Breathing—500 to 700 mL/24 hours
(Note: increases with fever and tachypnea)
c) Skin—≈300 mL/24 hours, increased with fever; thus, insensible fluid loss is not directly measured

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37
Q

THIRD SPACING
What are the quantities of daily secretions:
Bile
P111

A

≈1000 mL/24 hours

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38
Q

THIRD SPACING
What are the quantities of daily secretions:
Gastric
P111

A

≈2000 mL/ 24 hours

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39
Q

THIRD SPACING
What are the quantities of daily secretions:
Pancreatic
P111

A

≈600 mL/ 24 hours

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40
Q

THIRD SPACING
What are the quantities of daily secretions:
Small intestine
P111

A

≈3000 mL/day

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41
Q

THIRD SPACING
What are the quantities of daily secretions:
Saliva
P111

A

≈1500 mL/24 hours

Note: almost all secretions are reabsorbed

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42
Q

THIRD SPACING
How can the estimated levels of daily secretions from bile,
gastric, and small-bowel sources be remembered?
P111

A

Alphabetically and numerically: BGS and 123 or B1, G2, S3, because Bile, Gastric, and Small bowel produce roughly 1 L,
2 L, and 3 L, respectively!

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43
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises normal saline (NS)?
P111

A

154 mEq of Cl⁻

154 mEq of Na⁺

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44
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises 1/2 NS?
P111

A

77 mEq of Cl⁻

77 mEq of Na⁺

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45
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises 1/4 NS?
P111

A

39 mEq of Cl⁻

39 mEq of Na⁺

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46
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises lactated Ringer’s (LR)?
P111

A 
130 mEq Na⁺
109 mEq Cl⁻
28 mEq lactate
4 mEq K⁺
3 mEq Ca⁺
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47
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises D5W?
P111

A

5% dextrose (50 g) in H(2)O

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48
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What accounts for tonicity?
P112

A

Mainly electrolytes; thus, NS and LR are both isotonic, whereas 1/2 NS is hypotonic to serum

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49
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What happens to the lactate in LR in the body?
P112

A

Converted into bicarbonate; thus, LR cannot be used as a maintenance fluid because patients would become alkalotic

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50
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Gastric (NGT)
P112

A

D5 1/2 NS + 20 KCl

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51
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Biliary
P112

A

LR+/-sodium bicarbonate

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52
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Pancreatic
P112

A

LR+/-sodium bicarbonate

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53
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Small bowel (ileostomy)
P112

A

LR

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54
Q

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Colonic (diarrhea)
P112

A

LR+/-sodium bicarbonate

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55
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the 100/50/20 rule?
P112

A

Maintenance IV fluids for a 24-hour period:
100 mL/kg for the first 10 kg
50 mL/kg for the next 10 kg
20 mL/kg for every kg over 20 (divide by 24 for hourly rate)

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56
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the 4/2/1 rule?
P112

A

Maintenance IV fluids for hourly rate:
4 mL/kg for the first 10 kg
2 mL/kg for the next 10 kg
1 mL/kg for every kg over 20

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57
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the maintenance for a 70-kg man?
P112

A 
Using 100/50/20:
100 x 10 kg = 1000
50 x 10 kg = 500
20 x 50 kg = 1000
Total = 2500
Divided by 24 hours = 104 mL/hr maintenance rate
Using 4/2/1:
4 x 10 kg = 40
2 x 10 kg = 20
1 x 50 kg = 50
Total = 110 mL/hr maintenance rate
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58
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the common adult maintenance fluid?
P113

A

D5 1/2 NS with 20 mEq KCl/L

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59
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the common pediatric maintenance fluid?
P113

A

D5 1/4 NS with 20 mEq KCl/L (use 1/4 NS because of the decreased ability of children to concentrate urine)

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60
Q

CALCULATION OF MAINTENANCE FLUIDS
Why should sugar (dextrose) be added to maintenance
fluid?
P113

A

To inhibit muscle breakdown

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61
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the best way to assess fluid status?
P113

