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Pharm 2-EXAM #2 > Fluids & Electrolytes > Flashcards

Fluids & Electrolytes Flashcards

1
Q

ICF is _____of the human body, while ECF is ______

A

2/3

1/3

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2
Q

The ECF compartment its composed of

A

80% interstitial fluid

20% plasma

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3
Q

ICF compartment is rich in what electrolytes?

A

K+
Mg
Ca
Phos
Protein

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4
Q

ECF compartment is rich ini what electrolytes?

A

Na
Cl

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5
Q

Proteins & large molecules are prevented from free movement by

A

Vascular endothelial cell tight junctions

Endothelial glycocalyx layer

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6
Q

The inflammatory state will increase the number of

A

Pores

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7
Q

The inflammatory state will promote

A

Protein & macromolecule movement into the interstitial space, which can cause albumin to double (during surgery ~10% or more in sepsis ~20%)

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8
Q

Characteristics of Static parameters

A

Read in real time

Less accurate

Vascular status can goo unrecognized

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9
Q

Beta blockade can

A

Mask tachycardic response to hypovolemia

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10
Q

CVP may be inadequate in determining..

A

Preload

Fluid Responsiveness

Pulmonary Edema Risk

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11
Q

Inhalation anesthetics & surgical stress maay reduce

A

Urine output iin euvolemic patients

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12
Q

Intraop oliguria, _______, does not

A

<0.5 ml/kg/hr

Predict AKI

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13
Q

Mixed venous O2 saturation is intended to _________ & is proportional to________

A

Track global O2 delivery

Proportional to CO, tissue perfusion, & O2 delivery

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14
Q

Mixed venous O2 saturation may

A

NOT reflect tissue perfusion changes when O2 consumption is variable (fever/sepsis)

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15
Q

Characteristics of Dynamic parameters

A

More accurate

Preferred

Goal-directed

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16
Q

Characteristics of respiratory variations

A

Variations in PPV, SVV, SBPV

Controlled mechanical ventilation

Vasomotor tone & cardiac function

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17
Q

What is the normal variation with respirations?

A

<10-12%

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18
Q

What does it mean in variations are Greater than 10-12%?

Less than?

A

Greater than means fluid responsiveness

Less than means vasopressor responsiveness

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19
Q

What are the limitations to respiratory variations?

A

During spontaneous ventilation

Low TV/ High PEEP

Open thoracic surgery

Elevated intra-abdominal pressure

Tamponade

Arrhythmias

Right sided HF

Vasoactive infusions

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20
Q

When do we use End-expiratory occlusion test?

A

Used in ventilated patients with arrhythmias, spontaneous ventilation or low TV

Ventilation is interrupted for 15sec

Assess for >5% increase in pulse pressure or pulse contour CO

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21
Q

Fluid solution containing water-soluble electrolytes & low molecular weight molecules

A

Crystalloids

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22
Q

Crystalloids are classified by

A

tonicity

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23
Q

Isotonic & “balanced” crystalloids contain

A

Various levels of other electrolytes like K, Mg, & Cl

Contains organic anions (lactate, gluconate & acetate)

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24
Q

Isotonic & Balanced Crystalloids are used to treat

A

ECF deficits

Administration of drugs & blood products

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25
Q
A
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26
Q
A
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27
Q

What are examples of isotonic/balanced crystalloids

A

0.9% NaCl

LR

Plasmalyte

Normosol-R

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28
Q

What is the strong ion difference?

A

Difference between completely dissociated cations & anions in the plasma

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29
Q

What is the normal SID?

A

~40mEq/L

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30
Q

Increased SID _____ the pH

Decreased SID _____the pH

A

Increased SID= Increased pH

Decreased SID= Decreased pH

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31
Q

What can happen with excessive 0.9% NS infusion?

A

Lactic Acidosis

Hyperchloremic Metabolic Acidosis

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32
Q

When Isotonic crystalloids are given, what percent remains intravascularly?

A

20-25% in the healthy patient

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33
Q

In healthy patients, volume of distribution approximates ________

A

Relative size of intravascular & interstitial compartments

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33
Q

Effective SID also takes into account

A

Bicarb & the anion equivalent of albumin & phosphate

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34
Q

When isotonic crystalloids are infused, what percent of the infused volume can be lost?

