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pharm > Fluids and electrolytes Oguin > Flashcards

Fluids and electrolytes Oguin Flashcards

1
Q

daily fluid volume required to maintain TBW homeostasis in a a healthy adult

A

25 - 35 ml/kg per day

2~3 Liters per day

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2
Q

ICF concentrations of sodium/potassium/calcium

A

ICF Na = 10
ICF K = 150
ICF Ca = 1

Mag = 40 
Chloride = 103
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3
Q

EVC concentrations of sodium/potassium/calcium

A

ECF Na = 140
ECF K = 4.5
ECF Ca = 5

ECF Mag = 2
ECF chloride = 117

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4
Q

First drug given in hyperkalemia

A

Calcium gluconate

to STABILIZE CARDIAC MEMBRANES

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5
Q

things that move potassium intracellularly

A

insulin, albuterol, hyperventilation,

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6
Q

Patients with ESRD don’t always demonstrate

A

EKG changes as their potassium shifts

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7
Q

primary determinant of both capillary and interstitial oncotic pressure

A

albumin

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8
Q

under euvolemic conditions, net fluid filtration is equal

A

lympathic flow

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9
Q

things that can damage the endothelial glycocalyx

A

tons of crystalloid administration, uncontrolled long term DM2, hyperglycemia, infection, stress, critical illness

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10
Q

daily water fluctuation

A

0.2% TBW

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11
Q

UO is not reliable in the OR because

A

Stress response causes the release of ADH, so pt is euvolemic but not peeing.

OR

insufflation of abdomen can decrease uo

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12
Q

crystalloid solutions are preferable for

A

conditions of dehydration.

TBW loss leading to plasma hypertonicity

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13
Q

administration of isotonic crystalloids leads to the hydration of

A

the entire ECV restoring water and electrolyte homeostasis to both intravascular and interstitial spaces for normal cellular processes.

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14
Q

IMMEDIATE restoration of circulating volume =

A

crystalloids

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15
Q

crystalloids are preferred for

A

immediate restoration of circulating volume

  • preservation of microcirculatory flow

decrease in hormone mediated vasoconstriction

correction of plasma hyper viscosity

lack of allergenic potential

ease of metabolism and renal clearance

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16
Q

because of their low molecules weight, crystalloids

A

crystalloid solutions contribute to the hemodilution of plasma proteins and loss of capillary oncotic pressure

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17
Q

intravascular repletion with crystalloids is

A

immediate BUT transient, bc crystalloids will hydrate all of the. ECV meaning 75-80% of administered volumes will go to interstitial space

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18
Q

osmolality of 0.45% NaCl

A

154 mOsm/ L

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19
Q

osmolality of D5W

A

253 mOsm/L in bag, less in body r/t metabolism of dextrose

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20
Q

osmolality of NaCl 0.9%

A

308 mOsm/L

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21
Q

osmolality of LR

A

273 mOsm/L in bag,

less in body because body metabolizes lactate

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22
Q

Osmolality of Plasmalyte A

A

294 mOsm/L

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23
Q

Osmolality of NaCl 3%

A

1026 mOsm/L

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24
Q

Osmolality of D5 NaCl 0.9%

A

560 mOsm/L

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25
Q

Osmolality of D5 NaCl 0.45%

A

405 mOsm/L, probably less in body

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26
Q

Osmolality of D5LR

A

525 mOsm/L probably less in body

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27
Q

Isotonic Colloids

A

Albumin 5%
Voluven 6%
Hespan 6%

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28
Q

Osmolality of albumin 5%

A

300 mOsm/L

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29
Q

Osmolality of Voluven 6%

A

296 mOsm/L

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30
Q

Osmolality of Hespan 6%

A

309 mOsm/L

31
Q

Osmolality of Dextran 10%

A

350 mOsm/L

only hypertonic colloid?

32
Q

Composition of LR

sodium/potassium/chloride/lactate

A 
LR 
sodium: 130
Potassium: 4
Chloride: 110
Lactate: 28

calcium: 3
osmolality: 273! - slightly hypotonic, more so because the body will metabolize lactate

33
Q

Composition of 0.9% NaCl

A 
Composition of 0.9% NaCl 
Sodium = 154
Potassium = 0
Chloride = 154
Mag = 0

osmolality ; 308

34
Q

Composition of Plasmalyte A

A 
Sodium = 140-141 
Potassium = 5
Chloride = 98
Phosphate = 1
Magnesium = 3
35
Q

D5W is given in

A

patients receiving insulin,

sometimes neonates

even then typically D51/2NS

36
Q

D5W provides

A

170-300 calories / 1000 mL for energy

37
Q

Typical use of 3% or 5% NaCl is in

A

treatment of hyponatremia

USED FOR LOW VOLUME RESUSCITATION

38
Q

Risks associated with hypertonic 3%/5% NaCl

A

Hyperchloremia, hypernatremia, cellular dehydration,

potential for osmotic demyelination syndrome

39
Q

DEXTRAN

A

synthetic colloid. Made with sugars.

