Perioperative Fluid and Electrolytes

Question 1

what is Total Body Water (TBW)?

Answer 1

60% of total body weight

Question 2

TBW is broken down into IntraCellular Volume ___ and ExtraCellular Volume (ECV)____.

Answer 2

40%

20 %

Question 3

Blood volume is ___ % of TBW

Answer 3

7%

Question 4

Extracellular contains primarily what?

Answer 4

Na
Cl
HCO3

Question 5

intracellular fluid is mainly waht?

Answer 5

K
PO4
SO4

Question 6

most important osmotically active colloid in ECV and is normally 4g/L in serum vs. only 1g/L in interstitial fluid.

Answer 6

Albumin

Question 7

normal level of Na

Answer 7

140

Question 8

Normal level of Cl

Answer 8

100

Question 9

Normal level of K

Answer 9

4.0 mg/dl

Question 10

normal level of albumin

Answer 10

4.0 g/L

Question 11

what is the normal water loss per day

Answer 11

2.5-3 L / day

Question 12

what is the breakdown of water losses per day

Answer 12

urine 1-1.5 L
150 cc GI
1 L insensible losses (sweat, respiration)

Question 13

We generally required how many mEq/Kg/day of Na and Cl?

Answer 13

1-2 mEq/Kg/day

Question 14

we generally require less than __ mEq/Kg/day of K

Answer 14

1 mEq/Kg/day

Question 15

what is the 4-2-1 rule?

Answer 15

Appropriate maintenance fluids
4 ccs per hour for the first 10 kg of weight
2 cc’s per hour for the next 10 kgs
1 cc per hour for every kg beyond that

Question 16

what is in normal saline?

Answer 16

created the right concentration of salt in water at the same concentration as their blood (330 mEq/L)

Question 17

why does D5 1/2 NS not lyse the cells?

Answer 17

added 50 grams of sugar is enough to bring it up to same osmolarity as the blood

Question 18

what does lactated ringer’s contain.

Answer 18

4 K
2 Ca
28 lactate
(much closer analog of normal body’s makeup)

Question 19

for high volumes should you use LR or NS?

Answer 19

LR

Question 20

what fluids do you use for life saving measures?

Answer 20

NS

LR

Question 21

what are some scenarios where you lose more fluids?

Answer 21

fever
vomiting 
diarrhea
NGT
fistulas
bleedings
drains
long open abd cases 
third spacing

Question 22

where is albumin found

Answer 22

4 mg/dl in blood

1 in extracellular fluids

Question 23

what is the problem with giving albumin

Answer 23

a lot of it is in the interstitial space and is higher there

when the inflammation stops, the albumin is trapped in that space, so it is hard to unload the water in the third space

Question 24

what are the goals with fluid resucitation

Answer 24

normal BP
HR in double digits
urine out put of 1/2 cc/kg/hr
for child low end of normal is 1 cc/kg/hr

Question 25

He says that pt X is diabetic but has been placed on D5 NS and his sugars are high...would you change it to just NS please?

Answer 25

No, need some sort of glucose so they don't undergo gluconeogenesis. giving dextrose allows them to avoid this (only 600 calories a day) keeps them from breaking down muscle.

Question 26

Nurse says that pt Y has a BMP with a glucose of 488. What would you like him to do?

Answer 26

Ask if patient is awake (need to know if in DKA) | have them recheck their glucose on other arm (often did a draw above the IV site

Question 27

a drop a D5NS would read what on a glucometer?

Answer 27

5000

Question 28

a high K is associated with what?

Answer 28

arrhythmias and cardiac death

Question 29

what is a common reason for a high K reading?

Answer 29

hemolysis of blood during draw

Question 30

what is hypernatremia usually due to?

Answer 30

typically from loss of water without salts e.g. burns, fever, hyperventilation.

Question 31

what is hyponatremia usually due to?

Answer 31

loss of water with salts e.g. diuretics, NGT, vomiting, hypoproteinism (cirrhosis, nephrotic syndrome, malnutrition)

Question 32

should you correct hypernatremia or hyponatremia quickly or slowly?

Answer 32

slowly, or you can give permanent locked-in syndrome

Question 33

how do you figure out how much Na a patient needs

Answer 33

(140- plasma Na) X TBW

Question 34

for the amount of Na a patient needs, you should administer how much in the first 24 hours?

Answer 34

1/2

Question 35

what typically causes hypokalemia?

Answer 35

GI losses NGT renal losses prolonged NPO

Question 36

what should you think about adding for a patient who is NGT or vomitting?