A

~50% cane lost in ~30min

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35
Q

Giving hypotonic crystalloids will

A

Reduce the osmolarity of the ECF, making the water redistribute to the intracellular compartment

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35
Q

Hypotonic crystalloid have a _____effective osmolality than the patient

A

Lower

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36
Q

Hypotonic crystalloids are used as

A

Maintenance fluids

Treat solute-free water deficits

Administration of drugs

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37
Q

What are examples of Hypotonic crystalloids

A

0.45%NaCl

5% Dextrose in water

Plasma-Lyte 56 (5% dex)

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38
Q

Hypertonic crystalloids have a _______ effective osmolality than the patient

A

Greater

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39
Q

Hypertonic crystalloids _______the osmolality of ECF

A

Increase osmolality of the ECF, which causes water to redistribute out of the intracellular compartment

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40
Q

Hypertonic crystalloids are used to target

A

A desired solute concentration

Promote fluid redistribution

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41
Q

Examples of hypertonic crystalloids

A

Dextrose 5% in NS

3-7.5% Saline

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42
Q

What should be kept in mind of the fasting period

A

Try to minimize it

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42
Q

What is the positive fluid balance goal?

A

1-2L at the end of surgery

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43
Q

Which resuscitation method is preferred?

A

Balanced

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44
Q

What is the risk of balanced salt administration?

A

Large volumes place the patient at risk for hyperlactatemiaa, metabolic alkalosis, & hypotonicity

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45
Q

Ca+ containing solutions risk

A

The formation of micro thrombi when they are administered with citrate-containing blood products

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46
Q

Colloids are

A

A fluid solution containing large molecular weight particles suspended in a crystalloid solution

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47
Q

How are colloids categorized?

A

Natural or Synthetic

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48
Q

What are examples of natural colloids?

A

Whole Blood

Plasma

Concentrated Albumin Solutions

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49
Q

What are examples of colloid synthetics/semi-synthetics?

A

Gelatins

Hydroxyethyl starch (HES) solutions

Dextrans

Polysaccharides

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50
Q

Albumin increases

A

Serum albumin & colloid osmotic pressure

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51
Q

Albumin is pasteurized to

A

Reduce the risk of viral transmission

52
Q

Hydroxyethyl Starches are a

A

Variety of solutions with different concentrations, molecular weights & crystalloid carriers

53
Q

HES solutions affects

A

Osmotic pressure, half life, & coagulation effects

54
Q

What are the black box warnings of HES?

A

Critically ill/sepsis

Renal dysfunction or signs of renal injury after HES infusion

Open heart surgery w/CPB

Signs of coagulopathy after HES infusion

55
Q

Dose of HES?

A

20-50ml/kg/day

56
Q

What are the redistribution characteristics of HES?

A

Leaves the plasma

Temporary storage in the skin, liver, & kidneys

Trace amounts of HES detectable up to 6 months later

57
Q

Adverse effects of HES

A

Decrease ion factor 8 & von Willebrand factor

Decreased PLT function

Impaired renal function (renal injury)

58
Q

What happens once HES is really excreted?

A

Immediate glomerular filtration

Delayed filtration of large molecules

Hydrolysis in the plasma by alpha-amylase

Hydroxyethyl groups can slow the process

59
Q

When are crystalloids used intraoperatively?

A

Routine

Replacement of senile & insensible losses

Replace blood loss

Optimize intravascular volume

60
Q

What fluid can be used in renal patients?

A

NS

61
Q

Which solution is typically avoided?

A

Dextrose containing solutions due to hyperglycemia risk

62
Q

Colloids should be given in a ______ replacement

A

1:1

63
Q

Colloids can be used to

A

Expand microvasacular volume with minimal capillary leakage iiii fluid responsive patients

64
Q

When are colloids preferred?

A

In patients with fluid restrictions since it reduces the edema risks

65
Q

What increases the risk of significant HOTN during induction?

A

Fasting

Bowel prep

Diuretics

Inflammatory disorders

Interstitial edema

Active hemorrhage

66
Q

What surgical factor can lead to hypervolemia?

A

Excess crystalloid. colloid, or PRBC which dilutes coagulation factors leading to exacerbation of bleeding

67
Q

What patient factors can lead to hypervolemia?

A

CHF with compensatory fluid retention

Renal insufficiency

68
Q

General anesthesia can cause

A

Dose-dependent vasodilation, myocardial depression & HOTNN

69
Q

Neuraxial anesthesia can cause

A

Sympathetic blockade with overload of IVF

70
Q

What are the risk associated with fluid overload?

