Fluid Managment Flashcards
The standard SI unit of concentration is:
- molarity
- molality
- equivalency
- grams per liter
The standard SI unit of concentration is: molarity
The system of international units(SI) is gradually gaining acceptance in clinical practice. The standard SI unit of concentration is molarity, which expresses the number of moles of solute per liter of solution. Molality is an alternative term that expresses moles of solute per kilogram of solvent.
pg. 663
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
A 24 year old female is scheduled for resection of a mandibular tumor. The surgeon is expecting a large blood loss, and normovolemic hemodilution to minimize the need for transfusion is suggested. The target hematocrit after normovolemic hemodilution should be approximately:
- 15 - 18%
- 21 - 25%
- 26 - 29%
- 30 - 35%
21 - 25%
pg. 703
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
An acute reduction in serum potassium levels can be achieved with:
- phenylephrine administration
- isoproterenol administration
- calcium chloride administration
- hypoventilation
isoproterenol administration
B-2 stimulation has been shown to enhance cellular uptake of potassium. Although calcium chloride is effective in the management of the membrane effects of hyperkalemia, it does not lower the serum potassium concentration.
pg. 682
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 355
Hines, RL, and Marschall, KE. Stoelting’s Anesthesia and Co-existing Disease. 2008
Clinically significant hypocalcemia should be suspected in the transfusion rate exceeds:
- 1 unit per hour
- 1 unit every 30 minutes
- 1 unit every 15 minutes
- 1 unit every 5 minutes
1 unit every 5 minutes
Rapidly transfused blood can result in citrate intoxication that presents as hypocalcemia. Because citrate is primarily metabolized in the liver, patients with hepatic disease may require calcium infusion during massive transfusion.
pp. 378-379
Barash, PG, Cullen, BF Stoelting, RK, Calahan, MK and Stock, MC. Clinical Anesthesia 2009
Cations, such as potassium and sodium, penetrate the cell membrane through:
- direct diffusion through the membrane
- specialized protein channels
- reversible binding to a carrier protein
- losing their charge and entering as a salt
specialized protein channels
Diffusion between extracellular fluid and intracellular fluid may take place through one of several mechanisms:
-directly through the membrane
-through specialized protein channels
-reversible binding to a carrier protein
Cations penetrate the membrane poorly and can diffuse only through specific protein channels.
Pg. 665.
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
A list of estimates of the rate(per donor exposure) of transfusion-transmitted infectious disease in North America is shown below. By dragging & reordering the selections in yellow, match the estimated rate with the corresponding infectious process.
- Cytomegalovirus
- Hepatitis B
- Hepatitis C
- HIV
(1: 269,000)
(1: 1,600,000)
(1: 14)
(1: 1,780,000)
Cytomegalovirus-1:14
Hepatitis B-1:269,000
Hepatitis C-1:1,600,000
HIV-1:1,780,00
pg. 370
Barash, Clinical Anesthesia, 2009
The most common cause of hypernatremia with normal total body sodium content is:
- hyperglycemia
- diabetes insipidus
- syndrome of inappropriate ADH secretion
- mannitol administration
diabetes insipidus
Diabetes insipidus causes the loss of water resulting in hypernatremia despite normal total body sodium stores.
Pg. 670
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
Post-transfusion purpura:
- is due to inactivation of platelets by transfused leukocytes
- is typically seen several hours after transfusion
- is most commonly the result of ABO or Rh incompatibility
- is typically associated with a precipitous drop in the platelet count
Post-transfusion purpura: is typically associated with a precipitous drop in the platelet count.
Post-transfusion purpura is associated with profound thrombocytopenia and is due to the development of platelet antibodies. The platelet count typically falls about 1 week after transfusion therapy.
pg. 701
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
A 78 year old, 80 kg man is confused and combative in the post-anesthesia care unit after a transurethral prostate resection. Laboratory findings include a serum sodium concentration of 118 mEq/L. Correction of the sodium concentration to 125 mEq/L would require approximately:
_____ mEq of sodium
335 mEq of sodium
the sodium deficit can be estimated by the following formula:
Na deficit = TBW x (desired Na - present Na)
Na deficit = (80 x 60%) x (125 -118)=336 mEq
pg. 674
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
In the average adult male, the percentage of body weight composed of water is:
_____%
55-65%
The average adult male is approximately 60% water by weight, females are about 50%
pg. 878-879
Barash, Clinical Anesthesia, 2009
In the plasma, the majority of inorganic phosphorus is in the form of:
- H3PO4
- H2PO4-
- HPO4-2
- PO4-3
In the plasma, the majority of inorganic phosphorus is in the form of: HPO4-2
Plasma phosphorus exists in both organic and inorganic forms. Organic phosphorus is mainly in the form of phospholipids. The majority of inorganic phosphorus is in the form of HPO4-2
Pg. 686
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
Extra hepatic synthesis of clotting factors is seen with:
- factor II
- factor VII
- factor VIII
- factor XII
Extra hepatic synthesis of clotting factors is seen with: factor VIII
Most clotting factors are synthesized by the liver, however factor VIII also has some extra hepatic synthesis.
