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1a. 675 - Coexisting Diseases > Week 1 - Fluid, Electrolytes, & Acid-Base Disorders > Flashcards

Week 1 - Fluid, Electrolytes, & Acid-Base Disorders Flashcards

1
Q

Generally, how does a high anion gap acidosis occur?

A
  • ↓ in HCO3: Fixed acid added to ECF, dissociates to H+, forms carbonic acid
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2
Q

Generally, how does a non-anion gap acidosis occur?

A
  • ↑ in Cl to balance ↓ in HCO3: ↓ HCO3- counterbalanced by a net ↑ in Cl- to maintain electrical neutrality.
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3
Q

What is non-anion gap metabolic acidosis also known as?

A

Hyperchloremic Metabolic Acidosis

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4
Q

What is the most common cause of Non-anion gap acidosis? Additional causes?

A
  • Most common: Iatrogenic 0.9% NaCl administration
  • Other: GI & Renal losses of HCO3 (Diarrhea, Renal tubule acidosis, early renal failure)
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5
Q

How do you treat non-anion gap acidosis?

A

turn off the 0.9% NaCl

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6
Q

During your preop workup, your BSA 18% pt has labs cooking up, they’re experiencing restlessness, irritability & lethargy. What values are you concerned for?

A
  • ↓ Na+: Hypovolemic Hypo or Hypernatremia 2/2 3rd space losses
  • ↓ in Ca2+: Due to loss of albumin
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7
Q

A pt being worked up for surgery has CHF & is displaying confusion/disorientation, which electrolyte abnormality are you expecting to be off and why?

A

↓ Na+: Hypervolemic Hyponatremia

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8
Q

A pt has a low magnesium, what other electrolyte disorders might you see?

A
  • Hypokalemia
  • Hypocalcemia
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9
Q

If you have a pt with hypocalcemia that is refractory to replacement, what might you consider and why?

A
  • Replacing the Mg first
  • Mg required for production/release of PTH -> HypoPTH -> ↓ Ca2+
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10
Q

If you have a pt with hypokalemia that is refractory to replacement, what might you consider and why?

A
  • Replacing the Mg first
  • HypoMg -> ↓ in Na-K-ATPase activity ->↑ in membrane permeability (ICF to ECF) K+ loss -> ↑ renal K+ excretion
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11
Q

Your pt who had an initially normal EKG develops ST & QT interval shortening and is displaying ↑ in BP, what electrolyte abnormality might you be concerned of?

A

Hypercalcemia

Nagelhout pg. 398 box 21.10

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12
Q

What is considered a normal iCal level?

A
  • 4.5 - 5.5mg/dL
  • 2.2 - 2.6 mEq/dL
  • 1.16 - 1.32 mmol/dL
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13
Q

What electrolyte abnormalities may cause muscle weakness after NMB reversal?

4ish

A
  • Hypo/Hypercalcemia (Need Ca2+ for muscle contraction, Too much causes loss DTR)
  • Hypo/Hypermagnesmia (HypoMg -> hypoCa2+; hypermagnesemia -> muscle weakness)
  • Hypophosphatemia (Hypophosphatemia -> Hypercalcemia)
  • Hypokalemia - (Muscle fibers experience hyperpolarization w/ ↓ in serum K+)
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14
Q

Your Pre-eclamptic pt needs to go to the OR right meow. What is your knee-jerk consideration regarding electrolytes, and what might you do?

A
  • Hypermagnesemia
  • Lower your NMB dose
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15
Q

Your pt is in a Chronic hypovolemic hyponatremic state, what electrolyte will be utilized to compensate?

A

Potassium

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16
Q

Interpret this ABG:
* pH = 7.48
* HC03- = 13
* pC02 = 18

Yes I copied because I’m lazy. Just do the ABG

A

Partially compensated Respiratory Alkalosis

17
Q

Interpret this ABG:
* pH = 7.38
* HC03- = 8
* pC02 = 14

A

Compensated Metabolic Acidosis

18
Q

Interpret this ABG:
* pH = 7.31
* HC03- = 16
* pC02 = 33

A

Partially compensated metabolic acidosis

19
Q

Interpret this ABG:
* pH = 7.26
* HC03- =30
* pC02 = 70

A

Partially compensated Respiratory acidosis

20
Q

HCO3 & CO2 both ↑ ( HCO3 >26 & CO2 >45) What is going on?

