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Clin Specialties Surgery Exam > Lecture 5: Fluid, Electrolytes, Blood Replacement > Flashcards

Lecture 5: Fluid, Electrolytes, Blood Replacement Flashcards

1
Q

What type of Hyponatremia shows S/S of dehydration such as decreased skin turgor and dry mucous membranes?

A

HYPOvolemic HYPOnatremia

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2
Q

What type of Hyponatremia shows S/S of fluid overload such as edema and crackles?

A

HYPERvolemic HYPOnatremia

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3
Q

A patient has Euvolemic Hyponatremia how will his PE look?

A

normal PE

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4
Q

How can you differentiate Hypovolemic from Hypervolemic Hyponatremia based on labs?

A

Look at Urine Osm

  • Urine Osm will be more decreased in HYPERvolemic
  • Urine Osm could be high in HYPOvolemic
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5
Q

How can you differentiate Euvolemic Hyponatremia from the other two?

A

The Urine Na will be majorly increased (> 30) in Euvolemic Hyponatremia

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6
Q

How do you correct HYPOvolemic Hyponatremia?

A

replace their volum w/NS

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7
Q

How do you correct Euvolemic Hyponatremia?

A

Restrict Free Water

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8
Q

How do you correct HYPERvolemic Hyponatremia?

A

Diuretics

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9
Q

What is the problem that occurs if you correct Hyponatremia too rapidly?

Who’s mainly at risk for this?

A

Osmotic Demyelination Syndrome

Na <105, alcoholics, cirrhosis, malnutrition, HYPOkalemia

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10
Q

When do you use hypertonic saline for Tx in Hyponatremia?

A

Pts w/ life threatening Sxs (seizures)

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11
Q

Which type of Hyponatremia can you correct more rapidly?

A

Acute Hyponatremia

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12
Q

What are the causes of HYPERnatremia?

A 
Water loss (diabetes insipidus
Reduced water intake 
Excess Na intake
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13
Q

What is occuring in hypernatremia?

A

Intracellular volume depletion w/ loss of free water > Na loss

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14
Q

What is the Tx for HYPERnatremia?

What is the Tx for unstable pts?

A

Replace the free water deficit w/D5W
- by NG tube or IV (gut always better)

Give NS until they stabilize then D5W

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15
Q

Why must you only correct 1/2 of the free water deficit in the 1st 24 hrs for acute HYPERnatremia?

A

Corrected too rapidly –> cerebral edema

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16
Q

What are the EKG findings of hypokalemia vs hyperkalemia?

A

HypoK - flat/inverted T waves, U waves

HyperK - peaked T waves (“tent of bananas”)

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17
Q

What are the 4 major causes of hypokalemia? Others?

A
  1. Insulin (pushes K into cells)
  2. Metabolic Alkalosis
  3. Hyperaldosteronism
    (more aldost –> reabs more Na & excrete more K)
  4. Decreased intake (malnutrition, EtOH, anorexia)

Others: diarrhea, profuse sweating, decreased intake (malnutrition, EtOH, anorexia)

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18
Q

What is the general Tx approach for Hypokalemia?

A

Address underlying cause

  • Correct low Mg first!
  • Correct alkalosis
  • D/c offending meds (diuretic –> switch to K sparing)
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19
Q

How do you Tx uncontrolled diabetics w/Hypokalemia?

A

Give K+ then insulin

- giving insulin first –> more hypokalemia b/c pushes it into cells

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20
Q

What are some of the major causes of Hyperkalemia?

A
  1. metabolic acidosis
  2. Hypoaldosteronism
  3. Drugs (K sparing diuretics, ACEs)

note: first two are the opposite of hypokalemia

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21
Q

What is the Tx for hyperkalemia w/significant EKG findings?

A

CaCl or Ca gluconate IV

CALCIUM

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22
Q

What is the the medications given for hyperkalemia?

A
  • Insulin (pushes K into cells) & glucose
  • Na bicarb
  • inhaled B2-agonists (albuterol)
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23
Q

What is the Tx to remove K from the body in hyperkalemic pts?

A
  • Loop diuretics & isotonic fluids
  • Dialysis
  • Kayexalate
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24
Q

What is the Tx to remove K from the body in hyperkalemic pts?

A
  • Loop diuretics & isotonic fluids
  • Dialysis
  • Kayexalate
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25
Q

Signs/Sxs of dehydration (Mild -Severe)

- for reference

A

Mild: thirst, dry mouth, decr urine
Mod: dry eyes, dry mouth, oliguira, decr urine, tachycardia
Severe: tachycardic, oliguira to anuria, confusion, HoTN, shock

26
Q

What labs values are increased in dehydration states?

A

BUN/Cr ratio
Cr
Lactic Acid

will be HYPERnatremic

27
Q

What crystalloid fluids are isotonic? 3 Uses?

A

NS, LR, D5W

Uses: Hypovolemic shock (LR/NS), initial therapy for DKA, replacing fluids post-op

28
Q

What crystalloid fluid is hypotonic? Where do hypotonic fluids go in the body?

A

1/2 NS (.45%)

fluid goes from blood (intravascualar) –> intracellular/interstitial

29
Q

Since hypotonic crystalloid fluids like 1/2 NS enter the cells when do you NOT want to give it?

A

pts w/risk of increased ICP –> cerebral edema

pts w/liver failure, burns, trauma –> fluid leaves blood –> deplete their BV

30
Q

3 Uses for hypotonic crystalloid solutions?

A

intracellular dehydration, HYPERnatremia, DKA

31
Q

Where do crystalloid fluids that are hypertonic go in the body? Therefore what are its 2 uses?

