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Apex > Fluids,Electrolytes, and Acid-Base > Flashcards

Fluids,Electrolytes, and Acid-Base Flashcards

1
Q

In a textbook male, water represents what % or total body weight?

A

60%

OR 42 LITERS!!

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2
Q

Total body water can be divided into what two compartments?

A

Intracellular ~ 40%

Extracellular ~ 20%

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3
Q

What are the major ions of INTRAcellular volume?

A

“PMP”
“When you in the cell, you a PiMP”

Potassium
Mg
Phosphate

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4
Q

What are the major ions of EXTRAcellular volume?

A

“Salt, milk, and a hamburger shift”

Na
Ca
Cl- AND HCO3

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5
Q

How is extracellular fluid divided?

A

15 and 5 baby!

15% of total body weight = interstitial fluid

5% of total body weight = plasma

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6
Q

What does capillary hydrostatic pressure do?

A

Pushes fluid OUT of the capillary

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7
Q

What does interstitial oncotic pressure do?

A

Pulls fluid OUT of the capillary

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8
Q

What does interstitial hydrostatic pressure do?

A

Pushes fluid INTO capillary

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9
Q

What does capillary oncotic pressure do?

A

Pulls fluid into capillary

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10
Q

What is the equation for net filtration pressure?

A

(Capillary hydrostatic - interstitial hydrostatic) - (capillary oncotic - interstitial oncotic)

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11
Q

What is the glycocalyx?

A

Endothelial protective layer of the interior wall of a blood vessel. Acts as a “gate keeper”

***also has some anticoagulant properties

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12
Q

What happens when the glycocalyx is distrusted?

A

Capillary leak ~ reduces tissue oxygenation

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13
Q

What conditions impair the glycocalyx?

A

Sepsis
Ischemia
DM
Major vascular surgery

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14
Q

What is the hematocrit?

A

It is the fraction of blood volume that is occupied by erythrocytes

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15
Q

What is HCT increased by?

A

Increased number of RBCs (polycythemia) or decreased plasma volume (hypovolemia)

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16
Q

What is Hct decreased by?

A

Decreased number of RBCs (anemia) or an increased plasma volume (hemodilution)

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17
Q

What is osmoLALITY?!

A

Number of osmoles per kilogram of solution

“With a KILO of moles, you’re going to get LIT”

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18
Q

What is osmoLARITY?

A

Numbers of osmoles per liter of solution

“LAREN loves to drink LITERS of fluid”

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19
Q

What is osmosis?

A

Net mov of water across a semipermeable membrane (ONLY water)

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20
Q

What is diffusion?

A

It’s the net movement of a substance from an area of higher concentration to an area of lower concentration across a FULLY permeable membrane

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21
Q

What is osmotic pressure?

A

It’s the pressure of a solution against a semipermeable membrane that prevents water from diffusing that membrane

***function of the number of osmotically active particles in a solution

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22
Q

What is an osmole?

A

It is the number of osmotically active particles in a solution

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23
Q

How do you calculate plasma osmolarity?

A

(Na x 2) + (glucose/18) + (BUN/2.8)

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24
Q

What is a normal osmolarity?

A

280-290 mOsm/L

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25
Q

What is the MOST important factor in osmolarity?!?!

A

Sodium!

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26
Q

What do hypotonic fluids do?

A

Water enters and CELL SWELLS

Ex: NaCl 0.45%
D5W

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27
Q

What do isotonic fluids do?

A

No water transfer and cell remains same size

Ex: NaCl 0.9%, LR, Plasmalyte

IN ADDITION: albumin, voluven, hespan

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28
Q

What do hypertonic fluids do to the cell?

A

Water exits and cell shrinks

Ex: NaCl 3%, D5 NaCl 0.9%, D5 NaCl 0.45%, and D5 LR

IN ADDITION: Dextran 10%

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29
Q

How long do crystalloids remain in the intravascular space?

A

30 mins!

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30
Q

Why is LR a better choice for large volume resuscitation?

A

Because large amounts of NaCl can cause hyperchloremic metabolic acidosis

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31
Q

Which two solutions can be used to dilute RBCs?

A

Plasmalyte and normal saline

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32
Q

How long do colloids increase plasma volume?

A

3-6 hours

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33
Q

Which colloids reduces blood viscosity and improves micro circulatory flow in vascular surgery?

A

Dextran 40

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34
Q

What electrolyte abnormality can albumin cause?

A

Hypocalcemia

Binds to calcium

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35
Q

What are some traits about dextran, hetastarch and hextend?

A

Coagulopathy ~ dextran > hetastarch > hextend

Don’t exceed 20 mL/kg!!!

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36
Q

Which colloid has the highest anaphylactic potential?

A

Dextran

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37
Q

Which is the ONLY colloid derived from human blood products?

A

Albumin!

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38
Q

What is the black box warning in synthetic colloids?

A

Risk of renal injury

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39
Q

What is normal potassium?

A

3.5-5.5

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40
Q

What is the most abundant intracellular cation?