Answer 36

K+ 20 mEq/ bag of IVF

Question 37

primary danger of low K+

Answer 37

``` cardiac arrhythmias (surgery canceled if below 3.0) also postop ileus ```

Question 38

how do you correct low K+

Answer 38

oral or IV K+ (10 mEq/ hr) (will burn IV site) | can give 20 w/ a central line

Question 39

Low K+ can show ____ T waves

Answer 39

flattened

Question 40

what can cause refractory hypokalemia?

Answer 40

low Mg ( so check this if you give K+ and it isn't fixed)

Question 41

K- sparing diuretic?

Answer 41

spirolactone (give to cirrhotic patients)

Question 42

what causes hyperkalemia?

Answer 42

overadministration poor renal excretion transceullular shift

Question 43

what does hyperkalemia cause?

Answer 43

cardia carrhythmias spiked T waves sudden death

Question 44

Txs for hyperkalemia

Answer 44

Calcium (for the cardiac arrhythmias)

Question 45

what txs of hyperkalemia translocate potassium into cells in 30-60 minutes

Answer 45

glucose insulin soidum bicarb

Question 46

what is a treatment for hyperkalemia that binds and hastens excretion of K+ secreted into colon

Answer 46

rectally or orally administered potassium-binding resins

Question 47

what is calcium important for?

Answer 47

nerve conduction muscle contraction coagulation

Question 48

where is calcium only absorbed

Answer 48

duodenum

Question 49

what is the main controller of Ca level

Answer 49

parathyroid

Question 50

what causes high calcium

Answer 50

hyperparathyroid or malignancy

Question 51

symptoms of high calcium

Answer 51

``` fatigue muscle weakness depression anorexia ```

Question 52

Tx for hypercalcemia

Answer 52

give a ton of NS hydration and lasix (pee out extra calcium via chloride) sometime calcitonin or bisphosphonates

Question 53

what common cancer metastasize to the bone

Answer 53

``` BLT on a kosher pickle breast lung thyroid kidney prostate ```

Question 54

what is the name of the drug for lasix

Answer 54

``` furosemide (taken at 8 am and 2 pm) Lasts 6 (LASIX) ```

Question 55

what is hypocalcemia due to

Answer 55

post parathyroid surgery pancreatitis low albumin (calcium binds to albumin)

Question 56

symptoms of low calcium

Answer 56

numbness/ tingling around mouth | muscle spasms and can lead to tetany

Question 57

how do you treat low calcium

Answer 57

PO/IV calcium

Question 58

what is the taget level for magnesium?

Answer 58

2.0

Question 59

phosphate is high in what condition?

Answer 59

renal failure, should limit intake (limit milk, dairy, ice cream)

Question 60

almost any electrolyte abnormality can be treated w/ what?

Answer 60

dialysis

Question 61

indications for dialsysis

Answer 61

Acidosis Hyperkalemia Volume overload / difficulty breathing Symptomatic Uremia

Question 62

what is symptomatic uremia

Answer 62

uncontrollable itching | deposits in skin

Question 63

what is the ABG format order

Answer 63

pH/pCO2/pO2/HCO3/Base deficit

Question 64

what does the little p in pH mean

Answer 64

-log measuring concentration of hydrogen ions lower the number, high concentration of ions

Question 65

what does the little p in pCO2 stand for?

Answer 65

partial pressure

Question 66

what is a base deficit

Answer 66

how much base you need to bring it up to 7.4

Question 67

a very negative number in base deficit indicates what

Answer 67

acidosis

Question 68

what is a normal pCO2?

Answer 68

40

Question 69

A pCO2 change of 10 = a pH change of what?

Answer 69

0.08

Question 70

if pCO2 is >40 then there is a _________

Answer 70

respiratory acidosis

Question 71

if pCO2 is <40 then there is a __________

Answer 71

respiratory alkalosis

Question 72

what can cause respiratory acidosis

Answer 72

sedation, head injury, dec. resp drive.

Question 73

what can cause respiratory alkalosis

Answer 73

pain, fever, sepsis, intentional hyperventilation on vent

Question 74

most common causes (for surgery) of metabolic acidosis?

Answer 74

``` hypoperfusion of tissues leading to lactic acidosis renal impariment (inability to get rid of acids) ```

Question 75

pO2 is good for determining _______ O2 in the blood

Answer 75

dissolved

Question 76

If PO2 is 30, then percent saturation is _____

Answer 76

60%

Question 77

If PO2 is 60 then percent saturation is _____

Answer 77

90%

Question 78

If PO2 is 45, then percent saturation is _____

Answer 78

75% (typical for venous)

Question 79

to make oxygen unload from hemoglobin easier, what conditions are there?

Answer 79

hot acidic high CO2

Question 80

when CO2 goes down, what happens in the brain?

Answer 80

minimize cerebral blood flow

Question 81

only diuretic that intentionally causes metabolic acidosis?

Answer 81

Acetazolamide (only used for altitude sickness as they are in an alkalotic state) causes them to pee out base