A

Extravascular –> intravascular (plasma expanders)

Uses: Severe Hyponatremia, cerebral edema –> to remove fluid from cells

32
Q

What must you watch for when giving NS?

A

Hypercholermic acidosis - b/c it has higher levels of Cl than the body

33
Q

What is the makeup of colloid solutions, therefore where in the body do they go?

A

Large molecules –> cant cross cell mem –> stay in intravascular space –> volume expanders

34
Q

Since colloid solutions are volume expanders what are their 2 uses?

Examples?

A

hypovolemic shock, adjunct for burn resuscitation

Ex: blood products, albumin

35
Q

What is the most commonly used maintenance fluid for a normal adult patient?

A

1/2 NS

36
Q

What formula is used to calculate IVF maintenance? What is the alternative method based on?

A

Holiday Segar formula (100/50/20 rule)

Alt based on IBW: 35 cc/kg/day

37
Q

What is the fastest method of increasing the O2 carrying capacity to the blood?

A

Giving Blood products

38
Q

Unconscious man comes into the ER after suffering severe blunt forced trauma in a MVA and needs blood products immediately to replace lost volume, what type of blood can you give him?

A

O- or O+

For women give only O- due to the Rh antigen

39
Q

What is the difference for type and screen vs type and cross blood?

A

Screen: only determines ABO, Rh type, faster results
Crossmatch: recipient serum is tested against the donor’s RBCs, slower results, more specific match

40
Q

What are the 5 choices of blood products?

A
  1. Whole blood
  2. pRBCs
  3. FFP
  4. Cryoprecipitate
  5. Platelets
41
Q

What is removed from pRBCs and what is it used for?

A

platelets removed

use: incr O2 carrying capacity to tissues

42
Q

What is different in FFP from cryoprecipitate?

Uses for FFP?

A

FFP has all coag/clotting factors (cryo only has some), contains plasma proteins

Use: Elevated INR (d/t liver failure, warfarin, massive transfusion, DIC)

43
Q

What are the clotting factors in cryoprecipitate? Uses?

A

Fibrinogen, Fibronectin, Factor 8 & 13, vWF

Uses: Hemophilia, decr fibrinogen (DIC), uremic bleeding

44
Q

When giving platelets, what are you also giving? Uses?

A

also giving FFP b/c plts are suspended in plasma

Uses: active bleeding, pre-op surgery

45
Q

When giving 1 unit pRBCs how will the Hb and Hematocrit be affected?

If the expected response doesnt occur what does it suggest?

A

Increase Hb by 1
Increase Hematocrit by 3%

Doesnt occur –> active bleed

46
Q

In general when is transfusion of RBCs needed?

A

<8 if having surgery

<7 if hospitalized

47
Q

In general when is transfusion of platelets needed?

What level of platelets put you at risk for spontaneous hemorrhage?

A

general transfuse when platelets < 50,000

risk of spont hemorrhage when platelets <12, 000

note: norm = 150,000-400,000

48
Q

A patient comes in for a transfusion, but you know he has had an allergic rxn in the past to it, what can you give him prior to the infusion to prevent an allergic rxn?

A

Antihistamines or steroids

Benadryl or Atarax

49
Q

What is the cause of immediate acute hemolytic rxns? Major complication?
What is seen on lab values?

A

transfuse an non-compatible blood type

complication: Renal failure (caused by RBC destruction)

Labs: decr haptoglobin, incr indirect bili/LDH

50
Q

A patient has is receiving a transfusion when he starts feeling feverish, has HoTN and becomes tachycardic, is flushed and has severe anxiety all of a sudden - what is the best test to confirm the Dx and Tx?

A

DAT
- will be + –> immediate transfusion rxn

Tx: stop transfusion, give mannitol and monitor

51
Q

What is TRALI? What is it most commonly caused by? Tx?

A

Transfusion Related Acute Lung Injury

MC cause = FFP infusion

self-limited, resolves –> supportive tx

52
Q

What is the major complication in TRALI and how is it Dx?

A

ARDS

Dx: CXR = white out

53
Q

What is TACO? What does it cause?

Tx?

A

Transfusion Associated Circulatory Overload

causes: CHF

Tx: Lasix –> remove fluid

54
Q

What are the major differences b/t TRALI and TACO?

A

TRALI - FEVER, BNP norm

TACO - NO fever, BNP ELEV

55
Q

What is the common formula for massive transfusions?

A

1:1:1

1 unite pRBCs: 1 unit plt: 1 FFP

56
Q

What is the key lab value that indicates DIC?

A

DECREASED Fibrinogen (usually)

Also see: increased PT, PTT, D-dimer

57
Q

Patient Dx w/DIC is actively bleeding, what is the Tx?

A

Platelets

58
Q

Patient Dx w/DIC has active thrombosis, what is the Tx?

A

Heparin (decreases clotting)

59
Q

Patient Dx w/DIC has elevated PT or fibrinogen, what is the Tx?

A

FFP or cryoprecipitate (to make them clot)

60
Q

What are the low platelet counts in HIT usually triggered by and what is the main complication of HIT?

A

Heparin or Lovenox

Complication = thrombosis

61
Q

A patient taking Heparin after his hip replacement presents w/enlargement of a clot diagnosed after his surgery, what is the most likely Dx and how do you Dx it?

A

HIT

Dx: Thrombocytopenia 5+ days after exposure, check HIT panel/SRA

62
Q

Tx for HIT?

A

STOP HEPARIN

Start on different anticoag: Fondaparinux or Argatroban

Clin Specialties Surgery Exam (13 decks)

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