A

Potassium

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41
Q

Which “kalemia” hyperpolarizes the cell?

A

Hypokalemia!

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42
Q

Which type of “kalemia” depolarizes membranes?

A

Hyperkalemia!!

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43
Q

What are some EKG findings for hypokalemia <3.5?!

A

U wave
Flattened t wave
QT interval prolongation
PR interval prolongation

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44
Q

What are some EKG findings for Hyperkalemia >5.5?

A

5.5-6.5 ~ peaked T waves
6.5 -7.5 ~ p wave flattening, PR prolongation
7.5-8.5: QRS prolongation
> 8.5 sine wave ~ vfib

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45
Q

What are some things that redistribute K inward?

A

Insulin + D50
Bicarb
Hyperventilation
Beta 2 agonist

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46
Q

What are some things that redistribute potassium extracellularly?

A

Acidosis
Succinylcholine
Beta-blockers
Hyperkalemic periodic paralysis

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47
Q

What is the MOST common electrolyte disorder in clinical practice?

A

HYPOkalemia

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48
Q

How fast should you administer K in a peripheral line? How fast in a central line?

A

Peripheral: 10 mEq per hour
Central: 20 mEq per hour

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49
Q

What is Normal serum sodium?

A

135-145

50
Q

What is the most abundant extracellular cation?

A

Sodium

51
Q

at what sodium level should you delay surgery?

A

< 130 mEq/L

52
Q

How slowly should you correct disorders of sodium balance?

A

No more than 1-2 mEq/L/hr

53
Q

What can happen if you treat hyponatremia too quick?!

A

Causes fluid to shift from ICF to ECF ~ this can produce central pontine myelinoysis

54
Q

What can happen if you treat hypernatremia too quick?

A

Causes fluid to shift from ECF to ICF ~ this can produce cerebral edema

55
Q

What is factor 4 in the coagulation pathway?

A

Calcium

56
Q

What is a normal plasma Ca level? (Total and ionized)

A

Total: 8.5-10.5

Ionized: 4.65-5.28

57
Q

What is the most abundant electrolyte in the body?

A

Calcium

58
Q

Calcium antagonizes who’s effects at the neuromuscular junction?

A

Magnesium’s!

59
Q

How does acidosis affect calcium concentration?

A

Increases ionized calcium

60
Q

How does alkalosis affect ionized calcium?

A

It decreases ionized calcium

61
Q

What hormone raises Ca?

A

Parathyroid hormone

62
Q

What hormone reduces serum Ca?

A

Calcitonin

63
Q

What gland releases calcitonin?

A

Thyroid gland

64
Q

What are some presentations of hypocalcemia?

A

Skeletal musc cramps
Nerve irritability
Laryngospasm
Mental status changes ~ seizures
Chvosteks sign
Trousseau sign

65
Q

How does hypocalcemia affect the EKG?

A

Prolonged QT

(Maybe it takes long to get enough Ca to initiate contraction)

66
Q

What are some presentations of hypercalcemia?

A

Nausea
Abdominal pain
HTN
Psychosis

67
Q

How does hypercalcemia affect the EKG?

A

Short QT

(Maybe there is an abundant supply so it doesn’t take as long?)

68
Q

What is chvostek’s sign?

A

Tapping of angle of jaw ~ facial contraction

(Chvostek = cheek)

69
Q

What is trousseau Sign?

A

Upper BP cuff is inflated abound SBP for 3 mins ~ decreased blood flow accentuates neurmuscular irritability ~ muscle spasms of hand and forearm

70
Q

Loss of deep tendon reflexes is the result of what?

A

Hypermagnesemia

71
Q

What is a normal Mg level (total)?

A

1.7-2.4

72
Q

Which electrolytes does Mg antagonize the effects of?

A

Calcium!

73
Q

What is the dose of magnesium for pre-eclampsia?

A

4 gram load over 10-15 mins

1 g/h for 24 hours

74
Q

What are some common causes of Hypomagnesemia?! <1.8 mg/dL

A

Poor intake
ETOH
Diuretics
Illness
Common with hypokalemia

75
Q

What are some common causes of hypermagnesemia? > 2.5 mg/dL

A

Excessive administration
Renal failure
Adrenal insufficiency

76
Q

What is the EKG finding with Hypomagnesemia?

A

Torsades and/or prolonged QT

77
Q

What is the EKG finding with Hypermagnesemia?

A

Heart block

78
Q

What are the S&S of a Mg level of < 1.2?

A

Tetany
Seizures
Dysrhythmias

79
Q

What are the S&S of a mag level 1.2-1.8?

A

Neuromuscular irritability
Hypokalemia
Hypocalcemia

80
Q

What happens at a Mg level of 2.5-5 mg/dL?

A

Nothing typically

81
Q

What happens at a Mg level of 5-7?

A

Diminished tendon reflexes
Lethargy
Flushing
N&V

82
Q

What happens at a Mg level of 7-12 mg/dL?

A

Loss of deep tendon reflexes
Hypotension
EKG
Somnolence

83
Q

What happens at a Mg greater than 12 mg/dL?