A

Reduced tissue perfusion r/t tissue edema

Impaired O2 exchange & respiratory dysfunction

GI edema, decreased motility, ileus, or ascites

Coagulopathy

71
Q

What is a typical rate to infuse crystalloids, that supports fluid loss & metabolic rate?

A

3-5ml/kg/hr

72
Q

What bolus should be given to help support respiratory variations >10-12%

A

250cc bolus crystalloid/colloid

73
Q

The majority of Na is in the

A

ECF

74
Q

What are the functions of Na?

A

Water movement/balance

Control of osmotic pressure

Osmolality & volum eof ECF

Nerve impulse conduction

Muscle contraction

75
Q

Na excretion is stimulated by

A

parathyroid hormone & natriuretic peptides

76
Q

Hyponatremia can be caused by

A

Hypervolemic causes (CHF & cirrhosis)

Hypovolemia causes (diarrhea, vomiting & diuretics)

Salt wasting (intracranial injury)

Euvolemic causes (adrenal insufficiency & polydipsia)

77
Q

What are the symptoms of hyponatremia?

A

Cerebral edema

Confusion

Coma

N/V

Muscle cramps

78
Q

Hypernatremia is caused by

A

Water loss

Nephrogenic/central diabetes insipidus

Excessive Na administration

79
Q

Symptoms of hypernatremia

A

Signs of dehydration or fluid excess

Cellular death

AMS

Seizures

Coma

80
Q

The majority of K+ is in

A

ICF

81
Q

Function of K+

A

Cell membrane excitability (nerve, muscle & heart)

Kidney function

Endothelial-dependent vasodilator

Inhibits thrombus formation & PLT activation

Influences osmotic pressure

82
Q

What hormones affect K+ secretion?

A

Aldosterone

Glucocorticoids

Catecholamines

Arginine vasopressin

83
Q

Acidosis ______ K+ secretion

A

Decreases

84
Q

Alkalosis ________ K+ secretion

A

Increases

85
Q

Hypokalemia can be caused by

A

Diuretics

Beta Agonists

Insulin

Abx

Catecholamines

GI losses

86
Q

Symptoms of hypokalemia

A

Skeletal muscle weakness

Muscle cramps

Rhabdomyolysis

Ileus

N/v

Abdominal distention

Dysrhythmias

87
Q

What are the EKG characteristics with hypokalemia?

A

Hyperpolarization

Increased automaticity & excitability

T wave inversion

U wave

Tachyarrhythmias

Torsades

Afib

88
Q

How do you treat hypokalemia?

A

K+ replacement PO/IV

10mEq/hr IV

20mEq/hr central line

89
Q

K+ replacement in the setting of intracellular shifts

A

May cause hyperkalemia

90
Q

Patients with diminished regulation of K+ like DM or renal failure have a

A

Higher risk of hyperkalemia

91
Q

Hyperkalemia can be caused by

A

K+ redistribution or inhibition of secretion

Aldosterone antagonists

Beta antagonists

NSAIDs

Chemo

PRBC transfusion

92
Q

Symptoms of hyperkalemia

A

Peaked T waves

QRS widens

Prolonged PR

Cardiac conduction blockade

Decreased automaticity

VF

Asystole

Paresthesias

Skeletal muscle weakness

93
Q

How do you treat hyperkalemia?

A

Calcium IV ( not as fast)

Sodium bicarbonate 0.5-1mEq/kg IV

Insulin + glucose

Kayexalate

Beta agonists

Loops

94
Q

Calcium IV will

A

rapidly repair adverse cardiac conduction & contractility effects

95
Q

Sodium bicarbonate alkalinization will

A

shift K+ into the cells & promote secretion

96
Q

Giving insulin + glucose when treating hyperkalemia can decrease serum K+ by

A

1.5-2.5 mEq/L

97
Q

The majority of Mg is in

A

ICF (bone, muscle & soft tissue)

98
Q

What are the functions of Mg?

