Fluids/Electrolytes/Nutrition Flashcards
Roughly how much fluid passes through the GI tract daily?
9L
Small bowel secretes how much fluid/day?
Small bowel absorbs how much water?
- 5-2L
8. 5L
When can you use winter’s formula?
For METABOLIC ACIDOSIS. LOW BICARB. it determines what the PCO2 SHOULD BE.
Expected pCO2 = (1.5 x bicarb) + 8 +/-2
How much is daily biliary secretion?
Pancreatic secretion?
Biliary: 500cc
Pancreatic: 1.5 - 3L
What is the daily gastric secretion?
1-2L
Daily saliva sevretion
1.5L
How much fluid does the colon absorb?
400cc
ADH is synthesized where? Stored where?
Synthesized in hypothalamus
Stored in POSTERIOR pituitary
How does ADH affect coagulation?
Releases factor VIII and vwf from the endothelium
Renin is released from where?
What does it convert?
The juxtaglomerular apparatus of the AFFERENT arterioles
Converts angiotensinogen (comes from liver) to angiotensin I.
ACE (comes from lung) converts angiotensin I to angiotensin II
What happens to calcium when you hyperventilate?
Respiratory alkalosis Increases the binding capacity of calcium to albumin. Decreases ionized calcium lvl
Is aldosterone ADH?
How does potassium affect aldosterone?
How does sodium and potassium affect aldosterone?
No. ADH produced in hypothalamus, stored in posterior pituitary. Aldosterone produced by zona glomerulosa (outermost layer of the adrenal cortex)
Hyperkalemia leads to aldosterone production.
Hyponatremia leads to aldosterone production.
What is the most likely cause of hypermagnesemia?
NOT iatrogenic repletion
It’s renal failure
Ekg changes with hypercalcemia/hypocalcemia?
What is one of the earliest signs of hypocalcemia?
Shortened QT for hyper
Prolonged QT for hypo
Perioral numbness
Proteins and phosphates are buffers intra- or extracellularly?
Bicarb is a buffer intra- or extracellularly?
Proteins and phosphates: intracellular
Bicarb: extracellular
Active transport or facilitated diffusion?
- Fructose
- Galactose
- Glucose
- fructose: facilitated diffusion
- Galactose: active transport
- glucose: active transport
Lactate is released from where?
From glycolysis of skeletal muscles and erythrocytes and leukocytes
What is glucose + glucose?
Maltose
What is glucose + fructose?
Sucrose
What is glucose + Galactose?
Lactose
Kwashiorkor vs marasmus. Which one has anasarca? Which one is associated with total caloric deficit as opposed to protein malnutrition?
Kwashiorkor has anasarca
Marasmus: total calorie deficit.
Peripheral neuropathy, ataxia, hemolytic anemia
Deficiency of what?
Vit E
What are the essential trace elements?
Manganese, chromium, copper, zinc
And selenium
Long term tpn pt. Starts having rash and hair falling out. What is deficient?
Zinc
What happens with chromium deficiency?
Poor glycemic control
Do you use elemental formula for renal failure pts?
No. Renal failure pts need high calorie, low protein formula with electrolytes
Elemental formula for short bowel
Which amino acid boosts t lymphocytes and immune system when supplemented?
Arginine
The brain needs how much sugar a day at least?
150g
What is the daily protein requirement for someone under no stress?
What about under severe stress?
0.8 g/kg
70kg -> 56g
2 g/kg
70kg -> 140g
Protein digestion begins where?
In the stomach
Enterokinase is located where?
Duodenal mucosa
Absorption of amino acids is complete by what portion of the gi tract?
Complete by mid-jejunum
T/F: enteral nutrition has a lower overall mortality compared to parenteral nutrition
False. There is no survival benefits between any nutrition forms. Lower infectious morbidity though for enteral.
What are the albumin cutoffs for moderate and severe malnutrition?
Pre-albumin?
Moderate:
- albumin < 3
- pre-albumin < 15
Severe:
- albumin < 2.3
- pre-albumin < 10
T/F: post-pyloric feeds decrease the risk of aspiration
False. you’re stenting across the pylorus and most tubes are too short to reach the ligament of treitz
T/F: for liver failure pts, standard tube feeds is good enough
True. Nothing special. Special only for renal to reduce volume and protein
Equation for nitrogen balance?
