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NA 1 > Fluids, Electrolytes, and Goal-Directed Therapy > Flashcards

Fluids, Electrolytes, and Goal-Directed Therapy Flashcards

1
Q

ICV represents

A

2/3 of TBW

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1
Q

ECV represents

A

1/3 of TBW

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2
Q

perioperative fluid mamangment involves:

A
  • maintaining intravascular volume
  • augmenting CO
  • maintaining tissue perfusion
  • promoting oxygen delivery
  • correcting and maintaining electrolyte balance
  • enhancing the microcirculatory flow
  • facilitating the delivery of nutrients
  • clearance of metabolic waste
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2
Q

TBW in an average adult represents

A

60% of lean body mass

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3
Q

primary cation and anion in the ECV

A

sodium, chloride

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4
Q

primary cation and anion in the ICV

A

potassium, phosphate

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5
Q

resting membrane gradient for these electrolytes is maintained by the

A

Na and K ATPase

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6
Q

cell membrane is permeable to

A

water

as a result of the ICV and the ECV maintain a state of osmotic equilibrium

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7
Q

daily fluid volume required to maintain TBW homeostasis

A

25-35 mL/kg per day or 2-3 L/day

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8
Q

ECV is further divided into

A

intravascular compartment
interstitial compartment

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9
Q

interstitial compartment represents

A

3/4 of the ECV

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10
Q

intravascular compartment represents

A

1/4 of the ECV

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10
Q

ECV is also composed of a small amount of

A

transcellular fluid:
- CSF
- GI secretions
- intraocular fluid
- synovial fluid

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11
Q

Transcellular fluids are anatomically __ from the fluid dynamics that impact the remaining ECV, therefore they are considered ___

A

isolated; nonfunctional

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12
Q

Capillary hydrostatic pressure (Pc)

A

is the intravascular blood pressure, driven by the force of the CO impacted by the vascular tone

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13
Q

Interstitial fluid pressure (Pif)

A

is the hydrostatic pressure of the interstitial space

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14
Q

Pif of most tissues is slightly __ ; this is thought to be d/t the contraction of __ vessels in the interstitum

A

negative; lymphatic

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15
Q

what has a slightly positive Pif?

A

rigid or encapsulated tissues of the kidneys, brain, bone marrow, and skeletal muscle

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16
Q

plasma oncotic pressire (πp)

A

is the osmotic force of collodial proteins of the vasular space

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17
Q

interstitial oncotic pressure (πif)

A

is the osmotic force of the colloidal proteins within the interstitial space

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18
Q

what protein is the primary determinant of both capillary and interstitial oncotic pressures?

A

albumin

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19
Q

Increase in Pc and πif favor

A

filtration of fluid into the interstitial space

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20
Q

increase in Pif and πp favor

A

absorption of fluid into the intravascular space

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21
Q

Increased Kf favors

A

filtration

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22
Q

A sigma of 0 indicates

A

that the endothelium is freely permeable to the substance

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23
Q

a sigma of 1 indicates

A

that the endothelium si completely impermeable to the substance

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24
Q

positive net filtration favors fluid exudation into

A

the tissues

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25
Q

net filtration tends to be slightly __ at the arterial end of capillaries and slightly __ at the venous end

A

positive; negative

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26
Q

overall balance of filtration pressures within capillaries of the entire body is slightly

A

positive

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27
Q

at what rate is the intravascular volume being filtered into the interstitial space ?

