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Appendix > Fluids + Electrolytes > Flashcards

Fluids + Electrolytes Flashcards

1
Q

Water makes up what % of total body weight?

A

50-60 %

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2
Q

50-60% of total body weight is composed of what?

A

water

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3
Q

Relationship between TB weight and TBwater is a reflection?

A

body fat

**lean tissues like muscle and solid organs –> have higher water content than fat/bone

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4
Q

Lean tissues like muscle and solid organs have higher water content than what?

A

Fat/Bone

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5
Q

Why do young lean males have a higher proportion of TB water than an elderly or obese pt?

A

lean tissues like muscle and solid organs have more water content that fat/bone

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6
Q

TBWater and TBWeight in males vs females:

A

males–> TBwater makes up 60% of weight

females—> TBwater makes up 50% of weight
women have more adipose, less muscle tissue

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7
Q

The highest % of TBWater per weight is found in which pts?

A

newborns

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8
Q

In newborns what % of TBweight is TBwater?

A

80%

decreased to 65% by year 1 and then remains stable

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9
Q

In the body, water can be found in 3 compartments, what are they?

A

intracellular
intravascular
interstitial

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10
Q

2/3 of water in the body found where?

A

intracellular

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11
Q

Intravascular volume makes up what % of TB weight?

A

5-7%

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12
Q

Intracellular water makes up what % of an individual’s total body weight?

A

40%, mostly in skeletal muscle

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13
Q

What are the main intracellular cations??

A

K

Mg

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14
Q

What are the main intracellular anions?

A

phosphates

proteins

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15
Q

Extracellularly what is the predominant cation?

A

Na

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16
Q

Extracellularly what are the anions?

A

Cl

HCO3

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17
Q

The concentration gradient between intra-cellular and extra-cellular compartments is maintained by what?

A

Na-K ATPase

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18
Q

What determines osmolality?

A

Na
Glucose
BUN

2N + Glu/18 + BUN/2.8

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19
Q

What is the osmolality of intracellular and extracellular fluids?

A

290-310 mOsm

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20
Q

What are the daily water intakes and daily water losses?

A

Intake; 2 L/day, 75% from PO, 25% from solid foods

Losses: 800- 1200 cc in urine, 250 cc in stool, 600 cc insensible

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21
Q

To clear products of metabolism the kidney must excrete how much water daily?

A

500-800 cc of urine/daily

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22
Q

What is a simple way to calculate fluid rate in pts weighing more than 40kg?

A

40 + weight in kg

73 kg male maintenance rate is 73 + 40–> 113 cc/hr

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23
Q

Maintenance fluid formula?

A

4 cc/kg for first 10 kg
2 cc/kg for next 10 kg
1 cc/kg for every kg over 20

(ex; 45 kg pt–> 4 x10, 2x 10, 1 x25 = 85cc/hr)
(ex; 73 kg pt–> 4x 10, 2 x 10, 1x 53 = 113 cc/hr)

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24
Q

Daily Na and K needs for a 70 kg male?

A

Na 2-4 g

K 100 mEq

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25
Q

What’s oliguria defined as?

A

less than 400 cc of urine in 24 hrs

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26
Q

How much urine do we need to make daily to excrete toxins?

A

0.24 cc/kg/hr

normally we give 0.5 cc/kg/hr to over compensate

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27
Q

Normal K level range?

Hypokalemia?

Hyperkalemia?

A

3.5–>5

Hypo–> less than 3.5

Hyper–> greater than 5

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28
Q

What are sensible fluid losses?

A

fluid losses from diarrhea, NG tube, urine output

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29
Q

WHat are insensible fluid losses?

A

fluid losses from skin, respiratory tract, open abdomen

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30
Q

Adult K requirements?

A

0.5–0.8 mEq/kg/day

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31
Q

What are normal insensible fluid losses for an adult daily?

A

50-500 cc/day

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32
Q

Systemic sxs of hypokalemia?

A

Neuro; fatigue, paresthesia, paralysis, can exacerbate increased ammonia production–> hepatic encephalopathy

MSK: rhabdomyolysis, diminished deep tendon reflexes

Renal; polyuria and polydipsia secondary to decreased ability to concentrate urine

GI: anorexia, N/V, due to paralytic ileus

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33
Q

What are some signs of hypokalemia?

A 
constipation
muscle fatigue
parasthesia
paralysis
diminished deep tendon reflexes
parasthesias
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34
Q

What conditions can cause hyperkalemia?

A

rhabdo

acidosis

muscle relaxants for anesthesia

hypoaldosteronism

hyperpyrexia

35
Q

How does an acidosis cause hyperkalemia?

A

H ions are shifted into the intracellular space

K is shifted into the extracellular space

36
Q

How does alkalosis cause hypokalemia?

A

H ions are shifted to the extracellular space

K is shifted into the intracellular space

37
Q

EKG signs of hypokalemia?

A

low voltage, flattended, inverted T waves

prominent U waves

depressed ST segment

wide QRS

prolonged PR interval

38
Q

Low voltage, flattended, inverted T waves, prominent U waves seen with hyper or hypokalemia?

A

hypokalemia

39
Q

What EKG changes do we see with hyperkalemia?

A

peaked T waves (usually at K >6(

flattened P waves

can see complete heart block and atrial systole

40
Q

When do we see sine wave appearance on EKG of hyperkalemia?