A

Urine output (unless the patient has cardiac or renal dysfunction, in which case central venous pressure or wedge pressure is often used)

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62
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the minimal urine output for an adult on
maintenance IV?
P113

A

30 mL/hr (0.5 cc/kg/hr)

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63
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the minimal urine output for an adult trauma
patient?
P113

A

50 mL/hr

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64
Q

CALCULATION OF MAINTENANCE FLUIDS
How many mL are in 12 oz (beer can)?
P113

A

356 mL

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65
Q

CALCULATION OF MAINTENANCE FLUIDS
How many mL are in 1 oz?
P113

A

30 mL

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66
Q

CALCULATION OF MAINTENANCE FLUIDS
How many mL are in 1 tsp?
P113

A

5 mL

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67
Q

CALCULATION OF MAINTENANCE FLUIDS
What are common isotonic fluids?
P113

A

NS, LR

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68
Q

CALCULATION OF MAINTENANCE FLUIDS
What is a bolus?
P113

A

Volume of fluid given IV rapidly (e.g., 1 L over 1 hour); used for increasing intravascular volume, and isotonic fluids should be used (i.e., NS or LR)

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69
Q

CALCULATION OF MAINTENANCE FLUIDS
Why not combine bolus fluids with dextrose?
P113

A

Hyperglycemia may result

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70
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the possible consequence of hyperglycemia in
the patient with hypovolemia?
P114

A

Osmotic diuresis

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71
Q

CALCULATION OF MAINTENANCE FLUIDS
Why not combine bolus fluids with a significant amount of
potassium?
P114

A

Hyperkalemia may result (the potassium in LR is very low: 4 mEq/L)

72
Q

CALCULATION OF MAINTENANCE FLUIDS
Why should isotonic fluids be given for resuscitation
(i.e., to restore intravascular volume)?
P114

A

If hypotonic fluid is given, the tonicity of the intravascular space will be decreased and H(2)O will freely diffuse into the
interstitial and intracellular spaces; thus, use isotonic fluids to expand the intravascular space

73
Q

CALCULATION OF MAINTENANCE FLUIDS
What portion of 1 L NS will stay in the intravascular
space after a laparotomy?
P114

A

In 5 hours, only ≈200 cc (or 20%) will remain in the intravascular space!

74
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the most common trauma resuscitation fluid?
P114

A

LR

75
Q

CALCULATION OF MAINTENANCE FLUIDS
What is the most common postoperative IV fluid after
a laparotomy?
P114

A

LR or D5LR for 24 to 36 hours, followed by maintenance fluid

76
Q

CALCULATION OF MAINTENANCE FLUIDS
After a laparotomy, when should a patient’s fluid be
“mobilized”?
P114

A

Classically, POD #3; the patient begins to “mobilize” the third-space fluid back into the intravascular space

77
Q

CALCULATION OF MAINTENANCE FLUIDS
What IVF is used to replace duodenal or pancreatic fluid
loss?
P114

A

LR (bicarbonate loss)

78
Q

ELECTROLYTE IMBALANCES
What is a common cause of electrolyte abnormalities?
P114

A

Lab error!

79
Q

ELECTROLYTE IMBALANCES
What is a major extracellular cation?
P114

A

Na⁺

80
Q

ELECTROLYTE IMBALANCES
What is a major intracellular cation?
P114

A

K⁺

81
Q

HYPERKALEMIA
What is the normal range for potassium level?
P115

A

3.5–5.0 mEq/L

82
Q

HYPERKALEMIA
What are the surgical causes of hyperkalemia?
P115

A

Iatrogenic overdose, blood transfusion, renal failure, diuretics, acidosis, tissue destruction (injury/hemolysis)

83
Q

HYPERKALEMIA
What are the signs/ symptoms?
P115

A

Decreased deep tendon reflex (DTR) or areflexia, weakness, paraesthesia, paralysis, respiratory failure