A

2 mL/min

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28
Q

volume is returned to the intravascular space via the

A

lymphatic system

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29
Q

glycocalyx

A

is a gel layer on the luminal surface of the vascular endothelium that plays an important role in:

  • transcapillary fluid exchange
  • microcirculatory flow
  • blood component rheology
  • plasma oncotic pressure
  • signal transduction
  • immune modulation
  • vascular tone
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30
Q

glycocalyx diameter

A

0.1 to 0.2 micrometers

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31
Q

glycocalyx is composed of a matric of

A

glycoproteins, polysaccharides, and hyaluronic acid

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32
Q

dynamic barrier ionically repels __ charged polar compounds in addition to __ __

A

negatively; blood componenets

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33
Q

binding to circulating plasma albumin, the glycocalyx also helps preserve __ __ __ and __ capillary permeability to water

A

capillary oncotic pressure; decrease

this is known as the double barrier effect

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34
Q

the glycocalyx is thought to contain ___ ___ whose binding sites are enclosed in the matrix, helping prevent leukocyte adhesion

A

inflammatory mediators

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35
Q

other functions of the glycocalyx

A
  • scavenging of free radicals
  • binding and activation of anticoagulation factors
  • signal transduction that helps regulate local vasoactive responses to mechanical stress
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36
Q

normal daily alterations in TBW are regulated by

A

RAAS (renin-angiotensin-aldosterone system)
ADH (antidiuretic hormone)
ANP (atrial natriuretic peptide)

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37
Q

what is one of the primary determinants of serum osmolarity and water transport?

A

sodium

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38
Q

RAAS is an important regular of __ homeostasis

A

sodium

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39
Q

what detects hypotension in the RAAS?

A
  • intracardiac
  • renal afferent arteriole barorecpetos
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40
Q

juxtaglomerular cells of the kidney release

A

the enzyme renin

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41
Q

interaction of circulating renin with the precursor __ causes the cleaving of __ to the active substance __

A

angiotensinogen; angiotensinogen; angiotensin I

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42
Q

angiotensin I exerts local

A

vasoconstrictor activity

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43
Q

primary role of angiotensin I

A

is as a precursor for the more potent angiotensin II

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44
Q

this change occurs in the __ as a result of ACE acting as a catalyst for the conversion of angiotensin I to II

A

lungs

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45
Q

angiotensin II directly stimulates what to reabsorb sodium and water?

A

renal tubules

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45
Q

angiontensin II is a potent

A

vasoconstrictor

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46
Q

angiotensin II causes the __ __ to release aldosterone , which further stimulates Na and water retention by the kidneys

A

adrenal cortex

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47
Q

secretion of ADH contributes to an increase in

A

urine concentration and osmolarity

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47
Q

the ADH pathway functions primarily to regulate

A

water balance

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48
Q

Posterior pituitary gland releases __ which causes __ channels within the kidney to transiently reabsorb large quantities of __

A

ADH; aquaporin; water

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49
Q

ADH also plays a role in preserving blood pressure by

A

acting as a potent arterial vasoconstrictor

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50
Q

stretch receptors in the cardiac __ walls stimulate the release of __ from cardiac myocytes as a result of increased preload or hypervolemic state

A

atrial; ANP

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51
Q

the release of ANP stimulates

A

the kidney to release Na and water, thus reducing circulating blood volume and offloading the heart

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52
Q

ANP also produces __ responses in the afferent and efferent renal arterioles to __ the GFR, and it inhibits the release of __ & __

A

vasoactive; increase; renin; ADH

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53
Q

during periods of decreased preload, atrial receptors __ the release of ANP

A

inhibit

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54
Q

crystalloid infusions are preferable for resuscitation of

A

dehydration conditions

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55
Q

dehydration examples

A
  • prolonged fasting states
  • active GI losses
  • polyuria
  • hypermetabolic conditions
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56
Q

crystalloids are preferred for their lack of __ potential, ease of metabolism, and __ clearence

A

allergenic; renal

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57
Q

isotonic crystalloids are distributed evenly throughout the __ space, their ability to __ plasma volume is transient

A

extracellular; expand

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58
Q

crystalloids favor filtration approx ___ into the interstitial space

A

75%-80%

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59
Q

what is the most common crystalloid solution administered worldwide?