Use is largely abandoned.

Black box warning: acute renal failure

r/f noncardiac pulmonary edema
interference with crossmatching
anaphylaxis

40
Q

evaporative loss for superficial trauma (orofacial)

A

1-2 mL/kg per hr

41
Q

evaporative loss for minimal trauma

A

2-4 mL/kg per hr

42
Q

evaporative loss for moderate trauma (major non abdominal)

A

4-6 mL/kg per hr

43
Q

evaporative loss for severe trauma

A

6-8 mL/kg per hr

44
Q

things that cause an intracellular shift that lead to HYPOKALEMIA (3)

A

alkalosis, insulin, beta 2 agonist

45
Q

Presentation of hypokalemia (4) <3.5

A

skeletal muscle cramps
weakness
paralysis
worsens Digoxin toxicity

46
Q

iatrogenic hyperkalemia >5.5

A

succhs

47
Q

Presentation of hyperkalemia >5.5

A

cardiac dysthymias

48
Q

EKG changes with hyperkalemia >5.5

A

Early: PR long, T wave peaked, QT short
Middle: P flat, QRS wide
Late: QRS becomes sine wave -> VF.

49
Q

Presentation Hyponatremia <135

A

N/V
skeletal muscle weakness
mental status changes -> seizures, coma
cerebral swelling

50
Q

must avoid rapid correction of sodium to prevent

A

osmotic demyelination syndrome

51
Q

Presentations of hypernatremia >145

A

thirst, mental status changes -> seizures, coma

cerebral dehydration

52
Q

treatment for hypermagnesemia

A

calcium chloride

53
Q

levels of hypermagnesemia

A

Loss of DTR : 4 - 6.5 meq/L or 10-12 mg/dL
Respiratory Depression: 6.5 - 7.5 mEq/L or >18mg/dL
cardiac arrest: >10 mEq/L or >25 mg/dL

54
Q

decreased coronary blood flow is associated with

A

alkalosis

55
Q

decreased contractility is associated with

A

acidosis

56
Q

Increased pulmonary vascular resistance is associated with

A

acidosis

57
Q

solutions that contain calcium are incompatible with

A

blood products

58
Q

colloids act by producing

A

intravascular volume expansion by directly increasing plasma oncotic pressure AND interacting with the endothelial glycocalyx to decrease trans capillary filtration

59
Q

dextran has a half life of roughly

A

6 to 12 hours.

much longer than crystalloids

60
Q

dextran causes nephrotoxicity by

A
  1. indirect hyperosmotic renal injury

2. direct renal tubular damage as a result of accumulation

61
Q

dextran was popular in vascular surgery because

A

it has coagulopathic effects, antithrombin effects , platelet inhibition

62
Q

stress activates

A

hypothalamus-pituitary axis-release of cortisol

63
Q

release of catchecholaimes

A

increased HR, increased SVR, increased microcirculatory vasoconstriction, release of aDH, reabsorption of water, potassium excretion

64
Q

prophylactic volume administration in euvolemic patients

A

is an antiquated practice with substantial risk of disrupting the endothelial glycocalyx and contributing to pathological fluid overload

65
Q

If a patient is receiving maintenance fluid

A

there is no NPO deficit but consider other losses

66
Q

adult estimated blood volume

A

70 mL / kg

75 - 85 mL/ kg

67
Q

MAP, CVP, andUO do not

A

have good predictive value at measuring fluid responsiveness

68
Q

ERAS aim:

A

Utilize individualized hemodynamic end points to support oxygen transport balance by minimizing oxygen demand and optimizing CO, tissue oxygenation, capillary and macrovascualr flow, oxygen and nutrient delivery and end organ perfusion.

69
Q

failure to recognize preload independence in hypotensive patients is often the mechanism for

A

inappropriate fluid administration

70
Q

CDPA preservative

A

citrate - binds with calcium
dextrose for glycolysis
phosphate buffer acidosis
adenosine helps RBC synethesize ATP

71
Q

Citrate toxicity occurs with

A

multiple units, leads to hypocalcemia, monitor ionized calcium

72
Q

most common infectious complication

A

cytomegalovirus

73
Q

most common cause of transfusion related death

A

TRALI transfusion related acute lung injury

platelets and FFP have the highest risk *

pharm (4 decks)

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