84
Q

HYPERKALEMIA
What are the ECG findings?
P115

A

Peaked T waves, depressed ST segment, prolonged PR, wide QRS, bradycardia, ventricular fibrillation

85
Q

HYPERKALEMIA
What are the critical values?
P115

A

K⁺ >6.5

86
Q

HYPERKALEMIA
What is the urgent treatment?
P115

A
  • IV calcium (cardioprotective), ECG monitoring
  • Sodium bicarbonate IV (alkalosis drives K⁺ intracellularly)
  • Glucose and insulin
  • Albuterol
  • Sodium polystyrene sulfonate (Kayexalate) and furosemide (Lasix)
  • Dialysis
87
Q

HYPERKALEMIA
What is the nonacute treatment?
P115

A

Furosemide (Lasix), sodium polystyrene sulfonate (Kayexalate)

88
Q

HYPERKALEMIA
What is the acronym for the treatment of acute symptomatic hyperkalemia?
P115

A

“CB DIAL K”:
Calcium
Bicarbonate

 Dialysis
 Insulin/dextrose
 Albuterol
 Lasix

 Kayexalate
89
Q

HYPERKALEMIA
What is “pseudohyperkalemia”?
P115

A

Spurious hyperkalemia as a result of
falsely elevated K⁺ in sample from
sample hemolysis

90
Q

HYPERKALEMIA
What acid-base change lowers the serum potassium?
P116

A

Alkalosis (thus, give bicarbonate for hyperkalemia)

91
Q

HYPERKALEMIA
What nebulizer treatment can help lower K⁺ level?
P116

A

Albuterol

92
Q

HYPOKALEMIA
What are the surgical causes?
P116

A

Diuretics, certain antibiotics, steroids, alkalosis, diarrhea, intestinal fistulae, NG aspiration, vomiting, insulin, insufficient supplementation, amphotericin

93
Q

HYPOKALEMIA
What are the signs/symptoms?
P116

A

Weakness, tetany, nausea, vomiting, ileus, paraesthesia

94
Q

HYPOKALEMIA
What are the ECG findings?
P116

A

Flattening of T waves, U waves, ST segment depression, PAC, PVC, atrial fibrillation

95
Q

HYPOKALEMIA
What is a U wave?
P116 (picture)

A

(see picture)

96
Q

HYPOKALEMIA
What is the rapid treatment?
P116

A

KCl IV

97
Q

HYPOKALEMIA
What is the maximum amount that can be given through a peripheral IV?
P116

A

10 mEq/hour

98
Q

HYPOKALEMIA
What is the maximum amount that can be given through a central line?
P116

A

20 mEq/hour

99
Q

HYPOKALEMIA
What is the chronic treatment?
P116

A

KCl PO

100
Q

HYPOKALEMIA
What is the most common electrolyte-mediated ileus in
the surgical patient?
P116

A

Hypokalemia

101
Q

HYPOKALEMIA
What electrolyte condition exacerbates digitalis toxicity?
P117

A

Hypokalemia

102
Q

HYPOKALEMIA
What electrolyte deficiency can actually cause hypokalemia?
P117

A

Low magnesium

103
Q

HYPOKALEMIA
What electrolyte must you replace first before replacing K⁺?
P117

A

Magnesium

104
Q

HYPOKALEMIA
Why does hypomagnesemia make replacement of K⁺ with hypokalemia nearly impossible?
P117

A

Hypomagnesemia inhibits K⁺ reabsorption from the renal tubules

105
Q

HYPERNATREMIA
What is the normal range for sodium level?
P117

A

135–145 mEq/L

106
Q

HYPERNATREMIA
What are the surgical causes?
P117

A

Inadequate hydration, diabetes insipidus, diuresis, vomiting, diarrhea, diaphoresis, tachypnea, iatrogenic (e.g., TPN)

107
Q

HYPERNATREMIA
What are the signs/ symptoms?
P117

A

Seizures, confusion, stupor, pulmonary or peripheral edema, tremors, respiratory paralysis