A

0.9% NS

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59
Q

high chloride load contributes to

A
  • acid-base imbalances
  • hyperchloremic metabolic acidosis
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60
Q

normal physiologic concentration of Na and Cl is

A

Na is much higher than Cl

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60
Q

NS is roughly equal concentrations of

A

Na and Cl

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61
Q

hyperchloremia has a substantial impact on

A

renal function

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62
Q

increased Na load introduced by large volumes of NS shown to cause

A

increased salt and water retention, hemodilution, and interstitial edema well into the postop period

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63
Q

NS in modern anesthesia can be given in __ volumes to __ patients

A

small; neurosurgical

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64
Q

NS is the preferred fluid for patients at risk for

A

cerebral edema

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65
Q

NS may also be indicated in fluid management of patients with

A

anuria and ESRD who cannot excrete K content of a more balanced crystalloid solution

B/c NS does not contain K, avoid worsening hyperK, safe choice

LR contains K thats why its no good for ESRD pt’s

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66
Q

Hypertonic solutions (3% or greater) are sometimes used in low dose infusions in

A

trauma and head injury paitents

help w/ ICP improve CPP, osmotic effect: draw H2O out of braincells

volume-expanding effect, help CO, antiinflammatory effects, preservation fo cerebral blood flow

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67
Q

hypertonic solutions promote

A

volume expansion that mobilizes intracellular and interstitial fluids into the intravascular space

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68
Q

risks for hypertonic solutions

A
  • vascular irritation
  • sudden and pronounced fluid shift into the intravascular space
  • potential for dehydration of neural cells leading to osmotic demyelination syndrome
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69
Q

LR contains

A

sodium lactate as a bicarb substrate or buffering agent

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69
Q

LR is not recommended for

A
  • large volume administration in diabetic patients b/c byproducts of hepatic metabolism of lactate can result in gluconeogenesis

lactate is metabolized into bicarb in the liver –> metabloic alkalosis

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70
Q

T/F NS is more effective as a resuscitative fluid administration than LR for preserving intravascular volume

A

FALSE

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71
Q

LR is mildly __ and may cause transient serum hypo-osmolarlity and associated ___ __

osmolarity=meausre of the concentration of solute particles ina solution

A

hypotonic; cerebral edema

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72
Q

LR is contraindicated in patients with

A

TBI or other neurovascular insults

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73
Q

LR contains __ and is contraindicated in infusions with citrated (preservative used in blood products) d/t the risk of coagulation

A

calcium

citrate binds with calcium, risk for calcium chelation

preventing coagulation and preserving the viability of blood products

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74
Q

plasmalyte-A, Normosol-R, Isolyte S

A

most isotonic of the balanced solutions

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75
Q

what does plasmalyte use as alkalinizing buffers?

A
  • sodium gluconate
  • sodium acetate
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76
Q

colloids are suspensions of __-molecular weight molecules in __ solutions

A

high; electrolyte

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77
Q

colloids produce

A

intravascular volume expansion by directly increasing πp and interacting with the endothelial glycocalyx to decrease transcapillary permeability

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78
Q

colloids are effective for their plasma volume __, and are often used perioperativley for their __-__ effects compared to crystalloids

A

expansion; fluid-sparring

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79
Q

what is the only naturally occurring colloid solution available?

A

albumin

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80
Q

how are colloid infusions classified?

A
  • molecular weight
  • concentration
  • half-life
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81
Q

what is the oldest artificial colloid?

A

Dextran

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81
Q

dextrans characteristics

A
  • high-molecular-weight (40-70 kDa)
  • derived from bacterial metabolism of sucrose
  • first manufactured in 1940’s
  • markedly hyperosmolar
  • 1/2 life of 6-12 hours
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82
Q

Dextrans associated with a variety of coagulopathic effects d/t

A
  • Von Willebrand factor
  • activation of plasminogen
  • inerference with platetlet agreggation
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83
Q

Dextrans cause

A

acute RF

indirect hyperosmotic RI and direct RT damage as a result of accumulation

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84
Q

dextrans may also adhere to the surface of __ & __ and interefere with cross matching of bood products