Pg. 224
Barash, Clinical Anesthesia, 2006
In the distal renal tubule, calcium reabsorption is controlled by:
- parathyroid hormone
- aldosterone
- renin
- thyroid hormone
parathyroid hormone
In the distal tubules, calcium reabsorption is dependent on parathyroid hormone secretion, whereas sodium reabsorption is dependent on aldosterone secretion.
pg. 1284
Brash, Clinical Anesthesia, 2006
The most common cause of ABO incompatibility reactions is:
- blood typing error
- unknown antibodies in donor serum
- unknown antibodies in recipient serum
- patient misidentification
patient misidentification
pg. 700
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 372
Brash, Clinical Anesthesia, 2009
A list of pathophysiologic conditions is shown below. By dragging & reordering the selections in yellow, match the coag test with the corresponding condition.
- Liver Disease
- Hemphilia A
- DIC
- ASA Use
(Increased Bleeding Time)
(Increased aPTT)
(Increased PT)
(decreased Fibrinogen)
Increased PT—>Liver Disease
Increased aPTT—>Hemophilia A
Decreased Fibrinogen—>DIC
Increased Bleeding Time—>ASA Use
pg. 395
Barash, Clinical Anesthesia, 2009
A single unit of platelets can be expected to raise the platelet count by:
- 5,000 to 10,000
- 10,000 to 20,000
- 30,000 to 50,000
- 75,000 to 100,000
10,000 to 20,000
Each single unit of platelets may be expected to increase the count by 10,000 to 20,000. Platelet pheresis units contain the equivalent of six regular, single donor units.
pg. 669
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
An anesthesia consultation is requested for a 48 yer old man who has had a resection of an astrocytoma 12 hours earlier. The patient’s urine output is 500 mL/hour. The diagnosis of diabetes insipidus is suggested by:
- hyponatremia
- hyperglycemia
- urinary osmolality lower than plasma osmolality
- proteninuria
urinary osmolality lower than plasma osmolality
Diabetes insipidus causes the loss of water resulting in hypernatremia, increased serum concentration and urinary osmolality lower than plasma osmolality.
pg. 670
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 1301 - 1302
Brash, Clinical Anesthesia, 2009
The goal of fresh frozen plasma therapy is to achieve:
- 20% of the normal coagulation factor concentration
- 30% of the normal coagulation factor concentration
- 50% of the normal coagulation factor concentration
- 75% of the normal coagulation factor concentration
30% of the normal coagulation factor concentration
The initial therapeutic dose of FFP is usually 10-15 mL/kg. The goal is to achieve 30% of the normal coagulation factor concentration.
pg. 699
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 385
Brash, Clinical Anesthesia, 2009
In healthy patients, a urinary sodium concentration of 8 mEq/L is indicative of:
- decreased intravascular volume
- high cardiac output
- renal tubular dysfunction
- obstructive nephropathy
decreased intravascular volume
Urinary sodium concentration reflects circulating volume in the healthy patient. A low urinary sodium concentration(
In the average adult, interstitial fluid pressure is approximately:
-20 mmHg
-5 mmHg
10 mmHg
20 mmHg
-5 mmHg
Interstitial fluid pressure is generally thought to be negative, about -5 mmHg. As interstitial fluid volume increases, interstitial pressure rises and eventually becomes positive. When this happens, the free fluid increases rapidly and presents as edema.
pg. 664
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
Approximately 50% of the body’s magnesium is located in:
- bone
- intravascular fluid
- interstitial fluid
- striated muscle
bone
Only about 1 - 2% of total body magnesium stores are in the ECF. About 50% is located in bone and the remainder is located intracellularly.
pg. 320
Barash, Clinical Anesthesia, 2009
When properly stored, the shelf-life of a unit of platelets is approximately:
- 5 days
- 14 days
- 21 days
- 28 days
5 days
When properly stored at 20 - 24 degrees Celsius, the shelf-life of platelets is approximately 5 days.
