Fluids, Electrolytes, Blood Replacement

Question 1

Role of ADH/vasopressin

Answer 1

Increases volume status via DT/CD H20 reabsorb

Question 2

SIADH

Answer 2

When ingestion of water does not adequately stress ADH resulting in hyponatremia

Question 3

Two major players in sodium regulation

Answer 3

aldosterone: inc Na absorption
ANP: dec Na absorption

Question 4

Signs to assess patient’s fluid status

Answer 4

CXR
urine output
edema
Turgor
Lung crackles

Question 5

Tx for acute hyponatremia

Answer 5

No sx: 50 mL 3% saline bolus

Sx: 100 mL 3% saline bolus

Question 6

Tx for chronic hyponatremia

Answer 6

No sx: reverse cause
Mild sx: 30 mL 3% saline and desmopressin/lasix
Severe: 100 mL 3% saline bolus

Question 7

Na goal correction in hyponatremia

Answer 7

8-10 mEq/L in first 24 hours

Question 8

too rapid of a correction in hyponatremia?

Answer 8

Osmotic demyelination syndrome

more likely in <105, alcoholics, malnutrition

Question 9

Tx for SIADH

Answer 9

Fluid restriction
IV hypertonic soln
Diuretics
Vasopressin receptor antagonists

Question 10

Tx for hypernatremia

Answer 10

D5W (more for acute presentation)

Question 11

Too rapid of a correction in hypernatremia?

Answer 11

Cerebral edema, seizures

Question 12

Free water deficit calculation

Answer 12

0.6M/0.5W * weight (kg) * ((actual/140) -1)

Acute hypernatremia: correct 1/2 in first 24 hours

Question 13

EKG findings in hypokalemia

Answer 13

prolonged QT
U waves
Flat or inverted T waves

Question 14

Transcellular shift causes of hypokalemia

Answer 14

Alkalosis
Hyperventilation
Insulin
Beta agonists

Question 15

Hypokalemia tx

Answer 15

KCl 10 mEq/hr IV
Every 10 mEq will increase K by 0.1
(Need central line for >20 mEq/hr)

Question 16

Hyperkalemia EKG findings

Answer 16

Wide QRS
Peaked T waves
sine waves

Question 17

Tx for hyperkalemia

Answer 17

Give calcium to stabilize cell membrane
Push K into cells: insulin/glucose, bicarb, beta agonist
Remove K: loop diuretic or dialysis

Question 18

Maintenance calculation IVF adults

Answer 18

D5 1/2 NS
100/50/20 rule
100 ml/kg for first 10 kg
50 ml/kg for next 10 kg
20 ml/kg for every kg after that 
Divide by 24 hours

Question 19

Quick calc for IVF maintenance

Answer 19

35 cc/kg/day for IBW

Question 20

RBCs contents

Answer 20

centrifuged whole blood, platelets removed
Indicated to increase O2 capacity to tissues
1 unit inc Hgb by 1 g/dL and Hct by 3%

Question 21

FFP

Answer 21

Contains proteins and clotting factors

Indicated in elevated INR, DIC, liver dz/warfarin

Question 22

Cryoprecipitate

Answer 22

Fibrinogen, factor 8, vWF

Indicated: hemophilia A, DIC

Question 23

Type and screen

Answer 23

determines ABO and Rh type and screens for most common antibodies

Question 24

Type and cross

Answer 24

Recipient serum tested against intended donor RBC prior to transfusion

Question 25

TRALI

Answer 25

Transfusion Related Acute Lung Injury
Dyspnea, fever, hypotension
CXR: white out
Supportive care

Question 26

TACO

Answer 26

Transfusion Associated Circulatory Overload
Acute congestive HF, no fever, elevated BNP
Tx: lasix

Question 27

4 Ts of HIT likelihood

Answer 27

Thrombocytopenia
Timing of platelet fall
Thrombosis or other sequelae
Other causes of thrombocytopenia