A

platelets & RBCs

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85
Q

T/F Dextrans are still used in clinical practice

A

False

d/t the propensity to cause acute RF, and induce anaphylaxis, and coagulopathy

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86
Q

Genlatins are __ colloids derived form __ __

A

synthetic; bovine components

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87
Q

Gelatins characteristics

A
  • molecular weight of 30-35 kDa
  • shorter half-life 2-4 hours
  • limited duration of plasma expansion
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88
Q

Gelatins risks

A
  • interfere with platelet function
  • cause nephrotoxicity
  • high propensity of causing anaphylaxis
89
Q

Use of gelatins in clinical practice is

A

cautioned

90
Q

HES (hyroxylethyl starches) can cause allergic reactions in people who are allergic to

A

potatoes, maize, sorghum, and other components

91
Q

Hydroxyethyl starches (HES) are __ macromolecules derived from __ __

A

synthetic; starchy plants

92
Q

how does HES provide prolonged volume expansion?

A

high C2/C6 ratio indicated HES will be difficult to metabolize

93
Q

where is HES widely used?

A

European union

94
Q

first-generation HES are associated with

A
  • dose-dependent coagulopathy b/c of hemodilution and binding of clotting factors
  • interference of platelet adhesion
  • inhibition of fibrin polymerization
  • alterations in plasma viscosity
95
Q

HES can also accumulate for form interstitial colloid deposits in subcutaneous and other organ tissue than can lead to severe..

A

pruritus
nephrotoxicity

96
Q

FDA issued a black box warning for

A

HES in 2013 to notify for public risks of renal injury and increased mortality

97
Q

the PRAC and EMA issued a sudden recommendation to fully suspend all

A

HES solutions in jan 2018

98
Q

albumin is a

A

fractionated blood product produced from pooled human plasma

molecular weight of 65-69 kDa

99
Q

small volumes of __ provide __ degree of intravascular resuscitation as compared to equal or greater volumes of crystalloid

A

albumin; greater

99
Q

albumin is __ treated to __ pathogens and eliminate the risk of dx transmission

A

heat; inactivate

100
Q

T/F Albumin preparation is significantly more costly than crystalloid solutions

A

true

101
Q

T/F Albumin does not carry a risk for anaphylaxis

A

false

102
Q

albumin is a carrier for a # of protein-bound ionic substances including:

A
  • drugs and their metabolites
  • electrolytes
  • enzymes
  • hormones
103
Q

T/F albumin has a negative electrostatic charge

A

true

104
Q

Donnan effect

A

albumin molecules bind ions, which increase plasma osmolarity and intravascular volume

105
Q

stimulation of osmotic and autonomic afferent nerves in the area of surgical incision triggers the activation of

A

hypothalamic-pituitary axis (HPA)

106
Q

the hypothalamus releases __ which then elicits the creation and release of cortisol from the __ __

A

ACTH; adrenal cortex

107
Q

cortisol stimulates

A

protein catabolism, hepatic gluconeogenesis, and glycogenolysis, and increased hepatic production and release of plasma proteins

108
Q

hyperglycemia is a major risk factor for damage or destruction of the

A

endothelial glycocalyx

109
Q

hyperglycemia also contributes too

A
  • impaired wound healing
  • contributes to osmotic diuresis
  • interferes with immune response
110
Q

sympathetic stimulation in combination with hyperosmolar conditions triggers the release of

A

ADH

111
Q

most beneficial effect of cortisol

A

the anti-inflammatory effect it exerts by inhibiting the production, release, and vascular aggregation of inflammatory mediators

111
Q

“third space” was introduced in the 1960’s as

A

a nonfunctional component of the ECV

112
Q

EBL ratio of crystalloid to blood

A

3:1

113
Q

evidence demonstrates that actual observed ratio is less than

A

2:1

114
Q

4-2-1 calculation

A

0-10kg: 4mL/kg/hr
11-20kg: 2mL/kg/hr (for the first 10kg x4, next 10kg x2)
> 20kg: 1mL/kg/hr (for the first 10kgx4, next 10kgx2, everything after that x1)

