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SURGERY > Fluids and electrolytes > Flashcards

Fluids and electrolytes Flashcards

1
Q

Total body water (TBW) is approximately__ of your

body weight.

A

60%

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2
Q

Two-third of your total TBW is comprised by

________

A

Intracellular fluid (ICF)

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3
Q

one-third is comprised of

_____

A

Extracellular fluid (ECF).

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4
Q

ECF: 1/4

A

plasma

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5
Q

ICF: 3/4

A

interstitial fluid

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6
Q

Contain mainly in skeletal muscle (highest)

A

INTRACELLULAR (⅔)

  • 40% of body weight
  • 60% of TBW
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7
Q

Intracellular Cations

A

K, Mg

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8
Q

Intracellular Anions

A

PO3, SO3, Proteins

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9
Q

Interstitial Fluid (fluid that is in between your cells
and blood vessels) + Plasma Volume (All the fluid
that contain inside your BV)

A

EXTRACELLULAR (⅓)

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10
Q

EXTRACELLULAR cation

A

Na

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11
Q

EXTRACELLULAR anion

A

Cl, HCO3

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12
Q

transports 3 Na molecules out vs.
2 K molecules in (K accumulates inside the cell;
Na accumulates outside the cell resulting in a
gradient)

A

Na/K ATPase

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13
Q

T or F
Most significant gains and losses of body fluid
comes from the ICF compartment. Due to
vomiting and diarrhea and blood loss.

A

F

*intracellular

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14
Q
  • 15 % of body weight

* 25% of total body water

A

INTERSTITIAL FLUID

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15
Q

• 10% of total body water
• has high protein (organic anions) content
• 7% of body weight (in kg) = estimate of blood
volume

A

PLASMA

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16
Q

osmosis is determined by the ________ on

each side of the membrane

A

concentration of solutes

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17
Q

Fluid will move to move towards the container that has the

_______ concentration of solutes

A

higher

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18
Q

DETERMINANTS OF OSMOLALITY

A
  • Sodium (Na)
  • Blood Glucose
  • Blood Urea Nitrogen (BUN)
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19
Q

are the watery fluid that you
can measured and see. This are your oral fluid and
amount of solid food you eat. We can also have
measured urine, intestinal fluid, sweat.

A

Sensible water losses

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20
Q

are the water that you lose
through metabolism. i.e oxidation. It is water that we
lose through respiration and through our skin.

A

Insensible water losses

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21
Q

Kidneys must excrete a minimum of_____ ml /

day of urine to clear products of metabolism

A

500 to 800

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22
Q

▪ Specialized sensors that detect small chances

fluid osmolality

A

OSMORECEPTORS

▪ Act through the kidneys

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23
Q

Dehydration: ↑ plasma osmolality →

A

o ↑ thirst & water consumption +
hypothalamus
o VASSOPRESSIN → ↑ water
reabsorption in the kidney

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24
Q

Baroreceptors are located in ______

A

aortic arch & carotid sinus

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25
Q

Modulate volume in response to changes in BP &
blood volume (If your blood pressure is low, they
have to calibrate it in order to increase your blood
pressure)

A

BARORECPTORS

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26
Q

Acute Volume Deficit =

A

CVS & Nervous system

signs

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27
Q

Chronic Volume Deficit =

A 
Tissue signs (skin 
turgor, CVS & nervous system signs
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28
Q

ECF diagnostics

A

▪ ↑ BUN (if severe enough to ↓ glomerular filtration)
▪ Hemoconcentration (If you do CBC, you’ll see
that your hematocrit is higher than normal as your
blood is concentrated)
▪ ↑ Urine osmolality (very concentrated urine) >
Serum osmolality
▪ ↓ Urine NA < 20 meq/L

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29
Q

▪ ↑ both plasma + interstitial volumes

A

ECF VOLUME EXCESS

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30
Q

Causes of ECF volume excess

A

o Iatrogenic (excess IVF)
o 2° (secondary) to renal dysfunction,
congestive heart failure (CHF), liver
cirrhosis