pg. 385
Barash, Clinical Anesthesia, 2009
The percentage of free ionized calcium in the plasma is approximately:
- 10%
- 25%
- 50%
- 80%
50%
The normal plasma calcium concentration is 8.5 - 10.5 mg/dL. Approximately 50% is in the free ionized form, 40% is protein bound and 10% is complexed with citrate and amino acids.
pg. 314 - 315
Barash, Clinical Anesthesia, 2009
Vitamin K dependent clotting factor include(Select 4)
- Factor I
- Factor II
- Factor III
- Factor IV
- Factor V
- Factor VII
- Factor VIII
- Factor vWF
- Factor IX
- Factor X
- Factor XI
- Factor XII
II, VII, IX and X
Factors II, VII, IX and X undergo a final enzymatic addition of a carboxyl group that requires the presence of vitamin K. Without vitamin K, these factors are produced in normal amounts, but are nonfunctional.
pg. 389
Barash, Clinical Anesthesia, 2009
Factors that increase the rate of diffusion of a substance across the membrane include:
- a minimal concentration of differential
- a minimal pressure difference between both sides of the membrane
- positive ionic charge of the diffusing substance
- low molecular weight of the diffusing substance
low molecular weight of the diffusing substance
The rate of diffusion of a substance across a membrane depends on:
- the permeability of that substance across a membrane(depends on molecular weight)
- the concentration differential between the two sides of the membrane
- the electrical potential across the membrane for charged substances
pg. 665
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
The incidence of serious hemolytic reactions after transfusion of ABO- and Rh- compatible blood with a negative type and screen test, but without a crossmatch is:
- less than 1%
- 2 to 5%
- 7 to 10%
- 10 to 12%
less than 1%
The likelihood that the antibody screen will miss a potentially dangerous antibody has been estimated to be much less than 1:10,000.
pg. 384
Barash, Clinical Anesthesia, 2009
An anesthesia consultation is requested for a 78 year old, 70 kg man with a history of diabetes insidious. Significant laboratory findings include a serum sodium of 153 mEq/L. The water deficit in this patient is approximately:
_____ Liters
3.6 L
Diabetes insipidus causes the loss of water resulting in hypernatremia with the total body osmoles remaining unchanged. Free water loss can be calculated as follows:
Normal TBW x 140 = present TBW x 153
(70 x 0.6) x 140 = present TBW x 153
present TBW - 38.4 L
Normal TBW = 70 x 0.6 = 42L
Free water deficit = 42.0 - 38.4 = 3.6L
pg. 671
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
Redistribution and evaporative fluid losses during an inguinal herniorrhaphy are approximately:
- 0 to 2 mL/kg/hour
- 2 to 4 mL/kg/hour
- 4 to 6 mL/kg/hour
- 8 to 12 mL/kg/hour
4 to 6 mL/kg/hour
Although recent data suggests a more restrictive approach to fluid management in patients undergoing intra-abdominal surgery, congenitally, surgical fluid losses can be estimated as follows:
Minimal(herniorrhaphy)—> 4 to 6 mL/kg/hr
Moderate(cholecystectomy)—>6 to 8 mL/kg/hr
Severe(bowel resection)—>8 to 12 mL/kg/hr
The physiological effects of angiotensin II include:(select 2)
- renal efferent arteriolar vasodilation
- stimulation of ADH release
- increased glomerular filtration rate
- decreased sodium reabsorption
- increased aldosterone secretion
- reduction in plasma volume
stimulation of ADH release, increased aldosterone secretion
Angiotensin II induces renal efferent arteriolar vasoconstriction, promotes ADH release, stimulates aldosterone release resulting in intravascular volume expansion as well as increased sodium reabsorption.
pg. 1349
Barash, Clinical Anesthesia, 2009
Protein entering the interstitial space is returned to the vascular system by:
- reabsorption into the capillaries
- absorption into the arterial bed
- transfer into the intracellular compartment
- the lymphatic system
the lymphatic system
Only small quantities of proteins can normally cross capillary clefts. The protein content of interstitial fluid is relatively low, about 2 g/dL. Protein entering the interstitial space is returned to the vascular system via the lymphatics.
pg. 664-665
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 301-302
Barash, Clinical Anesthesia, 2009
Clinical manifestations of hypermagnesemia include(Select 2):
- hyperreflexia
- bradycardia
- vasoconstriction
- potentiation of non depolarizing muscle relaxants
- hypertension
bradycardia, potentiation of non depolarizing muscle relaxants
Clinical manifestations of hypermagnesiemia include hyporeflexia, sedation, weakness, vasodilation, bradycardia, myocardial depression and depressed release of acetylcholine with potentiation of non depolarizing neuromuscular blockade.
