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surgery > Response to injury > Flashcards

Response to injury Flashcards

1
Q

water constitutes ____ % of total body weight

A

50-60%

Male = 60%
Female = 50%
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2
Q

highest percentage of TBW is found in _____

A

newborns

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3
Q

Cite the three functional fluid compartment

A
  1. Plasma
  2. Interstitial fluid
  3. Intracellular fluid
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4
Q

The principal cation in the ECF is

A

Na

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5
Q

The principal anion in the ECF is

A

HCO3

Ions in the ECF

  1. Na
  2. Cl
  3. HCO3
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6
Q

The cations in the ICF are:

A
  1. Potassium

2. Magnesion

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7
Q

The principal anions in the ICF are

A
  1. Phosphate

2. Proteins

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8
Q

The maintains the concentration gradient between compartments

A

ATP driven NaK pumps

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9
Q

Cote the body composition of 70kg lean adult male as % body weight and volume

A 
60% water = 42L
40% ICF = 28L
20% ECF = 14 L
15% interstitial fluid = 10.5L 
5% plasma = 3.5L
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10
Q

Majority of the fluid output is due to?

A

Insensible losses

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11
Q

What is the daily Na requirement for Na in a 70 kg lean adult?

A

1-2 mEq/kg

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12
Q

What is the daily Na requirement for K in a 70 kg lean adult?

A

0.5 to 1.0 mEq/kg

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13
Q

What is the daily Na requirement for Ca in a 70 kg lean adult?

A

1000 mg/day

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14
Q

What is the daily Na requirement for PO4 in a 70 kg lean adult?

A

700 mg/day

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15
Q

What is the daily Na requirement for Mg in a 70 kg lean adult?

A

300-400mg/day

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16
Q

What is the daily Na requirement for Cl in a 70 kg lean adult?

A

1-2 mEq/kg

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17
Q

___ is the most common source of external fluid loss in a surgical patient is via?

A

the GIT

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18
Q

[Which part of the GIT]

highest Na

A

Duodenum, Ileum

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19
Q

[Which part of the GIT]

Highest K

A

Colon

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20
Q

[Which part of the GIT]

Highest Cl

A

Ileum

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21
Q

[Which part of the GIT]

Highest bicarbonate

A

Pancreas (115), Bile 35

Ileum (30)
Saliva (3)

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22
Q

[Which part of the GIT]

highest volume

A

Ileum 3000 mL

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23
Q

[among the electrolyte solutions for PN administration]

Which has the closest to body levels for Na

A

PNSS 154

24
Q

[among the electrolyte solutions for PN administration]

Which has the closest to body levels for K

A 
LR = 4
D5LR = 4
25
Q

[among the electrolyte solutions for PN administration]

Which has the closest to body levels for C

A

LR = 28

26
Q

[Guess the electrolyte solution]

Osm = 280
Na = 130
K = 4
Cl = 109
Ca = 28
A

LR

27
Q

[Guess the electrolyte solution]

Osm = 308
Na = 154
K = 0
Cl = 154
Ca = 0
A

PNSS

28
Q

[Holliday Segar Method]

70kg man

What is the maintenance fluid requirement needed?

A

2500 mL/day

10kg x 100 mkday = 1000 mL
10kg x 50mkday = 500mL
50 kg x 20mkday = 1000 mL

Remember: 100 - 50 - 20 mkday

29
Q

[classify the stage of dehydration]

(+) thirst
low urine volume
reduced sweating

A

Mild

2-5% loss

30
Q

[classify the stage of dehydration]

Severe thirst
Nausea
Dry axilla and groin
Tachycardia
Orthostatic hypotension
Low CVP
Poor skin rugor
Apathy
Oliguria
Hemoconcentration
A