A

Resp depression
CHB
Arrest
Coma
Paralysis

84
Q

How does magnesium work as an opioid sparing drug?

A

Antagonizes the NMDA receptor

85
Q

What equation states that a solution’s pH is a function of the ratio of dissociated anion to the non-dissociated acid?

A

Henderson-Hasselbach

pH = pK + log [A-]/[HA]

86
Q

What is the most important buffer of the blood?

A

Bicarbonate!

87
Q

What is the second most important buffer of the blood?

A

Hemoglobin!

88
Q

What is a normal anion gap?

A

8-12

89
Q

What are examples of metabolic acidosis with a NORMAL anion gap?

A

HARD UP

H: hypoaldosteronism
A: acetazolamide
R: renal tubular acidosis
D: diarrhea
U: uretosigmoid fistula
P: pancreatic fistula

90
Q

What is consider a increased anion gap?

A

> 12

91
Q

What are examples of metabolic acidosis with an increased anion gap?!

A

MUDPILES

M: methanol
U: uremia
D: diabetes ketoacida
P: paraldeyde
I: isoniazid
L: lactate
E: ethanol
S: Salicylates

92
Q

How does acidosis affect the heart?

A

Increase in P50 (shift to the right)
Increase in SNS
Increase risk dysrhythmias
Decreased contractility

93
Q

How does alkalosis affect the heart?

A

Decreased P50 (left=love)
Decreased coronary blood flow
Increase risk of dysrhythmias

94
Q

What type of acid-base disorder does untreated pain result in?

A

Resp alkalosis

95
Q

At what pH should you mechanically ventilate?

A

< 7.20

96
Q

In ACUTE resp distress, for every 10 mmHg increase in PaCO2 ~ pH decreased by what?

A

0.08

97
Q

In CHRONIC resp acidosis, for every 10 mmHg increase in PaCO2, pH decrease by what?

A

0.03

98
Q

When do you have CO2 narcosis?

A

PaCO2 > 90 mmHg

99
Q

What is the most common cause of respiratory acidosis?

A

Hypoventilation

100
Q

What is the most common cause of resp alkalosis?

A

Mechanical ventilation.

101
Q

When should your treat resp alkalosis? It specially in a spontaneously ventilating patient? And how should you treat it?

A

pH> 7.6

Give sedation

102
Q

What are the two most common causes for metabolic alkalosis?

A

Vomiting
Massive blood transfusion

103
Q

How do you treat metabolic alkalosis?

A

Acetazolamide
Spironolactone (mineralcorticoid antagonist)
Dialysis

104
Q

What is the calculation for determining fluid maintenance?

A

4:2:1

4 mL/kg for 1st 10 kg
2 mL/kg for 2nd 10 kg
1 mL/kg for subsequent kg of body weight

105
Q

How do you calculate fluid deficit?

A

Fasting hrs x hourly maintenance

106
Q

How do you calculate third space for very minor trauma?

A

1-2 mL/kg

Orofacial surgery

107
Q

How do you calculate third space for minimal trauma?

A

2-4 mL/kg

Hernia

108
Q

How do you calculate third space for moderate trauma?

A

4-6 mL/kg

Major NON-abd surgery

109
Q

How do you calculate third space for severe trauma?

A

6-8

Major abdominal surgery

110
Q

How much crystalloid is given to replace blood loss?

A

3:1

111
Q

How much colloid to replace for blood loss?

A

1:1

112
Q

What happens with too little fluid resuscitation?

A

Decreased volume (hypovolemia)
Decreased O2 delivery
Decreased organ perfusion
Hemoconcentration
Myocardial ischemia
PONV
Renal impairment

113
Q

What happens with too much volume resuscitation?

A

Excessive volume
Decreased O2 delivery (d/t microvascular congestion)
Impaired glycocalyx
Hemodilution
Impaired wound healing
Pneumonia
Liver congestion impaired gut fx

114
Q

On what part of the Starling curve, does additional fluid increase sarcomata stretch? Aka is responsive

A

Slope

115
Q

Which part of the starling curve describes the optimal balance b/t circulating volume and myocardial performance?

A

Plateau

Preload INDEPENDENCE

116
Q

Which part of the frank starling curve impairs myocardial performance?

A

Overshoot

117
Q

What are some preoperative components of the recommended ERAS?

A

Pre admission counseling
Fluid and carbohydrate loading
fasting
Abx prophylaxis
Avoidance of premedication
Thromboprophylaxis

118
Q

What are some intraoperative components of the ERAS?

A

Mid-thoracic epidural
Short-acting drugs
Goal-directed fluid therapy
Normothermia
PONV prophylaxis
No surgical drains (if possible)

119
Q

What are some post operative components of the ERAs protocol?

A

Mid-thoracic epidural
Opioid-sparing analgesia
Judicious fluid administration
PONV prophylaxis
No OG/NG
Encouraging gut motility
Early oral intake
Early removal of catheter early ambulation

120
Q

What are the common causes of hypercalcemia?

A

Hyperparathyroidism and cancer

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