108
Q

HYPERNATREMIA
What is the usual treatment supplementation slowly over
days?
P117

A

D5W, 1/4 NS, or 1/2 NS

109
Q

HYPERNATREMIA
How fast should you lower the sodium level in hypernatremia?
P117

A

Guideline is <12 mEq/L per day

110
Q

HYPERNATREMIA
What is the major complication of lowering the sodium
level too fast?
P117

A

Seizures (not central pontine myelinolysis)

111
Q

HYPONATREMIA
What are the surgical causes of the following types:
Hypovolemic
P117

A

Diuretic excess, hypoaldosteronism, vomiting, NG suction, burns, pancreatitis, diaphoresis

112
Q

HYPONATREMIA
What are the surgical causes of the following types:
Euvolemic
P118

A

SIADH, CNS abnormalities, drugs

113
Q

HYPONATREMIA
What are the surgical causes of the following types:
Hypervolemic
P118

A

Renal failure, CHF, liver failure (cirrhosis), iatrogenic fluid overload (dilutional)

114
Q

HYPONATREMIA
What are the signs/ symptoms?
P118

A

Seizures, coma, nausea, vomiting, ileus, lethargy, confusion, weakness

115
Q

HYPONATREMIA
What is the treatment of the following types:
Hypovolemic
P118

A

NS IV, correct underlying cause

116
Q

HYPONATREMIA
What is the treatment of the following types:
Euvolemic
P118

A

SIADH: furosemide and NS acutely, fluid restriction

117
Q

HYPONATREMIA
What is the treatment of the following types:
Hypervolemic
P118

A

Dilutional: fluid restriction and diuretics

118
Q

HYPONATREMIA
How fast should you increase the sodium level in
hyponatremia?
P118

A

Guideline is <12 mEq/L per day

119
Q

HYPONATREMIA
What may occur if you correct hyponatremia too quickly?
P118

A

Central pontine myelinolysis!

120
Q

HYPONATREMIA
What are the signs of central pontine myelinolysis?
P118

A
  1. Confusion
  2. Spastic quadriplegia
  3. Horizontal gaze paralysis
121
Q

HYPONATREMIA
What is the most common cause of mild postoperative
hyponatremia?
P118

A

Fluid overload

122
Q

HYPONATREMIA
How can the sodium level in SIADH be remembered?
P118

A

SIADH = Sodium Is Always Down

Here = Hyponatremia

123
Q

“PSEUDOHYPONATREMIA”
What is it?
P118

A

Spurious lab value of hyponatremia as a result of hyperglycemia, hyperlipidemia, or hyperproteinemia

124
Q

HYPERCALCEMIA
What are the causes?
P119

A

“CHIMPANZEES”:
Calcium supplementation IV
Hyperparathyroidism (1° /3° ) hyperthyroidism
Immobility/Iatrogenic (thiazide diuretics)
Mets/Milk alkali syndrome
Paget’s disease (bone)
Addison’s disease/Acromegaly
Neoplasm (colon, lung, breast, prostate, multiple myeloma)
Zollinger-Ellison syndrome (as part of MEN I)
Excessive vitamin D
Excessive vitamin A
Sarcoid

125
Q

HYPERCALCEMIA
What are the signs/ symptoms?
P119

A

Hypercalcemia—“Stones, bones, abdominal groans, and psychiatric overtones” Polydipsia, polyuria, constipation

126
Q

HYPERCALCEMIA
What are the ECG findings?
P119

A

Short QT interval, prolonged PR interval

127
Q

HYPERCALCEMIA
What is the acute treatment of hypercalcemic crisis?
P119

A

Volume expansion with NS, diuresis with furosemide (not thiazides)

128
Q

HYPERCALCEMIA
What are other options for lowering Ca⁺ level?
P119

A

Steroids, calcitonin, bisphosphonates (pamidronate, etc.), mithramycin, dialysis (last resort)

129
Q

HYPOCALCEMIA
How can the calcium level be determined with
hypoalbuminemia?
P119

A

(4-measured albumin level) x 0.8, then add this value to the measured calcium level

