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Phase 2a > WATER, ELECTROLYTES AND ACID BASE BALANCE > Flashcards

WATER, ELECTROLYTES AND ACID BASE BALANCE Flashcards

1
Q

Average total body water in L?

A

42L

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2
Q

Volume of water intravascular?

A

3L

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3
Q

Main intracellular and extracellular ion?

A

Intracellular - potassium

Extracellular - sodium

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4
Q

Hydrostatic pressure?

A

Intercapillary blood pressure

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5
Q

Oncotic pressure?

A

Pressure exerted by plasma proteins

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6
Q

Causes of oedema?

A

Increased hydrostatic pressure

Decreased oncotic pressure

occluded lymphatics

Increased vascular permeability

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7
Q

Difference between crystalloids and colloids?

A

Crystalloids - sodium chloride and contains low molecular weight molecules completely dissolved and moves freely between interstitium and intravascular

Colloids - contain larger molecular weight substance and has a longer-lasting effect - Haemorrhage, burns and sometimes septicaemia

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8
Q

What determines effective arterial blood volume?

A

Cardiac output and peripheral vascular resistance

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9
Q

Loop diuretics?

A

FUROSEMIDE

Decrease sodium and chloride reabsorption in the ascending loop of Henle

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10
Q

Thiazide Diuretic?

A

HYDROCHLOROTHIAZIDE

Decreased reabsorption of sodium in the distal convoluted tubule but associated with hypercalcaemia

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11
Q

Aldosterone antagonist?

A

SPIRONOLACTONE

Inhibits the effects of aldosterone

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12
Q

Potassium sparring Diuretics?

A

AMILORIDE

Not the strongest diuretics but prevents the exchange of sodium for potassium in the distal tubule

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13
Q

Calculated plasma osmolatlity?

A

(2x plasma sodium) + (urea) + (glucose)

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14
Q

Normal range of plasma osmolarity?

A

285 - 300 mosmol/kg

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15
Q

Where are osmoreceptors found?

A

Hypothalamus

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16
Q

Range of serum sodium?

A

135 to 145

17
Q

Causes of hypernatraemia?

A

Reduced water intake or increased water loss

increased administered sodium

Elderly, neonates or comatose patients not given enough fluids

18
Q

Management of hypernaetraemia?

A

Dextrose

19
Q

Types of hyponaetraemia?

A

Hypovolaemia - lose both water and sodium but more sodium

Dilutional - Excessive body water in relation to sodium by over-generous infusion of 5% glucose in post op patients

20
Q

At what sodium level does hyponatraemia show symptoms?

A

<120mmol/L

21
Q

symptoms of hypernatraemia?

A

Nausea, vomiting, fever or confusion

22
Q

Symptoms of hyponaetramia?

A

Muscle spasma and weakness

irritability

Nausea

Headache

Seizures

23
Q

Range of potassium?

A

3.5 to 5 mmol/L

24
Q

What can increase potassium?

A

Lysis or RBC or abnormal RBC disorders

Renal impairment of K excretion or drugs that interfere with this process

25
Q

Clinical features of high potassium?

A

Muscle spasms and paralysis

Metabolic acidosis with kussamals respiration - low deep sighing inspiration and expiration

ECG - Tall T wave, reduced P wave, wide QRS and since wave which is pre-cardiac arrest

26
Q

Causes of decreased potassium?

A

Diuretics and hyperaldosteronism

27
Q

Symptoms of low potassium?

A

Asymptomatic unless severe

Cardiac arrhythmia, muscle weakness or predisposed digoxin toxicity

28
Q

Increased magnesium?

A

Rare and iatrogenic - renal patients given medication containing magnesium

Causes neruo, cardiac and reps depression

Stop the Mg treatment, IV calcium gluconate (relieve toxic effects of too much Mg), Dextrose

29
Q

Low magnesium?

A

Loss of serum magnesium from the Gut or kidneys - severe diarrhoea, malabsorption, bowel resection or intestinal resection

Or diuretics, alcohol or osmotic stress - glycosuria in DM

  • Causes low calcium and potassium, inhibits the secretion of PTH and leads to PTH resistance
30
Q

Buffers of H+?

A

Haemoglobin proteins

Bicarbonate

Phosphate

31
Q

The enzyme used in acid-base conversions?

A

Carbonic anhydrase

32
Q

Respiratory acidosis?

A

Retention of CO2 due ventilatory failure

33
Q

What does the white box of the flenley acid-base nomogram show?

A

The approximate limits of arterial pH and PCO2 in normal individuals

34
Q

Respiratory alkalosis?

A

Hyperventilation so lots of CO2 is removed

35
Q

Metabolic acidosis?

A

Accumulation of any acid e.g. lactic acid

Hyperventilation, hypertension, cerebral dysfunction - confusion and fits

Anion gap normally 6 to 12 - if normal in the presence of acidosis - HCL being retained or NaHCO3 is being lost and if anion gap is greater then it is due to exogenous acid

lactic acidosis (septicemic and cardiogenic shock), DKA (ketones), Renal tubular acidosis (Failure of the kidneys to acidity urine), Uraemic acidosis (reduced capacity to excrete H+ and NH4+)

36
Q

Metabolic alkalosis?

A

Associated with potassium or volume depletion

D, V, Diuretic use or hyperaldosteronism

Cerebral dysfunction and respiratory depression

Replace with fluids

Phase 2a (7 decks)

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