pg. 321-322
Barash, Clinical Anesthesia, 2009
Body fluids that may contain a higher concentration of sodium than found in plasma include:
- sweat
- saliva
- high acidity gastric juice
- pancreatic secretions
pancreatic secretions
Pancreatic secretions contain a large amount of bicarbonate and chloride anions and as a result have a high concentration of sodium as well, as much as 180 mEq/L. Other body fluids with high sodium content are biliary secretions, ill fluid and diarrhea stool.
pg. 695
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
After induction of anesthesia, the patient’s pH falls from 7.40 to 7.20 secondary to hypoventilation. As a result of the pH change, the free ionized calcium will?
increase from 5.0 to 5.3 mg/dL
Changes in plasma pH directly affect the degree of protein binding of calcium and thus the ionized free calcium concentration. Ionized calcium increases approximately 0.16 mg/dL for each decrease of 0.1 unit in plasma pH.
pg. 683
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 314-315
Barash, Clinical Anesthesia, 2009
The use of 6% hetastarch in volumes greater than 20 mL/kg has been associated with:
- coagulopathy
- interference with blood typing
- adrenocortical depression
- high incidence of anaphylactoid reactions
coagulopathy
Large doses of hetastarch have been associated with coagulopathy. In contrast to dextran, hetastarch is non antigenic and anaphylactic reactions are rare.
pg. 694
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 302
Barash, Clinical Anesthesia, 2009
In the normal adult, daily fluid loss secondary to evaporation from the respiratory tract is approximately:
- 100 mL
- 200 mL
- 400 mL
- 800 mL
400 mL
Daily water loss averages 2500 mL and can roughly be accounted for by 1500 mL in urine, 400 mL in respiratory tract evaporation, 400 mL in skin evaporation, 100 mL in sweat and 100 mL in feces.
pg. 667
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
When a patient is first started on warfarin therapy, the first clotting factor to become inactivated is:
- II
- VII
- IX
- XI
VII
Vitamin K dependent clotting factors are II, VII, IX and X. Factor VII has the shortest half-life(6 hours) and is the first to become inactivated by warfarin therapy.
pg. 386, 400
Barash, Clinical Anesthesia, 2009
Causes of hyponatremia with increased total body sodium content include:
- syndrome of inappropriate ADH secretion
- diuretic use
- mineralocorticoid deficiency
- congestive heart failure
congestive heart failure
Hyponatremia despite increased total body stores of sodium occurs in the presence of impaired renal excretion of free water. This can be seen in CHF, cirrhosis, renal failure and nephrotic syndrome.
pg. 306
Barash, Clinical Anesthesia, 2009
Laboratory evidence of dehydration includes:(select 2)
- falling hematocrit
- urinary osmolarity > 450 mOsm/L
- hyponatremia
- urinary sodium > 10 mEq/L
- BUN:creatine ratio > 10:1
- progressive metabolic alkalosis
urinary osmolality > 450 mOsm/L, BUN:creatine ratio > 10:1
Laboratory signs of dehydration include a rising hematocrit, progressive metabolic acidosis, urinary specific gravity > than 1.010, urinary sodium 450 mOsm/L, hypernatremia and a BUN:creatinine > 10:1.
pg. 691
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
The physiological effects of atrial natriuretic peptide include:
- arterial vasoconstriction
- decreased urinary sodium excretion
- increased water excretion
- increased plasma volume
increased water excretion
Actions of atrial natiruetic peptide(ANP) include: arterial vasodilation, increased urinary sodium excretion, increased water excretion, inhibition of renin release, decreased aldosterone production and antagonism of ADH. ANP is released by the atria in response to distention.
pg. 297, 1349
Barash, Clinical Anesthesia, 2009
The most important determinant of intracellular osmotic pressure is:
- sodium
- potassium
- cytoplasmic protein
- glucose
potassium
Because cell membranes are relatively impermeable to sodium, and to a lesser extent potassium, potassium is concentrated intracellularly. As a result, potassium is the most important determinant of intracellular osmotic pressure and sodium is the most important determinant of extracellular osmotic pressure.
pg. 663
Morgan, GE, Mikhail, MS and Murray, Clinical Anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division, 2006
pg. 296
Barash, Clinical Anesthesia, 2009