31
Q

T or F
Changes in Na are usually inversely proportional
to TBW

A

T

32
Q

Normal Na =

A

130 - 150 mEq/L

33
Q

▪ serum Na ≤ 130 mEq/L

▪ occurs when ECF > serum Na

A

HYPONATREMIA

34
Q

Usually has very severe neurological symptoms:

Acute cerebral edema, seizures, coma

A

ACUTE HYPONATREMIA

35
Q

▪ Well-tolerated up to levels of 110 meq/L well
below

▪ confusion, decreased mental status,
irritability, ↓ Deep tendon reflexes

A

CHRONIC HYPONATREMIA

36
Q

o Form of paralysis that occurs because of
overcorrection of Na
o Sodium-Potassium pumps cannot handle
the load quickly enough
o Destroys CNS neurons- very sensitive to
electrolytes. Myelin sheath is destroyed

A

▪ CENTRAL PONTINE MYELINOLYSIS

37
Q

▪ Solute excess / osmotic particles in ECF
▪ Na is not the only particle that determines your
serum osmolality. It also includes your BUN and
your blood glucose. These two components
crowd out the sodium and the sodium becomes
proportionately lower
▪ The kidneys try to compensate so you urinate
more (like in diabetes) so you lose more water
and sodium (collateral damage).

A

HYPEROSMOLAR HYPONATREMIA

38
Q

Drug that is given to decrease CNS
swelling. It is a diuretic=removes Na. You
decrease blood volume in brain and pressure.

A

Mannitol

39
Q

▪ Na ≥150 mEq/L
▪ From
o Loss of free water (↓ ECF
o Gain in Na > ECF

A

HYPERNATREMIA

40
Q 
Volume deficit with free 
water loss> Na loss
- Insensible H2O loss 
from GIT/skin
- Thyrotoxicosis
- Hypertonic glucose 
solutions (peritoneal 
dialysis)
-- Diabetes insipidus
- Diuretics
- High output urine 
output from polyuric 
phase of ATN
A

• NORMOVOLEMIC HYPERNATREMIA

41
Q

• NORMOVOLEMIC HYPERNATREMIA: TREATMENT

A 
Replace water with 
PNSS
Free water deficit (L)=
𝑆𝑒𝑟𝑢𝑚 𝑁𝑎 − 140
140
× 𝑇𝐵𝑊
½ deficit = replace in 1st
8 hours
½ deficit = replace in 
next 16 hours
Once adequate volume 
achieved: replace water 
deficit with D5W or 
D5NSS or oral H2O
Titrate to achieve ↓Na 
by:
Acute HyperNa= 1 
mEq/L & 12 mEq/day
Chronic HyperNa = 0.7 
mEq/hou
42
Q
  • Urine Na > 20 mEq/L
  • Urine osmolality > 300
    mOsm/L
    –Mineralocorticoid
    excess
  • Hyperaldosteronism
  • Cushing’s Syndrome
  • Congenital adrenal
    hyperplasia
A

HYPERVOLEMIC HYPERNATREMIA

43
Q

Serum Ca =

A

1% of total body Ca

44
Q

o Ionized Ca (50%) = responsible for__________

A

neuromuscular stability

45
Q

▪ When serum calcium is > 10.5 mEq/ L or increase in

ionized Ca > 4.8 mg/dL

A

HYPERCALCEMIA

46
Q

It is Symptomatic HyperCa - if

A

> 12 mg/dL

47
Q

Critical Level of HyperCa =

A

15 mg/dL

48
Q

The most common cause of hypercalcemia in
admitted patients inside the hospital is actually
_________

A

Cancer.

49
Q 
The most common cause of hypercalcemia in 
outpatient setting (in the rest of the population) is \_\_\_\_\_\_\_\_\_\_
A

Primary Hyperparathyroidism.

50
Q

HYPERCALCEMIA TREATMENT

A

▪ Aggressive Isotonic IVF Resuscitation - diuresis and
excretion of Ca from kidneys
▪ Furosemide – for diuresis,
▪ Meds to Stop Osteoclastic Activity

51
Q

– It is a calcinamatic, it attaches to
parathyroid glands and signals to stop
releasing parathyroid harmone.

