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Electrolytes Flashcards

1
Q

On average, what percentage
of body weight does blood
account for in adults?

A

7

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2
Q 
What are the fluid
requirements every 24 hours
for each of the following
substances:
Water
Na
Potassium
Chloride
A

water 30 to 35 mL/kg
Na 1–2 mEq/kg
K 1 mEq/kg
Cl 1.5 mEq/kg

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3
Q

What is the major electrolyte

in colonic feculent fluid?

A

K 65 mEq/L

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4
Q

What is the physiologic

response to hypovolemia?

A

Sodium/H2O retention via renin -> aldosterone, water retention via ADH,
vasoconstriction via angiotensin II and
sympathetics, low urine output and
tachycardia (early), hypotension (late)

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5
Q

what is 3rd spacing

A

Fluid accumulation in the interstitium of
tissues, as in edema, e.g., loss of fluid into
the interstitium and lumen of a paralytic
bowel following surgery (think of the
intravascular and intracellular spaces as
the first two spaces)

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6
Q

When does “third-spacing”

occur postoperatively?

A

Third-spaced fluid tends to mobilize back
into the intravascular space around POD
#3 (Note: Beware of fluid overload once
the fluid begins to return to the intravascular
space); switch to hypotonic fluid
and decrease IV rate

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7
Q

What are the classic signs of

third spacing?

A

Tachycardia

Decreased urine output

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8
Q

tx for 3rd spacing

A

IVF isotonic

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9
Q

surgical cause of met acidosis

A 
Loss of bicarbonate: diarrhea, ileus,
fistula, high-output ileostomy,
carbonic anhydrase inhibitors
Increase in acids: lactic acidosis
(ischemia), ketoacidosis, renal failure,
necrotic tissue
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10
Q

surgical cause of hypoCl alk

A

NGT suction, loss of gastric HCl through

vomiting/NGT

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11
Q

surgical cause of met alk

A

Vomiting, NG suction, diuretics, alkali

ingestion, mineralocorticoid excess

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12
Q

surgical cause of resp acid

A

Hypoventilation (e.g., CNS depression),
drugs (e.g., morphine), PTX, pleural
effusion, parenchymal lung disease,
acute airway obstruction

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13
Q

surgical cause of resp alk

A

Hyperventilation (e.g., anxiety, pain, fever,

wrong ventilator settings)

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14
Q

What is the “classic” acidbase
finding with significant
vomiting or NGT suctioning?

A

Hypokalemic hypochloremic metabolic

alkalosis

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15
Q

Why hypokalemia with NGT

suctioning?

A

Loss in gastric fluid—loss of HCl causes

alkalosis, driving K into cells

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16
Q

With hypovolemia, what

changes occur in vital signs?

A 
Tachycardia, tachypnea, initial rise in
diastolic blood pressure because of
clamping down (peripheral vasoconstriction)
with subsequent decrease in both
systolic and diastolic blood pressures
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17
Q

What comprises lactated

Ringer’s (LR)?

A 
130 mEq Na
109 mEq Cl
28 mEq lactate
4 mEq K
3 mEq Ca
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18
Q

What accounts for tonicity?

A

Mainly electrolytes; thus, NS and LR are
both isotonic, whereas 1/2 NS is hypotonic
to serum

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19
Q

What happens to the lactate

in LR in the body?

A

Converted into bicarbonate; thus, LR
cannot be used as a maintenance fluid
because patients would become alkalotic

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20
Q

What is the common adult

maintenance fluid?

A

D5 1/2 NS with 20 mEq KCl/L add sugar to inhibit muscle breakdown

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21
Q

how to assess fluid status if cardiac or renal dysfunction

A

CVP or wedge pressure

22
Q

How many mL are in 12 oz

(beer can)?

A

356mL

23
Q

surgical hyperkalemia

A

Iatrogenic overdose, blood transfusion,
renal failure, diuretics, acidosis, tissue
destruction (injury/hemolysis)

24
Q

hyperK s and s

A

Decreased deep tendon reflex (DTR) or
areflexia, weakness, paraesthesia, paralysis,
respiratory failure

25
Q

HyperK tx

A 
CB DIAL K”:
IV calcium (cardioprotective), ECG
monitoring
Sodium bicarbonate IV (alkalosis drives
K intracellularly)
Glucose and insulin
Albuterol
Sodium polystyrene sulfonate
(Kayexalate) and furosemide (Lasix)
Dialysis
26
Q

What acid-base change

lowers the serum potassium?

A

alk so give bicarb for hyperK

27
Q

what weird tx can help lower K

A

albuterol

28
Q

hypoK causes

A

Diuretics, certain antibiotics, steroids,
alkalosis, diarrhea, intestinal fistulae, NG
aspiration, vomiting, insulin, insufficient
supplementation, amphotericin

29
Q

s and s of hypoK

A

Weakness, tetany, nausea, vomiting,

ILEUS, paraesthesia

30
Q

max KCl IV

A

10mEq/hr

31
Q

max KCl through central line

A

20mEq/hr

32
Q

what other electrolyte imbalnace should you look for if hypoK

A

low mag and must replace first

33
Q

Why does hypomagnesemia
make replacement of K
with hypokalemia nearly
impossible?

A

Hypomagnesemia inhibits K reabsorption

from the renal tubules

34
Q

hyperNa causes

A

Inadequate hydration, diabetes insipidus,
diuresis, vomiting, diarrhea, diaphoresis,
tachypnea, iatrogenic (e.g., TPN)

35
Q

hyperNa s and s

A

Seizures, confusion, stupor, pulmonary or
peripheral edema, tremors, respiratory
paralysis

36
Q

how and how fast should you lower Na

A

D5W, 1/2NS at <12mEq/L per day

37
Q

what is most major complication if lower too fast

A

seizures NOT central pontine myelinosis

38
Q

hypovolemic hypoNa causes

A

Diuretic excess, hypoaldosteronism,
vomiting, NG suction, burns, pancreatitis,
diaphoresis

39
Q

euvolemic hypoNa causes

A

SIADH, CNS abnormalities, drugs

40
Q

hypervolemic hypoNa causes

A

Renal failure, CHF, liver failure
(cirrhosis), iatrogenic fluid overload
(dilutional)

41
Q

tx for hypoNa

hypo, eu, and hypervolemic

A

hypo=NS IV, correct underlying cause

eu=SIADH: furosemide and NS acutely, fluid
restriction

hyper=Dilutional: fluid restriction and diuretics

42
Q

how fast can you increase Na

A

<12mEq/L/day

43
Q

What are the signs of central

pontine myelinolysis?

A
  1. Confusion
  2. Spastic quadriplegia
  3. Horizontal gaze paralysis
44
Q

What is the most common
cause of mild postoperative
hyponatremia?

A

fluid overload

45
Q

what are the causes of psuedohypoNa

A

hyperglycemia, hyperlipidemia,

or hyperproteinemia

46
Q

What is the acute treatment

of hypercalcemic crisis?

A

Volume expansion with NS, diuresis with

furosemide (not thiazides)

47
Q

What is the possible complication
of infused calcium if
the IV infiltrates?

A

Tissue necrosis; never administer
peripherally unless absolutely necessary
(calcium gluconate is less toxic than
calcium chloride during an infiltration)

48
Q

If hyperkalemia is left

untreated, what can occur?

A

v tach or v fib

49
Q

What is a colloid fluid?

A

Protein-containing fluid (albumin)

50
Q

What electrolyte is associated

with succinycholine?

A

hyperK

51
Q

Where is calcium absorbed?

A

Duodenum (actively)

Jejunum (passively)

surg (9 decks)

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