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Anesthesia Principles 1 > Fluids , Electrolytes, and Acid-Base > Flashcards

Fluids , Electrolytes, and Acid-Base Flashcards

1
Q

What fraction of body water is found in extracellular space?

A

20% and 14 Liters
Major ions = Sodium, Chloride, Ca+, and Bicarb

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2
Q

70kg adult has how many Liters of body water? Volume is what percent of weight?

A

42L and 60% of body weight

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3
Q

Intracellular Volume

A

40% of total body weight
28L
Major ions = Potassium, Magnesium, and Phosphate

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4
Q

ECV can be further divided into?

A

Interstitial fluid and plasma

-Interstitial fluid = 16% TBW or 11 L
-Plasma = 4% TBW or 3L

can be (15% and 5%)

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5
Q

What population has the highest TBW of water?

A

Neonates 80%

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6
Q

What population has the lowest TBW of water?

A

Females, the obese, and the elderly

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7
Q

What determines the net movement of fluid between the intravascular space and interstitial spaces?

A

Starling forces and Glycocalyx

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8
Q

Forces that move fluid from CAPILLARY to INTERSTITIAL SPACE

A

Pc= Capillary hydrostatic pressure (PUSHES fluid out of capillary)

^ if = Interstitial oncotic pressure (PULLS fluid out of capillary)

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9
Q

Forces that move fluid from INTERSTITIAL space into CAPILLARY

A

P if= Interstitial hydrostatic pressure (pushes fluid into capillary)

^ c= Capillary oncotic pressure (pulls fluid into capillary)

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10
Q

What is the pressure of a solution against a semipermeable membrane that prevents water from diffusing across that membrane?

A

Osmotic pressure

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11
Q

Which solutes cannot diffuse across semipermeable membrane?

A

ions, protiens, glucose

carrier proteins transport these solutes from one side to the other

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12
Q

Equation to calculate Plasma Osmolarity

A

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

Normal = 280- 290 (high is hyper and low is hypo)

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13
Q

What is the most important determinant of plasma osmolarity?

A

Sodium

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14
Q

Conditions that increase osmolarity include…..

A

hypernatremia, hyperglycemia, and uremia

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15
Q

What does giving a hypotonic solution do to ECF, ICF and plasma osmolarity?

A

Increase ECF and ICF volumes
Decreases plasma osmolarity

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16
Q

What fluid should you never give a patient with increase ICP?

A

HYPOTONIC!!!
poor expanders of intravascular volume

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17
Q

What does giving isotonic solution do to ECF, ICF, and plasma osmolarity?

A

Increase ECF
ICF and plasma osmolarity stay the same!

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18
Q

How long do Crystalloids stay in the intravascular space for?

A

30 minutes

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19
Q

What can cause hypercholemic metabolic acidosis? What is given instead for large-volume resuscitation?

A

NaCl can cause it

LR is used (the lactate functions as a buffer because the lactate is converted to bicarb by the liver and kidneys)

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20
Q

What fluids are given to dilute PRBCs?

A

NS and Plasmalyte

LR contains calcium which is why it is avoided. (book answer)

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21
Q

What organ is the most important regulator of potassium homeostasis?

A

Kidneys (decreased GFR/renal failure increases serum potassium)

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22
Q

Causes of Hypokalemia (< 3.5 mEq/L)

A

poor intake, GI loss, renal loss, or redistribution (K+ shifts IN to cells)

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23
Q

Causes of Hyperkalemia ( > 5.5 mEq/L)

A

Increased total body potassium and redistribution (K+ shift OUT of cells)

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24
Q

What is responsible for maintaining the intracellular distribution of potassium?

A

the Na+K+ATPase pump

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25
Q

Hyperkalemia does what to membranes?
Hypokalemia?

A

Hyperkalemia DEpolarizes membranes
Hypokalemia HYPERpolarizes membranes

26
Q

HYPOkalemia symptoms

A

skeletal muscle cramps —> weakness —-> paralysis
Worsens Digoxin toxicity

27
Q

HYPERkalemia symptoms

A

Cardiac rhythm distrubances

28
Q

EKG findings of HYPOkalemia

A

LONG–> PR interval
LONG–> QT interval
FLAT–> T wave
U wave

29
Q

EKG findings of HYPERkalemia

A

5.5 - 6.5 = Peaked T waves
6.5 - 7.5 = P wave flattened
7.0- 8.0 = QRS prolongation
8.5 or greater = VF or sine wave

30
Q

Most common electrolyte disorder in clinical practice?