130
Q

HYPOCALCEMIA
What are the surgical causes?
P119

A

Short bowel syndrome, intestinal bypass, vitamin D deficiency, sepsis, acute pancreatitis, osteoblastic metastasis, aminoglycosides, diuretics, renal failure,
hypomagnesemia, rhabdomyolysis

131
Q

HYPOCALCEMIA
What is Chvostek’s sign?
P119

A 
Facial muscle spasm with tapping of
facial nerve (Think: CHvostek = CHeek)
132
Q

HYPOCALCEMIA
What is Trousseau’s sign?
P120

A

Carpal spasm after occluding blood flow in forearm with blood pressure cuff

133
Q

HYPOCALCEMIA
What are the signs/symptoms?
P120

A

Chvostek’s and Trousseau’s signs, perioral paraesthesia (early), increased deep tendon reflexes (late), confusion, abdominal cramps, laryngospasm, stridor, seizures, tetany, psychiatric abnormalities (e.g., paranoia, depression, hallucinations)

134
Q

HYPOCALCEMIA
What are the ECG findings?
P120

A

Prolonged QT and ST interval (peaked T waves are also possible, as in hyperkalemia)

135
Q

HYPOCALCEMIA
What is the acute treatment?
P120

A

Calcium gluconate IV

136
Q

HYPOCALCEMIA
What is the chronic treatment?
P120

A

Calcium PO, vitamin D

137
Q

HYPOCALCEMIA
What is the possible complication of infused calcium if the IV infiltrates?
P120

A

Tissue necrosis; never administer peripherally unless absolutely necessary (calcium gluconate is less toxic than
calcium chloride during an infiltration)

138
Q

HYPOCALCEMIA
What is the best way to check the calcium level in the ICU?
P120

A

Check ionized calcium

139
Q

HYPERMAGNESEMIA
What is the normal range for magnesium level?
P120

A

1.5–2.5 mEq/L

140
Q

HYPERMAGNESEMIA
What is the surgical cause?
P120

A

TPN, renal failure, IV over supplementation

141
Q

HYPERMAGNESEMIA
What are the signs/ symptoms?
P120

A

Respiratory failure, CNS depression, decreased deep tendon reflexes

142
Q

HYPERMAGNESEMIA
What is the treatment?
P120

A

Calcium gluconate IV, insulin plus glucose, dialysis (similar to treatment of hyperkalemia), furosemide (Lasix)

143
Q

HYPOMAGNESEMIA
What are the surgical causes?
P120

A

TPN, hypocalcemia, gastric suctioning, aminoglycosides, renal failure, diarrhea, vomiting

144
Q

HYPOMAGNESEMIA
What are the signs/symptoms?
P121

A

Increased deep tendon reflexes, tetany, asterixis, tremor, Chvostek’s sign, ventricular ectopy, vertigo, tachycardia,
dysrhythmias

145
Q

HYPOMAGNESEMIA
What is the acute treatment?
P121

A

MgSO4 IV

146
Q

HYPOMAGNESEMIA
What is the chronic treatment?
P121

A

Magnesium oxide PO (side effect: diarrhea)

147
Q

HYPOMAGNESEMIA
Hypomagnesemia may make it impossible to correct what other electrolyte abnormality?
P121

A

Hypokalemia (always fix hypomagnesemia with hypokalemia)

148
Q

HYPERGLYCEMIA
What are the surgical causes?
P121

A

Diabetes (poor control), infection, stress, TPN, drugs, lab error, drawing over IV site, somatostatinoma, glucagonoma

149
Q

HYPERGLYCEMIA
What are the signs/symptoms?
P121

A

Polyuria, hypovolemia, confusion/coma, polydipsia, ileus, DKA (Kussmaul breathing), abdominal pain, hyporeflexia

