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*OldSurgery > Perioperative Fluid and Electrolytes > Flashcards

Perioperative Fluid and Electrolytes Flashcards

1
Q

what is Total Body Water (TBW)?

A

60% of total body weight

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2
Q

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

A

40%

20 %

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3
Q

Blood volume is ___ % of TBW

A

7%

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4
Q

Extracellular contains primarily what?

A

Na
Cl
HCO3

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5
Q

intracellular fluid is mainly waht?

A

K
PO4
SO4

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6
Q

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

A

Albumin

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7
Q

normal level of Na

A

140

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8
Q

Normal level of Cl

A

100

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9
Q

Normal level of K

A

4.0 mg/dl

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10
Q

normal level of albumin

A

4.0 g/L

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11
Q

what is the normal water loss per day

A

2.5-3 L / day

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12
Q

what is the breakdown of water losses per day

A

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

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13
Q

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

A

1-2 mEq/Kg/day

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14
Q

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

A

1 mEq/Kg/day

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15
Q

what is the 4-2-1 rule?

A

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

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16
Q

what is in normal saline?

A

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

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17
Q

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

A

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

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18
Q

what does lactated ringer’s contain.

A

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

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19
Q

for high volumes should you use LR or NS?

A

LR

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20
Q

what fluids do you use for life saving measures?

A

NS

LR

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21
Q

what are some scenarios where you lose more fluids?

A 
fever
vomiting 
diarrhea
NGT
fistulas
bleedings
drains
long open abd cases 
third spacing
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22
Q

where is albumin found

A

4 mg/dl in blood

1 in extracellular fluids

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23
Q

what is the problem with giving albumin

A

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

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24
Q

what are the goals with fluid resucitation

A

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

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25
Q

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?

A

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.

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26
Q

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

A

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

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27
Q

a drop a D5NS would read what on a glucometer?

A

5000

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28
Q

a high K is associated with what?

A

arrhythmias and cardiac death

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29
Q

what is a common reason for a high K reading?

A

hemolysis of blood during draw

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30
Q

what is hypernatremia usually due to?

A

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

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31
Q

what is hyponatremia usually due to?

A

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

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32
Q

should you correct hypernatremia or hyponatremia quickly or slowly?

A

slowly, or you can give permanent locked-in syndrome

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33
Q

how do you figure out how much Na a patient needs

A

(140- plasma Na) X TBW

34
Q

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

A

1/2

35
Q

what typically causes hypokalemia?

A

GI losses
NGT
renal losses
prolonged NPO

36
Q

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

A

K+ 20 mEq/ bag of IVF

37
Q

primary danger of low K+

A 
cardiac arrhythmias (surgery canceled if below 3.0)
also postop ileus
38
Q

how do you correct low K+

A

oral or IV K+ (10 mEq/ hr) (will burn IV site)

can give 20 w/ a central line

39
Q

Low K+ can show ____ T waves

A

flattened

40
Q

what can cause refractory hypokalemia?

A

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

41
Q

K- sparing diuretic?

A

spirolactone (give to cirrhotic patients)

42
Q

what causes hyperkalemia?

A

overadministration
poor renal excretion
transceullular shift

43
Q

what does hyperkalemia cause?

A

cardia carrhythmias
spiked T waves
sudden death

44
Q

Txs for hyperkalemia

A

Calcium (for the cardiac arrhythmias)

45
Q

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

A

glucose
insulin
soidum
bicarb

46
Q

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

A

rectally or orally administered potassium-binding resins

47
Q

what is calcium important for?

A

nerve conduction
muscle contraction
coagulation

48
Q

where is calcium only absorbed

A

duodenum

49
Q

what is the main controller of Ca level

A

parathyroid

50
Q

what causes high calcium

A

hyperparathyroid or malignancy

51
Q

symptoms of high calcium

A 
fatigue
muscle
weakness
depression
anorexia
52
Q

Tx for hypercalcemia

A

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

53
Q

what common cancer metastasize to the bone

A 
BLT on a kosher pickle
breast
lung
thyroid
kidney
prostate
54
Q

what is the name of the drug for lasix

A 
furosemide  (taken at 8 am and 2 pm) 
Lasts 6 (LASIX)
55
Q

what is hypocalcemia due to

A

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

56
Q

symptoms of low calcium

A

numbness/ tingling around mouth

muscle spasms and can lead to tetany

57
Q

how do you treat low calcium

A

PO/IV calcium

58
Q

what is the taget level for magnesium?

A

2.0

59
Q

phosphate is high in what condition?

A

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

60
Q

almost any electrolyte abnormality can be treated w/ what?

A

dialysis

61
Q

indications for dialsysis

A

Acidosis
Hyperkalemia
Volume overload / difficulty breathing
Symptomatic Uremia

62
Q

what is symptomatic uremia

A

uncontrollable itching

deposits in skin

63
Q

what is the ABG format order

A

pH/pCO2/pO2/HCO3/Base deficit

64
Q

what does the little p in pH mean

A

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

65
Q

what does the little p in pCO2 stand for?

A

partial pressure

66
Q

what is a base deficit

A

how much base you need to bring it up to 7.4

67
Q

a very negative number in base deficit indicates what

A

acidosis

68
Q

what is a normal pCO2?

A

40

69
Q

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

A

0.08

70
Q

if pCO2 is >40 then there is a _________

A

respiratory acidosis

71
Q

if pCO2 is <40 then there is a __________

A

respiratory alkalosis

72
Q

what can cause respiratory acidosis

A

sedation, head injury, dec. resp drive.

73
Q

what can cause respiratory alkalosis

A

pain, fever, sepsis, intentional hyperventilation on vent

74
Q

most common causes (for surgery) of metabolic acidosis?

A 
hypoperfusion of tissues leading to lactic acidosis
renal impariment (inability to get rid of acids)
75
Q

pO2 is good for determining _______ O2 in the blood

A

dissolved

76
Q

If PO2 is 30, then percent saturation is _____

A

60%

77
Q

If PO2 is 60 then percent saturation is _____

A

90%

78
Q

If PO2 is 45, then percent saturation is _____

A

75% (typical for venous)

79
Q

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

A

hot
acidic
high CO2

80
Q

when CO2 goes down, what happens in the brain?

A

minimize cerebral blood flow

81
Q

only diuretic that intentionally causes metabolic acidosis?

A

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

*OldSurgery (22 decks)

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