115
Q

estimated fluids deficit

A

estimated fluid deficit = maintenance requirment x fasting hrs

116
Q

superficial trauma (orofacial)

A

1-2 mL/kg/hr

117
Q

minimal trauma (herniorrhaphy)

A

2-4 mL/kg/hr

118
Q

moderate trauma (major nonabdominal surgery or laparoscopic abd surgery)

A

4-6 mL/kg/hr

119
Q

severe trauma (major open abd surgery)

A

6-8 mL/kg/hr

119
Q

consequences of under resucitation

A
  • hypovolemia
  • decreased microvascular perfusion leading to decreased O2 delivery
  • reduced tissue perfusion
  • end-organ complications
  • PONV
  • renal dysfunction
  • myocardial ischemia
  • hemoconcentration leading to increased blood viscosity, thrombotic events
120
Q

consequence of overresuscitation

A
  • vascular overload, acute CHF
  • microvascular congestion leading to decreased oxygen delivery
  • endothelial glycocalyx disruption
  • decreased tissue oxygenation
  • altered coags and potential hemorrhage
  • hemodilution leading to anemia, thrombocytopenia, altered viscosity
  • decreased gut motility
  • increased infection rates
  • decreased organ perfusion
  • increased EVLWI? and prolonged post-op MV
  • increased incidence of VAP
  • hepatic congestion and dysfunction
  • abd compartment syndrome
121
Q

aim of GDFT is

A

utilize individualized hemodynamic endpoints to support oxygen transport balance by minimizing O2 demands and optimizing CO, tissue oxygenation, capillary and macrovascular flow, oxygen, nutrient delivery, and end-organ perfusion

122
Q

GDFT protocols begin with a baseline assessment of target __ measures followed by the administration of a __ volume fluid bolus

A

hemodynamic; small (200-250)

123
Q

basis of the frank-starling mechanism is the relationship between

A

LVEDP and myocardial contractility (SV)

124
Q

the FS is highly effective until

A

the point at which the sarcomere cannot generate additional force

further increases in preload after this threshold will generate no further increases in SV

125
Q

limitations of dynamic measures

A
  • SV (spontaneous ventilation)
  • small TV
  • open chest
  • sustained arrhythmias
  • PEEP
  • right heart dysfunction
126
Q

ERAS means

A

enhanced recovery after surgery

127
Q

ERAS was initially developed for

A

colon surgery

128
Q

primary cellular injury can

A

impair O2 and nutrient delivery to vital organs resulting from local and global perfusion changes

129
Q

secondary cellular injury

A

process caused by the stress response associated with surgery that results in the release of local inflammatory mediators or hormones

130
Q

combination of primary and secondary cellular injury result in

A

delayed wound healing and gut dysfunction and may lead to postsurgical complications

131
Q

two fundamental elements that affect postsurgical outcomes are attributed to

A

fluid therapy and effective pain managment

132
Q

BBB has limited permeability

A

to ionic solutes

132
Q

normal values
CO
CI
EVLWI (extravascular lung water index)
FTc (corrected flow time)
GEDI (global end diastolic index)
change in peak pressure
PPV/ change in pulse pressure
PVI (plethysmography variability index)
ScvO2 (central venous O2 saturation)
SPV (systolic pressure variation)
SV/SVI
SVR/SVRI
Svo2 (mixed venous O2 saturation)
SVV

A

4-8 L/min
2.5-4 L/min/m^2
3-7 mL/kg
330-360 ms
680-800 mL/m^2
> 12% predicts preload responsiveness
> 13% predicts preload responsiveness
> 14% predicts preload responsiveness
normal value 70% (blood in the SVC)
> 14% predicts preload responsiveness
SV: 60-100 mL/beat, SVI: 33-47 mL/m^2/beat
SVR: 800-1200 dynes-sec/cm-5/m^2 SVRI: 1970-2390
60-80% (blood in PA measured by PAC)
> 13% predicts preload responsiveness

133
Q

changes in water concentration are largely d/t

A

sodium

134
Q

limited permeability in the BBB prevents the equilibration of __ active ionic solutes between ECV & ICV

A

osmotically

135
Q

most important osmotically active substance influencing the water content of the brain tissues?

