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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
What's oliguria defined as?
less than 400 cc of urine in 24 hrs
26
How much urine do we need to make daily to excrete toxins?
0.24 cc/kg/hr | normally we give 0.5 cc/kg/hr to over compensate
27
Normal K level range? Hypokalemia? Hyperkalemia?
3.5-->5 Hypo--> less than 3.5 Hyper--> greater than 5
28
What are sensible fluid losses?
fluid losses from diarrhea, NG tube, urine output
29
WHat are insensible fluid losses?
fluid losses from skin, respiratory tract, open abdomen
30
Adult K requirements?
0.5--0.8 mEq/kg/day
31
What are normal insensible fluid losses for an adult daily?
50-500 cc/day
32
Systemic sxs of hypokalemia?
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
33
What are some signs of hypokalemia?
``` constipation muscle fatigue parasthesia paralysis diminished deep tendon reflexes parasthesias ```
34
What conditions can cause hyperkalemia?
rhabdo acidosis muscle relaxants for anesthesia hypoaldosteronism hyperpyrexia
35
How does an acidosis cause hyperkalemia?
H ions are shifted into the intracellular space K is shifted into the extracellular space
36
How does alkalosis cause hypokalemia?
H ions are shifted to the extracellular space K is shifted into the intracellular space
37
EKG signs of hypokalemia?
low voltage, flattended, inverted T waves prominent U waves depressed ST segment wide QRS prolonged PR interval
38
Low voltage, flattended, inverted T waves, prominent U waves seen with hyper or hypokalemia?
hypokalemia
39
What EKG changes do we see with hyperkalemia?
peaked T waves (usually at K >6( flattened P waves can see complete heart block and atrial systole
40
When do we see sine wave appearance on EKG of hyperkalemia?
at K >8 wide QRS complexes merge with T waves ***this can be followed by v-fib and cardiac arrest
41
What do we do if hypokalemia is caused by low magnesium and low Ca?
replace Mg and Ca first
42
When treating a pt with hyperkalemia, what are some rapidly acting methods to correct?
IV calcium IV insulin/glucose **do not remove K from the body, just shift it in and out of cells
43
What are some methods of removing K from the body in cases of hyperkalemia?
loop diuretics;for use in pts without renal impairment kayexalate dialysis**very effective
44
2nd most prevalent intracellular cation?
Mg
45
What does Mg do?
cofactor in ATP-powered rxns modulates Ca-influx has a role w/muscles including myocyte contraction
46
Normal ranges of Mg?
1.5--2.5
47
Most abundant intra-cellular anion?
P
48
Role of phosphate?
organic form is important in ATP rxns inorganic form (85%) is in bone, contributing to strength and structure
49
Normal serum P levels?
2.5--4.5
50
What cause hypomagnesemia?
renal, GI, skin losses | hungry bone syndrome
51
GI, renal, and skin causes of hypomagnesemia?
GI: chronic diarrhea, high output fistula Renal: diuresis skin: burns, TEN
52
How does etoh cause hypomagnesemia?
diuretic effect magnesium deficiency
53
Causes of hypermagnesemia?
theophylline toxicity magnesium containing antacids magnesium infusion in obstetric pts w/preeclampsia
54
Causes of low phosphate?
hyperparathyroidism causes increased renal excretion of P after major liver resection--> regenerating hepatocytes use phosphate rapidly
55
Causes of high phosphate?
pts w/renal insufficiency pts w/tumor lysis syndrome, rhabdo, hemolysis
56
When do we start seeing sxs of hypomagnesemia in pts?
when levels fall below 1.2
57
Sxs of hypomagnesemia?
neuromuscular and CNS irritability
58
Seere hypomagnesemia in post-surgical pts can lead to what?
ventricular arrhythmia like Torsades
59
Sxs of hypermagnesemia?
usually with Mg >6 loss of deep tendon reflexes --> can progress to paralysis, apnea, heart failure, coma
60
Sxs of low phosphate?
muscle weakness pts can become vent dependent or difficult to wean from vent after major liver resection
61
Sxs of high phosphate?
typically asymptomatic
62
How do we treat Torsades?
1 to 2 g magnesium bolus during 5 minutes
63
TX for hypermagnesemia?
Ca to stabilize heart NS for fluid expansion loop diuretics to excrete Mg out
64
Normal Ca ranges?
8.5--10.2
65
Most common Ca-binding protein?
albumin
66
Corrected Ca formula?
(0.8 x (Normal alb - Pt's alb)] + serum Ca
67
How does blood transfusion cause hypocalcemia?
citrate in blood binds Calcium
68
Causes of low Ca?
massive transfusion hypothyroidism after thyroid/parathyroid surgery Vit D deficiency gastric bypass acute pancreatitis osteoblastic mets
69
Causes of hypercalcemia?
``` malignancy sarcoidosis 1, 3 hyperparathyroidism loops, thiazides FHH ```
70
What sxs do we normally see with hypocalcemia?
perioral numbness tingling of extremities muscle cramps
71
Trousseau sign seen in hypocalcemia?
carpopedial spasm when inflating BP cuff
72
Chvostek sign of hypocalcemia?
contraction of ipsilateral facial muscles by tapping facial nerve anterior to ear
73
Sxs of hypercalcemia?
fatigue depression constipation
74
Acute hypercalcemia shows what EKG changes?
short QT interval
75
Hypocalcemia shows what EKG changes?
prolongation QT interval
76
Classifying hyponatremia as mild;moderate;severe;
mild; 130-138 moderate; 120-130 severe; <120
77
Sxs of severe hyponatremia?
headaches lethargy induce comas/seizures cells swell due to inability to maintain homeostatic osmolality
78
What does hypernatremia cause?
cells shrink cause confusion, coma, intracranial hemorrhage
79
For central diabetes insipidus what drug can we give?
DDVAVP
80
Corrected Na formula?
[Na] + 0.016 x (glucose -100)
81
Formula for serum osmolality?
2 x [Na] + BUN/2.8 + Glucose/18
82
4:2:1 rule of fluid replacement;
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
Why do we want to correct hyponatremia gradually?
avoids central pontine myelinosis seen 1 -6 days after sxs; pseudo-bulbar palsy, quadriparesis, movement disorders, decreased consciousness
84
Rapid correction of severe hypernatremia causes?
irrerversible neurological deficits due to cerebral edema

Appendix (39 decks)

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