A

at K >8

wide QRS complexes merge with T waves

***this can be followed by v-fib and cardiac arrest

41
Q

What do we do if hypokalemia is caused by low magnesium and low Ca?

A

replace Mg and Ca first

42
Q

When treating a pt with hyperkalemia, what are some rapidly acting methods to correct?

A

IV calcium

IV insulin/glucose

**do not remove K from the body, just shift it in and out of cells

43
Q

What are some methods of removing K from the body in cases of hyperkalemia?

A

loop diuretics;for use in pts without renal impairment

kayexalate

dialysis**very effective

44
Q

2nd most prevalent intracellular cation?

A

Mg

45
Q

What does Mg do?

A

cofactor in ATP-powered rxns

modulates Ca-influx

has a role w/muscles including myocyte contraction

46
Q

Normal ranges of Mg?

A

1.5–2.5

47
Q

Most abundant intra-cellular anion?

A

P

48
Q

Role of phosphate?

A

organic form is important in ATP rxns

inorganic form (85%) is in bone, contributing to strength and structure

49
Q

Normal serum P levels?

A

2.5–4.5

50
Q

What cause hypomagnesemia?

A

renal, GI, skin losses

hungry bone syndrome

51
Q

GI, renal, and skin causes of hypomagnesemia?

A

GI: chronic diarrhea, high output fistula

Renal: diuresis

skin: burns, TEN

52
Q

How does etoh cause hypomagnesemia?

A

diuretic effect

magnesium deficiency

53
Q

Causes of hypermagnesemia?

A

theophylline toxicity

magnesium containing antacids

magnesium infusion in obstetric pts w/preeclampsia

54
Q

Causes of low phosphate?

A

hyperparathyroidism causes increased renal excretion of P

after major liver resection–> regenerating hepatocytes use phosphate rapidly

55
Q

Causes of high phosphate?

A

pts w/renal insufficiency

pts w/tumor lysis syndrome, rhabdo, hemolysis

56
Q

When do we start seeing sxs of hypomagnesemia in pts?

A

when levels fall below 1.2

57
Q

Sxs of hypomagnesemia?

A

neuromuscular and CNS irritability

58
Q

Seere hypomagnesemia in post-surgical pts can lead to what?

A

ventricular arrhythmia like Torsades

59
Q

Sxs of hypermagnesemia?

A

usually with Mg >6

loss of deep tendon reflexes –> can progress to paralysis, apnea, heart failure, coma

60
Q

Sxs of low phosphate?

A

muscle weakness

pts can become vent dependent or difficult to wean from vent after major liver resection

61
Q

Sxs of high phosphate?

A

typically asymptomatic

62
Q

How do we treat Torsades?

A

1 to 2 g magnesium bolus during 5 minutes

63
Q

TX for hypermagnesemia?

A

Ca to stabilize heart

NS for fluid expansion

loop diuretics to excrete Mg out

64
Q

Normal Ca ranges?

A

8.5–10.2

65
Q

Most common Ca-binding protein?

A

albumin

66
Q

Corrected Ca formula?

A

(0.8 x (Normal alb - Pt’s alb)] + serum Ca

67
Q

How does blood transfusion cause hypocalcemia?

A

citrate in blood binds Calcium

68
Q

Causes of low Ca?

A

massive transfusion
hypothyroidism after thyroid/parathyroid surgery

Vit D deficiency
gastric bypass
acute pancreatitis
osteoblastic mets

69
Q

Causes of hypercalcemia?

A 
malignancy
sarcoidosis 
1, 3 hyperparathyroidism
loops, thiazides
FHH
70
Q

What sxs do we normally see with hypocalcemia?

A

perioral numbness
tingling of extremities
muscle cramps

71
Q

Trousseau sign seen in hypocalcemia?

A

carpopedial spasm when inflating BP cuff

72
Q

Chvostek sign of hypocalcemia?

A

contraction of ipsilateral facial muscles by tapping facial nerve anterior to ear

73
Q

Sxs of hypercalcemia?

A

fatigue
depression
constipation

74
Q

Acute hypercalcemia shows what EKG changes?

A

short QT interval

75
Q

Hypocalcemia shows what EKG changes?

A

prolongation QT interval

76
Q

Classifying hyponatremia as mild;moderate;severe;

A

mild; 130-138

moderate; 120-130

severe; <120

77
Q

Sxs of severe hyponatremia?

A

headaches
lethargy
induce comas/seizures

cells swell due to inability to maintain homeostatic osmolality

78
Q

What does hypernatremia cause?

A

cells shrink

cause confusion, coma, intracranial hemorrhage

79
Q

For central diabetes insipidus what drug can we give?

A

DDVAVP

80
Q

Corrected Na formula?

A

[Na] + 0.016 x (glucose -100)

81
Q

Formula for serum osmolality?

A

2 x [Na] + BUN/2.8 + Glucose/18

82
Q

4:2:1 rule of fluid replacement;

A

4cc/kg/hr for first 10 kg

2 cc/kg/hr for next 10 kg

1 cc/kg/hr for every kg over 20 kg

Ex: 73 kg male; 4x 10 + 2 x10 + 1 x 53 = 113

83
Q

Why do we want to correct hyponatremia gradually?

A

avoids central pontine myelinosis

seen 1 -6 days after

sxs; pseudo-bulbar palsy, quadriparesis, movement disorders, decreased consciousness

84
Q

Rapid correction of severe hypernatremia causes?

A

irrerversible neurological deficits due to cerebral edema

Appendix (39 decks)

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