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My Cards Flashcards

1
Q

Total Body Water

A

Men 60%
Women 50%

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2
Q

Extracellular Fluid

A

TBW x 33%

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3
Q

Intracellular Fluid

A

TBW x 67%

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4
Q

Intravascular Fluid

A

ECF x 25%

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5
Q

Interstitial Fluid

A

ECF x 75%

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6
Q

Respiratory Quotient

A

.71 = fat oxidation
.82 = protein oxidation
.85 = mixed substrate utilization
1.0 = carb oxidation

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7
Q

Respiratory Alkalosis

A

pH >7.45, low pCO2 from hyperventilation

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8
Q

Causes of Respiratory Alkalosis

A

Hyperventilation - CNS hyperactivity, Anxiety/pain, Pregnancy, Salicylate, Hep Encephalopathy, Catecholamines

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9
Q

Respiratory Acidosis

A

pH <7.35, high pCO2 from hypoventilation or increased CO2 production

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10
Q

Causes of Respiratory Acidosis

A

Hypoventilation/increased CO2 production - CNS depression, Neuromuscular, Pulm disease, Obese hypoventilation, OVERFEEDING

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11
Q

Metabolic Alkalosis

A

pH >7.45, Increased HCO3-, hypoventilation = increased pCO2

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12
Q

Metabolic Acidosis

A

pH < 7.35, decreased HCO3-, hyperventilation = dec pCO2

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13
Q

Causes of Metabolic Alkalosis

A

V - Vomiting/NG suction
O Overcorrection of hypercapnia
M Mineralcorticoid excess (inc aldosterone)
I Iatrogenic (NaHCO3-)
T Total volume loss (diuretic/renal)
Others - Severe hypokalemia, licorice

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14
Q

Anion Gap

A

AG = Na-Cl+HCO3-
Normal = 9
For every 1g/dL dec in albumin, 2.5 added to AG

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15
Q

NAGMA

A

Normal Anion Gap Metabolic Acidosis
H Hyperalimentation/TPN/EN
A Acetazolamide
R Renal Tubular Acidosis
D Diarrhea

U Ureterostomies
P Pancreatic fistulas

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16
Q

AGMA

A

Anion Gap Metabolic Acidosis
M Methanol
U Uremia
D DKA/Alcoholic KA/Starvation KA
P Paracetamol, acetaminophen, phenformin/paraldehyde
I Iron, Isoniazid, Inborn errors
L Lactic acidosis
E Ethanol, Ethylene glycol
S Salicylates, ASA, aspirin

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17
Q

Electrolyte Disorder Management

A

Excess
-Remove outside sources
-D/C meds/agents
-Facilitate removal
-Treat other conditions

Deficient
-Available admit routes
-GI tract function
-Renal function
-Fluid status
-Concurrent lyte changes
-Product availability

18
Q

Hyponatremia

A

Na <135, Clinically relevant <130, CNS dysfunction < 125, Death < 120

Hypertonic - Inc BG, mannitol = correct to get true Na
Isotonic - rarely observed
Hypotonic - 3 types

19
Q

Hypotonic Hyponatremia

A

Hypovolemic - Na loss> water loss
-Na loss = GI, skin, third spacing, SAH
-Water loss = renal loss/diuretic
TREAT - isotonic fluids (NS/LR)

Euvolemic - Retain fluid d/t ADH
-SIADH, hypothyroid, polydipsia, head/CNS trauma, PNA
TREAT - Fluid restrict, symptomatic = add NaCl

Hypervolemic - fluid retention
- renal failure, CHF, cirrhosis
TREAT - Na and fluid restriction

Do not correct more than 10-12 meq/dL per 24 hrs

20
Q

Free Water Deficit

A

TBW x [1-(140/Na)]
Underestimates by 1-2.5L

21
Q

Content of 1 L NS

A

ECF gets 1000ml: interstitial - 750ml, intravascular 250ml

22
Q

Insensible Fluid Loss

A

1 L via skin/lungs

23
Q

Hypernatremia

A

Na>145, death >160

Hypovolemic - fluid loss
Euvolemic - concentration of Na
Hypervolemic - increased water and Na

Do not correct more than 10/day if chronic/unknown duration. 2/L/hr to 145 if acute

24
Q

Hypovolemic Hypernatremia

A

Cause - fluid loss
Diuretics, inc BG, azotemia
Diarrhea, sweating

TREAT - Hypotonic fluids 1/2 NS, D5W

25
Q

Euvolemic Hypernatremia

A

Cause - concentration of Na
Diabetes insipidus, CNS issue - dec ADH
Nephrogenic/renal impairment
Water loss in urine

TREAT - replace water, correct Ca and K+

26
Q

Hypervolemic Hypernatremia

A

Cause - inc fluid and Na
Iatrogenic, mineralcorticoids (inc aldosterone, Cushing’s, adrenal cancer)