A

HYPOkalemia

31
Q

How fast to administer IV K+ ?

A

Peripheral = 10mEq per hour
Central = 20mEq per hour

32
Q

Treating HYPOnatremia too quickly causes what?

A

Fluid to shift from ICF to ECF too quickly which can produce pontine myelinolysis

33
Q

Treating HYPERnatremia too quickly causes what?

A

Fluid shifts from ECF to ICF which produces cerebral EDEMA

34
Q

Rate to correct insensible fluid loss

A

2ml/kg/hr of crystalloid

35
Q

Administering a large volume of albumin can lead to __________.

A

HYPOcalcemia

36
Q

Acidosis _______ ionized calcium

A

INCREASES

37
Q

Parathyroid _________ serum calcium and calcitonin __________ serum calcium.

A

Raises, Lowers

38
Q

Which phase in the cardiac muscle cell action potential does Ca+ play a crucial role?

A

Phase 2

39
Q

Normal plasma calcium (total)

A

8.5-10.5 md/dL or 4.5- 5.5 mEq/L

40
Q

Normal ionized calcium level

A

4.65 - 5.28 mg/dL or 2.2 - 2.6 mEq/L

41
Q

Primary treatment for magnesium toxicity?

A

CALCIUM! it antagonizes the effects of magnesium at the NMJ

42
Q

What is the most abundant electrolyte in the body?

A

CALCIUM (nearly all stored in bone)
Calcium is factor 4 in coagulation pathway

43
Q

Acidosis________ ionized calcium (albumin binds H+ and displaces Ca++ into plasma)

A

INCREASES

44
Q

Alkalosis_______ ionized calcium. (albumin binds Ca++ and displaces H+ into the plasma)

A

DECREASES

45
Q

Hypocalcemia EKG findings

A

LONG QT interval

46
Q

Hypercalemia EKG findings

A

SHORT QT interval

47
Q

Hypercalcemia Tx?
Hypocalcemia Tx?

A

Hyper= 0.9 NS and Loop diuretic
Hypo= calcium and vitamin D

48
Q

Magnesium _________ the effects of calcium.

A

antagonizes

49
Q

Tx for Pre-eclampsia

A

4g load IV over 10-15 minutes then 1g/hr for 24 hours.
Mag crosses the placenta

50
Q

The Henderson-Hasselbalch equation details what?

A

How PaCO2 and HCO3- influence pH

51
Q

Acidosis effects (P50, SNS, CBF, ICP, K+, SNS tone)

A

Increase P50 (right = release)
Increase SNS tone
Increase risk of dysrhythmias
decrease contractility
increase CBF and ICP

HYPERKALEMIA

52
Q

Alkalosis effects (P50, SNS, CBF, ICP, K+, SNS tone)

A

Decrease P50 (left = love)
decrease coronary blood flow
increase dyshrythmias
decrease CBF and ICP

HYPOKALEMIA
decreased ionized calcium

53
Q

How does hypercarbia effect the lungs compared to the peripheral circulation?

A

in the lungs CO2 is a direct-acting vasoconstrictor where it can cause pulmonary HTN and increased RV workload (dilates periphery)

54
Q

Most common cause of Respiratory Acidosis?

A

Hypoventilation

55
Q

What happens when alveolar ventilation exceeds CO2 production?

A

Respiratory alkalosis

56
Q

Most common cause of Respiratory Alkalosis?

A

Iatrogenic —> Mechanical Ventilation

also pain, anxiety, pregnancy, PE

57
Q

How does the body compensate for Respiratory Alkalosis?

A

Kidenys excrete Bicarb to return pH to normal
takes a few days

58
Q

Increased anion gap determines acidosis from what?

A

DKA, salicylates, and cyanide poisoning

59
Q

Normal anion gap determines acidosis from what?

A

Diarrhea, pancreatic fistula, NaCl solutions for resuscitation

60
Q

Causes of Metabolic Acidosis

A

accumulation of nonvolatile acids, loss of bicarb, or large volume resuscitation with NS

61
Q

Causes of Metabolic Alkalosis

A

increased bicarb, loss of acids (NG suction), increased mineralocorticoid activity (Cushing’s syndrome)

Anesthesia Principles 1 (11 decks)

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