A

Protein synthesis

Nucleic acid stability

Neuromuscular function

Muscle relaxation

Antiarrhythmic

Vasodilation

Stabilization of BBB

Limits cerebral edema

Decreases anesthetic requirements

99
Q

Hypomagnesemia is caused by

A

diet

GI malabsorption

Renal losses

Citrate binding in massive transfusions

100
Q

Symptoms of hypomagnesemia

A

Prolonged PR & QT

Diminished T wave

Torsades

Arrhythmias

Weakness

Tetany

Fasciculations

Convulsions

N/V

101
Q

Hypermagnesemia is caused by

A

Excessive administration

102
Q

Symptoms of hypermagnesemia

A

QRS widens

Conduction blockade

Asystole

HOTN

Respiratory depression

Muscle paralysis

Diminished reflexes

Narcosis

103
Q

How to treat hypermagnesemia

A

Calcium glutinate 10-15mg/kg IV

Diuretics or dialysis

104
Q

What is preeclampsia

A

A pregnancy disorder of HHTN, proteinuria & liver dysfunction

105
Q

We give Mg to treat preeclampsia, since its MOA is to cause

A

Systemic, vertebral & uterine vasodilation

Increase concentration of endogenous vasodilators

Attenuate endogenous vasoconstrictors

106
Q

What is the recommended dose of Mg in the treatment of preeclampsia?

A

4g loading dose + 1g/hr IV (24hrs)

107
Q

What happens when Mg crosses the placenta?

A

Will have neonatal lethargy

HOTN

Respiratory depression

108
Q

What arrhythmias can Mg treat?

A

Polymorphic wide complex tachycardias

Long QT syndrome

Digoxin induced tachyaarrhythmias

109
Q

Mg is used during CPB/CABG since

A

It may help decrease post-op Afib

110
Q

Mg is effective in being an analgesia due to

A

Antinociceptive affects & NMDA antagonism

111
Q

Mg is helpful in treating asthma by being a

A

Bronchodilator via inhibition of calcium, histamine, & ACh

IV Mg may improve bronchodilation when other therapies fail

112
Q

Mg can help treat Pheochhromocytoma (tumor w/ excess catecholamine) by

A

Causing arterial smooth muscle relaxation

Reducing catecholamine release

113
Q

Plasma ionization of calcium depends on pH…

A

Acidosis increases

Alkalosis decreases

114
Q

Calcium may shift storage sites

A

In low albumin states

115
Q

Functions of Ca+

A

Musculoskeletal strength & contraction

Neuromuscular transmission

Cardiac muscle contractility, relaxation & rhythm

Vascular motor tone

Coagulation

Intracellular signaling

116
Q

Ca+ involvement in homeostasis

A

Endocrine control through Vet D, parathyroid hormone & calcitonin

Regulates intestinal absorption, renal reabsorption & bone turnover

117
Q

Hypocalcemia is caused by

A

Decreased albumin & Vit D

Hypoparathyroid

Pancreatitis

Chronic renal failure

Citrate binding

118
Q

How to treat hypocalcemia

A

Calcium chloride (27mg)

Calcium Gluconate (9mg)

118
Q

Symptoms of hypocalcemia

A

Neuromuscular excitation (twitching, spasms, paresthesia & tetany)

Seizures

Dysrhythmias

119
Q

How should Ca+ chloride be administered?

A

Central line or it can cause extravasation, leading to subcutaneous irritation, necrosis or sloughing

120
Q

Avoid rapid IVP administration of

A

Ca+

121
Q

Dose of Ca+ treatment?

A

0.5-2g

122
Q

Hypercalcemia is caused by

A

Hyperparathyroid

Parathyroid adenoma

Malignancies

Excess in dietary

Meds

123
Q

Symptoms of hypercalemia

A

GI smooth muscle relaxation (N/V & constipation)

Decreased neuromuscular transmission (lethargy & hypotonia)

Polyuria

Dehydration

Renal Stones

Shortened QT

124
Q

How is hypercalcemia treated?

A

Goal is to promote renal calcium excretion

IVF

Loops

Corticosteroids

Biophosphonates

Calcitonin

Gallium nitrate

Mithramycin

Hemodialysis

125
Q

The majority of Phosphate is

A

Intracellular (bone & soft tissues)

126
Q

What are the functions of phosphate?

A

Energy metabolism

Intracellular signaling (cAMP)

Immune system regulation

Coagulation cascade regulation

Buffer for acid base balance

127
Q

Phosphate play a role in homeostasis by influencing

A

Vit D

Parathyroid hormone (GI absorption)

Renal reabsorption

Bone storage

128
Q

Hypophosphatemia permits an

A

Increase in serum calcium

129
Q

Hypophosphatemia decreases

A

ATP & 2,3 DPG in erythrocytes, which decreases the release of O2

130
Q

Hypophosphatemia will cause

A

Skeletal muscle weakness & hypoventilation

CNS dysfunction

Peripheral neuropathy

Pharm 2-EXAM #2 (5 decks)

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