A
  • Primary acid-base disorder
  • With a compensatory secondary disorder
  • Brings the ratio of HCO3 to CO2 back toward 20:1.
21
Q

Pt is receiving a massive blood transfusion, what electrolyte disorders would you anticipate and why?

A
  • Hyperkalemia from RBC hemolysis
  • Hypocalemia from Citrate binding to Ca2+
22
Q

What kind of electrolyte disturbances would you expect to see in a obstructive bowel pt who has been hospitalized for a couple days?

A
  • ↓/↑ Na+ (Dilutional IVF, ↑ Na from IVF)
  • ↓ K+ (NG tube suction/Vomiting)
  • ↓ Cl- (NG suction/Vomiting)
  • ↓ Ca2+ (Alkalosis -> ↑ binding to albumin)
  • ↓ Mg2+ (Malabsorption/NG suction)
23
Q

What kind of acid-base balance would you expect in the pt w/ a bowel obstruction? What kind of compensation would you see?

A

Metabolic alkalosis
* Hypoventilation (Hypercarbia)

24
Q

Pt has hyperkalemia, what interventions will help?

6

A
  • CaGl or CaCl - ↑ Threshold potential
  • Insulin + Glucose - drives K+ into ICF
  • β2 agonist - drives K+ into ICF
  • NaHCO3 - ↑ pH & shift K+ in ICF
  • Diuretics - ↑ K+ excretion
  • Hyperventilation - ↑ pH & shift K+ in ICF
25
Q

Pt has hyperkalemia, what interventions will Hurt?

3

A
  • Hypoventilation - ↓ pH & ↑ serum K+
  • LR or Normalsol (contain 4 & 5 mEq/L K+)
  • Succinylcholine (Transiently ↑ K+ by 0.5 mEq/L)
26
Q

Normal ranges for CO2 & HCO3 on ABG?
Normal Midline?

A
  • CO2: 35-45 mmHg; 40 mmHg
  • HCO3: 22-26 mEq; 24 mEq
27
Q

How do you hand calculate the serum osmolality?

A

2(Na+) + (Glucose/18) + (BUN/2.8)

28
Q

Risk factors for developing TURP syndrome?

4

A
  1. Procedure > 1hr
  2. Fluids > 40cm above head
  3. Hypotonic irrigation fluid
  4. Bladder pressure >15 cmH2O
29
Q

What percent of Ca2+ is bound & unbound in the ECF?

A

60% unbound
40% bound to albumin/protein

30
Q

Anesthetic implications of Hypocalcemia?

4

A
  • Avoid hyperventilation/HCO3
  • High risk laryngospasm during emergence
  • Ca2+ binding with citrate during massive transfusion
  • Hypothermia, liver disease, & renal failure impair citrate clearance
31
Q

Anesthetic implications of Hypercalcemia

A
  • Neuromuscular monitoring if weakness/hypotonia/loss of DTR
  • CVP/PAP monitoring w/ fluid resuscitation & diuresis
32
Q

What diuretic should be avoided in pts w/ hypercalcemia and why?

A

Thiazide
* Renal tubule reabsorption of Ca2+

33
Q

Anesthetic implications of hypomagnesemia

3

A
  • TDP
  • use PNS to guide NMB (muscle excitation & weakness)
  • Avoid NS & diuresis since Mg+ follows Na excretion
34
Q

Anesthetic implications of hypermagnesemia

5

A
  • Invasive monitoring to tx HoTN/vasodilation
  • Fluid resuscitation w/ forced diuresis
  • Avoid acidosis (↑ Mg)
  • Controlled ventilation/ABGs to monitor pH
  • Low dose NMB w/ muscle weakeness
35
Q

Causes of respiratory acidosis?

5

A
  • Drug-induced ventilatory depression
  • Permissive hypercapnia
  • Upper airway obstruction
  • Status Asthmaticus
  • Restrictive ventilation (Rib fx/flail chest)
36
Q

Causes of respiratory alkalosis?

4

A
  • Iatrogenic (mechanical ventilation)
  • High Altitude
  • Pregnancy
  • Saliylate OD
37
Q
  1. TBW makes up what % of body weight?
  2. What % of TBW is intracelluar vs. extracelluar fluid?
  3. What % of ECF is Interstitial vs. Plasma?
A
  1. 60%
  2. ICF: 66% (2/3) & ECF: 33% (1/3)
  3. Interstitial: 75% (3/4) & Plasma: 25% (1/4)

1a. 675 - Coexisting Diseases (12 decks)

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