A

sodium

136
Q

sodium imbalances reflect an impaired

A

concentration between water and Na

137
Q

hyponatremia

A

the intracellular environment is hyperosmolar compared to the ECV leading to an influx of water into the ICV

138
Q

most significant consequences of hyponatremia is

A

cerebral edema

139
Q

whos at an increased risk of brain damage resulting from hyponatremia?

A

menstruating women

believed that progesterone and estrogen inhibit the efficiency of Na-K-ATPase pump

female sex hormones may facilitate the movement of water into the brain through the mediation of ADH

140
Q

what is the most common electrolyte abnormality in hospitalized patients?

A

hyponatremia

141
Q

development of hypervolemic hyponatremia in patients with ___ & ___ is assoicated with an increased risk of death

A

CHF; cirrhosis

bonus polycystic kidney dx

142
Q

rapid correction of hyponatremia particularly in patients with chronic hyponatremia can result in

A
  • seizures
  • spastic quadriparesis
  • coma d/t osmotic demyelination
143
Q

vasopressin receptor antagonists are available to treat

A

hypervolemic or euvolemic hyponatremia

medications antagonize arginine vasopressin by inhibition of renal V1a, V1RA, V2, & V3RA receptors. result in increased free water excretion by the kidneys

144
Q

initial treatment of hyponatremia usually includes

A

fluid restriction & diuresis

145
Q

myelinolysis

A

Central pontine myelinolysis
can lead to disorders of the upper neurons, spastic quadriparesis, pseudobulbar palsy, mental disorders, death

146
Q

serum Na concentrations should be increased no more than ___ mEq/L per hour

A

1 to 2

146
Q

whos at risk for myelinolysis ?

A

hyponatremic greater than 48 hrs, orthotopic liver tx, hx of alcohol abuse

147
Q

symptomatic patients can infuse

A

3% saline at a rate of 1 to 2 mL/kg/hr

148
Q

what is the usual cause of hypernatremia

A

impaired water itnake

149
Q

If the hypernatremia is acute, water deficits can be replaced relatively __ with __ solution

A

rapidly; hypotonic

150
Q

if chronic hypernatremia is accompanied by volume __, the volume disorder is corrected first with __ __

A

depletion; isotonic crstalloids

151
Q

once the circulating volume is restored, __ solutions are used to correct the water deficit

A

hypotonic

152
Q

plasma Na should be decreased by __ to __ mEq per hour until to the patient is clinically stable

A

1 to 2

153
Q

__ within these compartments are in large part responsible for the resting membrane potential

A

K

154
Q

Homeostasis is maintained by absorption of K from

A
  • GI tract
  • renal excretion
  • reabsorption into the peritubular capillary network
155
Q

renal regulation of K is dependent on

A
  • the concentration gradient between the distal tubules and collecting duct relative to the peritubular capillary network
  • the distal convoluted tubular flow rate and Na concentration
  • aldosterone concentration
  • changes in pH
156
Q

aldosterone has a potent effect on __ levels

A

K

157
Q

hyperkalemia causes adrenal cortical synthesis and the release of

A

aldosterone

which promotes potassium excretion from the distal renal tubules

158
Q

hypokalemia is defined as

A

less than 3.5

159
Q

redistribution of K from the ECV to the ICV can lead to

A

hypokalemia

160
Q

hypokalemia can result from

A

GI losses, renal loss, intracellular shift, increased nonrenal losses, endocrinopathies, and poor intake

161
Q

what is the most common electrolyte abnormality to come across in clinical practice?