Moderate

6-10% loss

31
Q

[classify the stage of dehydration]

stupor
Hypotension
severe oliguria
Thready pulse
shock
A

severe

11-15% loss

32
Q

Cite causes of HAGMA

A 
Methanol
Uremia
DKA
Propylene glycol, paraldehyde
Infection, Iron, Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
33
Q

Cite exogenous acid ingestion that causes HAGMA

A

Ethylene Glycol
Salicylate
Methanol

Propylene glycol
Paraldehyde

34
Q

Cite endogenous causes of acid production in HAGMA

A

Ketoacidosis
Lactic acidosis
Renal insufficiency

35
Q

Cite causes of NAGMA

A 
Hyperalimentation
Acetazolamide
RTA
Diarrhea
Uteroenteric Fistula
Pancreaticoduodenal fistula
36
Q

[bicarbonate generation]

Cite causes of increased bicarbonate generation that is chloride losing

A

Mineralocorticoid excess

Profound potassium depletion

37
Q

[bicarbonate generation]

Cite causes of increased bicarbonate generation that is chloride sparing

A

Loss from gastric secretion

Diuretics

38
Q

[IV fluid of choice]

In management of hypernatremia

A

PNSS

Rate of decrease in serum Na = <1 mEq/l/hr

39
Q

Rapid correction of hypernatremia can cause

A

cerebral edema

Herniation

40
Q

[IV fluid of choice]

In management of hyponatremia

A

None.

Restrict Na

41
Q

[what electrolyte imbalance]

restlessness, irritability, seizures, coma

can lead to SAH

A

hypernatremia

42
Q

[what electrolyte imbalance]

headache, confusion, seizures, coma

increased ICF

A

hyponatremia

43
Q

[IV fluid of choice]

In management of symptomatic hyponatremia

A

3% normal saline until serum Na is 130 or resolution of symptoms

rate: not more than 1mEq/l/hr

44
Q

[IV fluid of choice]

In management of asymptimatoc hyponatremia

A

3% normal saline

rate: not more than 0.5 mEq/l/hr

max goal: 12 mEq/l/hr

45
Q

[what electrolyte abnormality]

nausea/vomiting
weakness, paralysis
arrhythmia

peaked T waves

A

hyperkalemia

46
Q

In managing hyperkalema, how many mg of nebulized salbutamol will you administer

A

10-20mg

47
Q

When will you immediately administer calcium chloride or calcium gluconate in hyperkalemic patients?

A

when ECG changes are present

48
Q

[what electrolyte abnormality]

ileus, constipation

decreased paralysis

cardiac muscle arrest

flat T wave

A

hypokalemia

49
Q

[management of hypokalemia]

in mild asymptomatic hypokalemia, the treatment of choice is?

A

KCl 40 mEq/enteral access x 1 dose

50
Q

[management of hypokalemia]

what is the rate of IV repletion in patients with hypokalemia

A

no more than 10mEq/hr

51
Q

[what electrolyte abnormality]

neurologic impairment
MSK weakness and pain

T wave flattening
shortened QT interval
Prolonged PR and QRS interval
AV block

A

hypercalcemia

52
Q

what is the cut off serum Ca level wherein you should start treatment?

A

when serum level exceeds 12 mEq/L

53
Q

[What electrolyte abnormality]

prolonged QT interval
T wave inversion
VFib
heart block

A

hypocalcemia

54
Q

Ca level when neuromuscular and cardiac symptoms occur

A

iCa is below 2.5mg/dL

55
Q

what electrolyte abnormality is associated with hypocalcemia?

A

hypomagnesemia
hypokalemia

Remember, hypomagnesemia can lead to hypocalcemia leading to persistent hypokalemia

56
Q

[IV fluid of choice]

In management of cute symptoms of hypermagnesemia

A

calcium chloride

57
Q

[IV fluid of choice]

This is given to counteract the adverse side effects of rapidly rising Mg level

A

calcium gluconate

Remember, hypomagnesemia can lead to hypocalcemia leading to persistent hypokalemia

surgery (19 decks)

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