(Protein in/6.25) - (24hr urinary urea nitrogen + 4)
For rhabdomyolysis, what electrolye should you replete with hydration?
What organ contains the largest body pool of this electrolyte?
Potassium
Muscles contain the largest pool of potassium
What is the protein requirement for a critically ill pt? Caloric requirement?
2-2.5 g/kg of protein
25-30 kcal/kg
Opioid dependence/overdose is more likely to be seen in:
- Poor black men with no insurance vs old rich white women
- renal insufficiency vs hepatic insifficiency
- Old rich white women more likely
- renal insufficiency
Does lasix cause acidosis or alkalosis?
Alkalosis. Blocks sodium reabsorption in the loop of henle
Distal tubules try to compensate and hold on to sodium in exchange if peeing out potassium
Then the body tried to hold onto potassium by peeing our H+ resulting in metabolic alkalosis
Daily protein requirement for non-stressed pt vs septic/burn pt?
Non-stressed: 0.8g/kg
Burn: 1.5g/kg
Half life of pre-albumin?
What has a shorter half life than prealb?
2-3 days
Retinol binding protein 12-24hr
What’s a negative acute phase reactant?
Are they negative or regular acute phase reactants?
- pre-albumin
- retinol binding protein
- CRP
- transferrin
Levels fall after injury/sepsis
Pre-albumin, RBP, transferrin are negative reactants. CRP is positive
What levels of sodium and potassium stimulate the release of aldosterone?
What does dopamine do to aldosterone?
Think if what would happen if there was 0 aldo
Hyponatremia
Hyperkalemia
Dopamine inhibits the secretion of aldosterone
How much protein should be supplemented in tpn for pts with ESRD?
How much fat?
How much fluid for a 70kg person?
What % dextrose?
1.2-1.5g/kg/day
10-20% fat. Too little fat causes essential fatty acid deficiency
30cc/kg. 2100cc
25-50% dextrose. You don’t have to adjust sugar for ESRD nutrition
Describe the 0 and 1st order kinetics of pharmacology
0th order: elimination is constant regardless of blood concentration
1st order: elimination is proportional to the blood concentration
Which amino acid enhances immune by stimulation of T-lymohocytes
Arginine
What does hyperventilation do to calcium?
Alkalosis Increases the binding capacity of calcium for albumin. Less ionized calcium. Lower iCa
Which vitamin deficiency causes peripheral neuropathy, myopathy, ataxia, thrombocytopenia, and hemolytic anemia?
Vitamin E
What is the mechanism for polyuria with hypercalcemia?
It induces nephrogenic diabetes insipidus (resistant to ADH)
Trousseau vs chvostek. What’s the difference?
Both are for hypocalcemia
Trousseau: BP cuff
Chvostek: cheek muscles tapping on parotid.
Chvo is cheek.
Active transport or facilitated diffusion?
- glucose
- fructose
- Galactose
- glucose: active transport
- fructose: facilitated diffusion
- Galactose: active transport.
What is
- fructose
- Galactose
- maltose
- fructose = glucose + sucrose
- Galactose = glucose + lactose
- maltose= glucose + glucose
Cori cycle can provide what % of circulating glucose during fasting?
What are the precursors of glucose in gluconeogenesis?
What is the ATP balance for cori cycle?
40%
Lactate, lyrucate, glycerol, amino acids
4 ATP loss to make 1 glucose
What do you get with chromium deficiency?
Poor glycemic control
What is the most common cause of hypermagnesemia?
Renal failure»_space; iatrogenic use in the hospital
Hypoparathyroidism causes hypo or hyperphosphatemia?
Hypophosphate
PTH raises both Ca and Phos
What is the % of total body weight for extracellular volume vs intracellular volume?
ECV: 20%
ICV: 40%
What’s an indication for elemental formula?
What’s the difference between that and renal formulas?
Elemental: proteins are substituted by amino acids. It’s for short bowel syndrome
Renal: high calorie. Low to moderate protein.