TREAT - correct disorder, diuretics, replace water

27
Q

Hypokalemia

A

K+ <3.6
Causes
Renal loss - diuretics, cortisones, Mg lowering drugs

Stool loss - sorbitol, polystyrene, patiromer/phenophtalein

ECF->ICF shift - insulin, caffeine, verapamil, B2 adrenergic, epi/pseudophedrine, albuterol

TREAT - oral (best)/IV (need CVC) -20-100 meq to treat, 10-30 to maintain

28
Q

Hyperkalemia

A

K+ >5, asymptomatic until 5.5
Causes
CKD/ESRD - diuretics NSAIDS, Tacrolimus

Inc PO - K+ supps, salt subs, pRBC, Pen G

ICF –>ECF - beta blocker, succinylcholine, digoxin toxicity, NaHCO3-, D50+insulin, albuterol

TREAT - Lasix, polystyramine, patiromer, HD
Ca gluconate to prevent cardiac, goal to shift or increase loss

29
Q

Hypomagnesemia

A

Mg < 1.8, Inc NM issues/tetany
If Mg low, also K+ and Ca
Reduces insulin sens/secretion, glucose uptake, dec Lipoprotein lipase

Causes
Dec PO - MN, Mg free IV/PN, AUD, ostomy, SBS, intestinal bypass

Inc loss - Tubular necrosis/acidosis, Bartter syndrome, Inc aldosteronism, loop thiazides/diuretics

ECF–>ICF - refeeding, DKA, MI, hyperthyroid

TREAT - oral/IV (best): oral is slow absorption, need to keep IV < 1g/hr OR 8 meq/hr, dec dose for renal

30
Q

Hypermagnesemia

A

Mg >2.8, issues at >4.8

Causes - CKD

TREAT - IV CaCl/Ca gluconate for severe, inc Mg to reverse cardiac/NM effects, remove sources of Mg (drugs, IV, PN), dec Mg in diet, loop thiazide diuretics

31
Q

Hypocalcemia

A

Ca< 8.6 OR ionized Ca < 1.12

Causes - 2/2 low alb, low vit D/inc phos, low PTH, CRRT, hungry bone

Common in critically ill/sepsis/rhabdo/large vol transfusion, biphosphonate use, calcitonin, furosemide, foscarnet, LT phenobarb/pheny

TREAT - if < 7.5/<.9 use IV Ca gluconate/cl over 10 min (not with vent/pressors/critically ill d/t inc mort/ARF/shock)

If Mg also low, replete to correct Ca
If phos also high, use phos binders
Chronic def - oral Ca+Vit D

32
Q

Hypercalcemia

A

Ca >10.2, ionized >1.3

Causes - Inc PTH, cancer with bone mets, inc vit A or D, milk/ca carbonate intake with renal/adrenal insufficiency, TB, lithium/thiazides, immobilizations

TREAT - mild - hydration/ambulation, severe - IV NS at 200-300 ml/hr then 40-80 IV lasix
Calcitonin can be used, HD/biphosphonates
can be used for long term maintenance

33
Q

Hypophosphatemia

A

Phos <2.7, mod/severe (<1.5)

Causes - AUD, critically ill, resp/met alkalosis, DKA, phos binders, refeeding

TREAT - mild: oral, but SE of loose BMs/absorption
Mod/severe: IV K or Na Phos (KPhos unless K+ >4 or renal issues)
Dec dose for renal issues
< 7mmol/hr or else risk of thrombophlebitis or soft tissue deposition

34
Q

Hyperphosphatemia

A

Phos > 4.5

Causes - CKD, massive trauma/cytotoxic agents, inc catabolism, hemolysis, rhabdo, malignant hyper therm, resp/met acidosis, phos laxatives

Calcification: Ca x Phos > 55

TREAT - dec phos intake, inc alum/Ca binders, HD, volume repletion in normal renal fx

35
Q

GLP-1

A

Distal gut
Reduced app/energy intake
Delays gastric emptying
Enhances post radial insulin release

36
Q

Leptin

A

Gastric mucosa, neurons in brain
Low levels increase energy intake and decrease energy expenditure

37
Q

Ghrelin

A

Stomach
Increases food intake

38
Q

CCK

A

L cells of the gut, nerves in distal ileum and colon, neurons in brain
Inhibits gastric emptying
Reduces food intake

39
Q

Primary Fuel Sources in Starvation

A

Fed - Glycolysis/TCA
2-3 hrs - Glycogenolysis from hepatic glycogen (stores depleted after 24 hrs)
4-6 hrs - Gluconeogenesis from AA stores
48+ hrs - free fatty acid oxidation broken down to ketone bodies

40
Q

Osmolarity of PN Components

A

Dextrose - 5mosm/g
AA - 10mosm/g
Electrolytes- 1mosm/meq

41
Q

Holliday-Segar Method

A

estimates caloric expenditure in fixed weight categories
assumes that for each 100 calories metabolized, 100 mL of H2O will be required.
This method is not suitable for neonates <14 days old.

first 10 kg - 100 mL/kg/d
second 10 kg - 50 mL/kg/d
each additional kg - 20 mL/kg/d (≤ 50 kg.) OR 15 mL/kg (> 50 kg.).

42
Q
A

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