150
Q

HYPERGLYCEMIA
What is the treatment?
P121

A

Insulin

151
Q

HYPERGLYCEMIA
What is the Weiss protocol?
P121

A

Sliding scale insulin

152
Q

HYPERGLYCEMIA
What is the goal glucose level in the ICU?
P121

A

80–110 mg/dL

153
Q

HYPOGLYCEMIA
What are the surgical causes?
P121

A

Excess insulin, decreased caloric intake, insulinoma, drugs, liver failure, adrenal insufficiency, gastrojejunostomy

154
Q

HYPOGLYCEMIA
What are the signs/ symptoms?
P121

A

Sympathetic response (diaphoresis, tachycardia, palpitations), confusion, coma, headache, diplopia, neurologic deficits, seizures

155
Q

HYPOGLYCEMIA
What is the treatment?
P121

A

Glucose (IV or PO)

156
Q

HYPOPHOSPHATEMIA
What is the normal range for phosphorus level?
P122

A

2.5–4.5 mg/dL

157
Q

HYPOPHOSPHATEMIA
What are the signs/symptoms?
P122

A

Weakness, cardiomyopathy, neurologic dysfunction (e.g., ataxia), rhabdomyolysis, hemolysis, poor pressor response

158
Q

HYPOPHOSPHATEMIA
What is a complication of severe hypophosphatemia?
P122

A

Respiratory failure

159
Q

HYPOPHOSPHATEMIA
What are the causes?
P122

A

GI losses, inadequate supplementation, medications, sepsis, alcohol abuse, renal loss

160
Q

HYPOPHOSPHATEMIA
What is the critical value?
P122

A

<1.0 mg/dL

161
Q

HYPOPHOSPHATEMIA
What is the treatment?
P122

A

Supplement with sodium phosphate or potassium phosphate IV (depending on potassium level)

162
Q

HYPERPHOSPHATEMIA
What are the signs/symptoms?
P122

A

Calcification (ectopic), heart block

163
Q

HYPERPHOSPHATEMIA
What are the causes?
P122

A

Renal failure, sepsis, chemotherapy,

hyperthyroidism

164
Q

HYPERPHOSPHATEMIA
What is the treatment?
P122

A

Aluminum hydroxide (binds phosphate)

165
Q

MISCELLANEOUS
This ECG pattern is consistent with which electrolyte abnormality?
P122 (picture)

A

Hyperkalemia: peaked T waves

166
Q

MISCELLANEOUS
If hyperkalemia is left untreated, what can occur?
P123 (picture)

A

Ventricular tachycardia/fibrillation → death

167
Q

MISCELLANEOUS
Which electrolyte is an inotrope?
P123

A

Calcium

168
Q

MISCELLANEOUS
What are the major cardiac electrolytes?
P123

A

Potassium (dysrhythmias), magnesium

dysrhythmias), calcium (dysrhythmias/inotrope

169
Q

MISCELLANEOUS
Which electrolyte must be monitored closely in patients on digitalis?
P123

A

Potassium

170
Q

MISCELLANEOUS
What is the most common cause of electrolyte-mediated
ileus?
P123

A

Hypokalemia

171
Q

MISCELLANEOUS
What is a colloid fluid?
P123

A

Protein-containing fluid (albumin)

172
Q

MISCELLANEOUS
What is the rationale for using an albuminfurosemide
“sandwich”?
P123

A

Albumin will pull interstitial fluid into the intravascular space and the furosemide will then help excrete the fluid as urine

173
Q

MISCELLANEOUS
An elderly patient goes into CHF (congestive heart failure) on POD #3 after a laparotomy. What is going on?
P123

A

Mobilization of the “third-space” fluid into the intravascular space, resulting in fluid overload and resultant CHF (but
also must rule out MI)

174
Q

MISCELLANEOUS
What fluid is used to replace NGT (gastric) aspirate?
P123

A

D5 1/2 NS with 20 KCl

175
Q

MISCELLANEOUS
What electrolyte is associated with succinycholine?
P123

A

Hyperkalemia

Section I, Surgical Recall Sixth Edition (33 decks)

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