A

Calcitonin

52
Q

Serum Ca < 8.5 mEq/L or Ionized Ca < 4.2 mEq/L

A

HYPOCALCEMIA

53
Q

The most common cause of hypocalcemia is ________-

A

thyroid surgery (Thyroidectomy)

54
Q

This occurs due to damage to parathyroid
gland, and most common cause of that is
thyroid surgery, because it accidentally
damages parathyroid. Hypoparathyroidism
(most common cause)

A

Transient Hypocalcemia or Postoperative

hypocalcemia for < 6 months (post thyroidectomy).

55
Q

in hypoproteinemia

(low albumin) state.

A

Asymptomatic Hypocalcemia

56
Q

Classic signs of Hypocalcemia

A

Peri-oral numbness
Cramps
Chvostek’s sign
Trosseau’s sign

57
Q

HYPOCALCEMIA TREATMENT

A

▪ Asymptomatic - oral supplementation with 500 mg
Calcium Carbonate 2 tabs TID
▪ Symptomatic - monitored & treated
o IV calcium gluconate

58
Q

▪ The 1o
intracellular divalent anion
▪ Increase in metabolically active cells
▪ Involved in energy production during glycolysis
▪ Controlled by renal excretion. .
▪ It is present in increased amounts in highly
metabolically active cells like your bone, GIT.

A

PHOSPHOROUS

59
Q

PAROXYSMAL RHABDOMYOLISIS causes ________

A

hyperphosphatemia

60
Q

MALIGNANT HYPERTHERMIA

causes________

A

hyperphosphatemia

61
Q

HYPERPHOSPHATEMIA TREATMENT

A 
▪ Oral: 
o PHOSPHATE BINDERS - Sucralfate / 
Aluminum-containing antacids 
o Ca Acetate Tabs - if associated with 
simultaneous hypocalcemia 
▪ Dialysis
62
Q

Hypophostanemia (intracellular shift acute cases)

A

Respiratory alkalosis
Insulin therapy
Refeeding syndrome
Hungry bone syndrome

63
Q

HYPOPHOSPHATEMIA TREATMENT

A 
▪ Oral 
o Neutra Phos packets - 2 packets Q6 per NGT 
▪ IV 
o Potassium phosphate (KPHO4) 
o NaP04 IV
64
Q

▪ 4th most common mineral in the body
▪ Mainly intracellular
o Present in every cell type, binds to ATP,
required for enzymes

A

MAGNESIUM

65
Q

Magnesium total body content:

A

2000 mEq

66
Q

HYPERMAGNESEMIA TREATMENT

A

▪ Ca Chloride (5-10 mL) - given IV to antagonize
cardiovascular events
o Hemodialysis
o Correct acidosis and volume deficits

67
Q

▪ Common in critically ill hospitalized patients
▪ Can produce hypocalcemia and lead to persistent
hypokalemia

A

Hypomagnesemia

68
Q

HYPOMAGNESEMIA TREATMENT

A 
C. IV 
o Magnesium Sulfate Drip - recheck Mg level 
in 3 days 
D. Oral
o Milk of magnesia per NGT
69
Q

• 3 SYSTEMS THAT MAINTAIN pH RANGE

A
  1. Carbon Dioxide: excreted by lungs to maintain
    normal CO2
  2. Strong Ions: completely dissociate in water (Na, Cl,
    Ca, Mg, K)
  3. Weak Acids: buffering systems of water (protein,
    phosphates)
70
Q

• pH < 7.35

A

ACIDOSIS

71
Q

• pH will decrease when

A

o ↑ pCO2 concentration or ↓ HCO3 concentration
o ↑ concentration of strong anions
o ↑ concentration of weak acid

72
Q

● From ↑ CO2 retention secondary to decreased alveolar

ventilation

A

RESPIRATORY ACIDOSIS

73
Q

• RESPIRATORY ACIDOSIS TREATMENT

A

o ↑ Alveolar ventilation
o Reversing agents for drug overdose
o Intubation with mech ventilation to clear CO2

74
Q

• From loss of HCO3, intake of acids, or ↑

generation of acids

A

METABOLIC ACIDOSIS

SURGERY (6 decks)

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