A

hpokalemia

162
Q

what promotes the movement of K into the ICV

A

B-adrenergic stimulation, insulin, and alkalosis

163
Q

hypokalemia is __ times more likely to occur with patients on thiazide diuretics & __ as high for men than woman

A

11; twice

164
Q

symptoms of mild hypokalemia

A
  • palpitations
  • skeletal muscle weakness
  • muscle pain
165
Q

symptoms of K < 2.5

A
  • paresthesia
  • depressed deep tendon reflexes
  • fasciculations
  • muscle weakness
  • altered level of consciousness
166
Q

patients with CHF & ischemia, hypokalemia increases the potential for

A

dysrhhythmias

167
Q

common cardiac dysrhythmias present with hypokalemia are

A
  • first-degree heart block
  • second-degree heart block
  • a-fib
  • vfib
  • asystole
168
Q

ECG abnormalities with hypokalemia include

A
  • ST depression
  • flattened T-wave
  • the presence of U wave
169
Q

What’s the fastest K can be given? and why?

A

40mEq per hour if levels are less than 2.0

170
Q

maximum rate of 10-20mEq is recommended to avoid in

A

iatrogenic hyperkalemia? i think the book meant hypokalemia

171
Q

IV K can be replaced with __ because __ makes it difficult for the kidney to conserve K

A

chloride; hypochloremia

172
Q

hyperkalemia is defined as serum K

A

< 5

occurs less commonly compared to hypokalemia if renal causes are excluded

173
Q

what meds increase ECV K

A
  • beta blockers
  • ACEIs
  • ARBs
173
Q

causes of hyperkalemia

A
  • impaired renal excretion
  • high intake of K
  • shift of K from the ICV to the ECV
174
Q

hyperkalemia can lead to increased __ production and apoptosis

A

LA

175
Q

decreasing angiotensin, ___/___ can cause hyponatremia and hyperkalemia

A

ACEIs/ARBs

176
Q

what is laboratory artifact?

A

pseudohyperkalemia

177
Q

pseudohyperkalemia results from

A

hemolysis of the blood sample, leukocytosis, thrombosis, prolonged fist clenching during blood drawing

178
Q

treatment of hyperkalemia accomplishes 3 physiologic effects

A

1.) stabilization of the cardiac membrane
2.) driving K from ECV to ICV
3.) removal of K from the body

179
Q

treatment of hyperkalemia

A

10 units of regular insulin
1 ampule of D50

a complication can be hypoglycemia

180
Q

what percent of calcium is found in the bones as hydroxyapitate ?

A

99%

181
Q

remaining 1% of calcium exists in

A

the plasma and body cells

182
Q

calcium as a second messenger is critical for functions of

A

muscle contractions, release of hormones, and neuotransmitters

183
Q

calcium plays an important role in

A

blood coagulation, muscle function (myocardial contractility)

184
Q

calcium in the ECV is found in 3 distinct fractions

A
  • 50% is ionized Ca and is the physiologically active portion
  • 10% of Ca is bound to anions
  • 40% bound to plasma proteins primarily albumin
185
Q

total of circulating Ca within the blood is

A

9.0 to 10.5 mg/dL

186
Q

serum Ca levels are maintained by the release of inhibition of

A

PTH but also by vitamin D and calcitonin

187
Q

causes of hypocalcemia

A

hyperventilation and massive rapid transusion

hypervent causes respalkalosis, decr conc of ionized Ca by incr bind alb

187
Q

hyperventilation leads to __ pH, which facilitates __ protein binding of calcium, thus __ serum ionized Ca

A

increased; increased; decreasing

188
Q

citrate is a

A

preservative added to pRBCs

189
Q

citrate chelates or binds to calcium, __ serum Ca available for physiological reactions

A

decreasing

190
Q

massive rapid blood transfusions can cause acute

A

hypocalcemia

191
Q

treatment of hypocalcemia involves the infusion of

A

Ca salts

cause signif venous irritation and tissue necrosis as compared to Ca gluconate

192
Q

Ca gluconate preparation

A

10 mL of 10% Ca gluconate over 10 mins followed by an infusion of 0.3 - 2 mg/kg per hour

193
Q

second most common cause?

A

malignancy

193
Q

hypercalcemia results usually from

A

movement of ca from bone to the ECV

which exceeds the kidney to excrete the Ca

194
Q

what accounts for more than 1/2 of the cases of hypercalcemia?

A

primary hyperparathyroidism

195
Q

treatment of hypercalcemia involves

A

volume expansion with NS, increase renal excretion of Ca

addition of a loop diuretic

196
Q

also been used to treat hypercalcemia

A
  • bisphosphonates
  • mithramycin
  • calcitonin
  • glucocorticoids
  • phosphate salts
197
Q

HD is an acute treatment to rapidly lower

A

serum Ca

198
Q

Mag is the __ most abundant intracellular cation

A

second

199
Q

what percent of Mag is stored in muscle and bone?
within the cells?
and within the serum?

A

40-60%
30%
1%

200
Q

importance of mag in its role as a cofactor in

A
  • enzymatic reactions (involving energy metabolism)
  • protein synthesis
  • neuromuscular excitability
  • function of the Na-K-ATPase pump
201
Q

regulation of Mag occurs where?

A

intestines and kindeys

202
Q

hypomagnesemia increases cardiovascular death in men and women by what percentage?

A

8% & 16%

203
Q

hypomagnesemia has an __ effect on the Na-K-ATPase pump resulting in __ ICV of K

A

inhibitory; decreased

204
Q

IV infusion of mag can relieve severe __ , and it can decrease __ __

A

bronchospasm; postoperative pain

204
Q

hypo magnesium causes

A

increased renal or GI losses or poor mag intake and/or medications

205
Q

ECG changes seen with hypomagnesemia

A
  • flat T waves
  • presence of U waves
  • prolonged QT interval
  • widened QRS complexes
  • atrial and ventricular arrhythmias
206
Q

treatment of hypomagnesemia

A

IV 1 to 2 g of mag sulfate over 5 mins followed by 1 to 2 g per hour

207
Q

hypermagnesemia is the most commonly the result of

A

iatrogenic causes

208
Q

hypermagnesemia can result from

A
  • treatment of preeclampsia
  • preterm labor
  • ischemic heart dx
  • cardiac dysrhythmias
209
Q

symptoms of hypermagnesemia

A

depression of the peripheral and central NS, hypotension, QRS segment widening, PR & QT segment prolongation, heart block, and cardiac arrest

210
Q

magnesium potentiates the action of

A

NDMR

211
Q

treatment of hypermagnesemia

A
  • d/c mag
  • in urgent situations (brady, heart block, resp depression) calcium chloride should be used as an antagonist
212
Q

majority of phosphate is located in

A

bone 85%

213
Q

small amount of phosphate is located in

A

plasma, phospholipids, phosphate esters, inorganic phosphate (which is the ionized form)

214
Q

intracellular phosphate has numerous metabolic effects such as

A

component of ATP, and 2,3 -diphosphoglycerate, also acts as a buffer in the regulation of acid/base imbalance

215
Q

the concentration of phosphate in plasma in inversley proportional to

A

calcium

216
Q

hypophosphatemia is defined as

A

< 2.0 mg/dL

217
Q

hypophosphatemia causes

A

increased renal excretion & intestinal malabsorption

218
Q

resp alkalosis can also cause low phosphate levels how?

A

accelerated use of ATP by cells

219
Q

hypophosphatemia decreased 2-3-DPG is in RBC’s causing what shift in ODC

A

leftward

220
Q

hyperphosphatemia is defined as

A

greater than 4.7 mg/dL

221
Q

majority of phosphate exists within the ECV, and cellular __ is a leading cause

A

destruction (exp. metastatic dx)

222
Q

increase phosphate levels cause __ CA levels

A

decreased

so symptoms are synonymous with hypocalcemia

NA 1 (15 decks)

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