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Flashcards in #Acid&Base/Endocrine Deck (44):
0

Describe how PaCO2 change will effect pH

PaCO2 change 10 mmHg = pH change 0.08
Opposite Direction.

1

pH & potassium change calculation

pH 0.1 = K 0.6 in opposite direction.

2

PaCO2 & K change equation

PaCO2 10 torr = K 0.5 mEq/l (same direction)

3

To increase serum potassium 1 mEq/L, how much potassium must be given?

100-200 mEQs

4

1. DKA: don't drop glucose levels faster than:
2. At what bs do you start d5w?

1. 100 mg/dL/hr
2. <300 mg/dL

5

Oat cell carcinoma: mimics which 2 hormones causing which 2 syndromes.

-ADH: SIADH (no urinating)
-cortisol : cushings disease (adrenal overloaed)

(Small cell carcinoma typically in lungs)

6

Causes of SIADH

(Syndrome of innappropriate Antidiuretic syndrome)

-oat cell carcinoma
-viral pneumonia & TB
-head injury
-opiates, pain, anxiety (temporary)

7

SIADH presentation

Dilution army hyponatremia
=cerebra edema
=seizures
=elevated urine osmolality / specific gravity
-fluid doesn't get into kidneys

8

Treatment for SIADH

-restrict fluids
-Diuresis: 1st degree loop diuretics
-demeclocycline (tetracycline fam / ADH receptor antagonist)

9

Thyroid storm aka, presentation, tx

Graves' disease
Presentation: high idle speed, weight loss, cp, sob, fever, tremors/nervousness, marked tachycardia, AFib.

Tx: anti thyroid meds, antipyretics, electrolytes, fluids, glucocorticoids (dexamethasone= prevents production t4-t3), hr will not respond to digitalis.

10

Myxedema Coma cause, presentation, tx

Hypothyroidism - autoimmune due to infection
Presentation: women, >60, winter. Fatigue, weight gain, cold intolerance, deep voice, coarse hair. ALOC=coma

Tx: supportive, IV levothyroxine (t4), watch for adrenal insufficiency.

11

Steroid production pathway

Steroid mechanisms:

CRH (cortical releasing hormone) released from brain. > to anterior pituitary > release of ACTH (adrenal corticotropin hormone) > to adrenals > release of glucocorticoids, androgens, mineralcorticoids.

Management of sugars, breakdown from muscles, fatty tissues, sex hormones, electrolytes, aldosterone levels, alpha/beta receptor response.

12

Addison's causes (primary/secondary)

Primary: autoimmune
Secondary: pituitary malfunction = low ACTH
Other: acute glucocorticoid withdraw

13

Addison's presentation, tx

Presentation: inadequate aldosterone cortisol, androgens. Fatigue, weakness, low BP, low h2o / Na retention, hypoglycemia, poor catecholamine response.

Tx w/steroids, fluid

14

Cushings disease causes, presentation, tx

Causes: chronic steroid use w/ abrupt DC, pituitary disorder (high ACTH), oat cell, adrenal carcinoma (high cortisol)
Presentation: upper body obesity, thin arms/legs (muscle wasting), round face, buffalo hump, fatique, HTN, high BS, fatty & amino acids to glucose, pancreatic overload (DMII)' increase Epi/NE
TX: steroid management, supportive, surgery.
Solu-cortef (low potency), Decadron high potency.

15

Pancreatitis causes

ETOH, biliary stone, steroids & antibiotics, viral/bacterial infection, bowel obstruction

16

Pancreatitis presentation (7)

1. Low ca
2. L base atelectasis = elevation L diaphragm
3. Bilateral pleural effusion
4. Sepsis & ARDS
5. Renal failure
6. Cullen's sign: peri umbilical bruising
7. Gray-Turner's sign: flank & groin bruising

17

Pancreatitis tx (7)

1. Fluid resuscitation
2. NPO, NG/OG (stimulate stomach=stimulate pancreas)
3. Meperidine (similar to atropine, increased GI motility / relaxation, sphincter if odi relaxation)
4. Alternate atropine, Narcan, beta blockers, tetrodotoxin
5. Anticipate progression (ARDS, Sepsis, MOzdS, DIC)
6. Antibiotics for sepsis
7. Surgery

18

Why is liver failure common w/ GI bleeds?

Body is metabolizing blood proteins
-metabolism of proteins = ammonia production

19

Liver failure / hepatic encephalopathy presentation

Elevated AST, ALT, SGOT/SPGT,
Elevated BUN (Ammonia coverts to blood urea nitrogen)
Hypokalemia - K follows ammonia as excreted

20

Kehr's sign

Splenic - L shoulder pain

21

Brudzinski vs kernig sign

Brudzinski's: flex neck, want to bring hamstring up
Kernig: brig up hamstring, want to flex neck.

(Releases tension on hamstrings)

22

Murphy's sign

Gall bladder - push on RUQ
-traps gallbladder between hand n liver
-pt cannot take a deep breath.

23

Venous blood gasses

PH 7.31-7.41
PvCO2 40-50
HCO3 22-26
PvO2 35-40
SvO2 70-75%
BE -2 to 2

24

HCO3 change = pH change

HCO3 10 mEq = pH 0.15 (same direction)

25

Bicarbonate replacement therapy

(Weight kg/4) x BE

1/2 given IVP
1/2 given in L fluid / hr

26

Minute ventilation calculation & normal value

Ve = Vt x f (frequency)

Normal value: 6.0 LPM

27

Alveolar minute ventilation calculation & normal value

Va = (Vt - Vd) x f

Vd=dead space (.33Vt or 1ml/lb IBW)

Normal: 4.2 l/min

28

Attempting to blow off co2, adjust vent rate or volume?

Increase rate, decrease volume = decrease Va
Decrease rate, increase volume = increase Va

29

Normal anion gap

8-16 (w/o K)
10-20 (w/ K+)

30

4 primary suspects of metabolic acidosis

#1: lactic Acidosis
2. DKA
3. Renal failure
4. Toxins

31

MUD PILES

M - methanol
U - uremia
D - DKA
P - paraldehyde
I - isoniazide
L - lactate
E - Ethylene Glycol
S - Salicylate

32

How quickly can magnesium be administered?

1g / 30 minutes (sometimes faster)

33

Alveolar O2 pressure calculation

PAO2 = FiO2 (PBAR -PH2O) - 1.2 (PaCO2)

PBAR: barometric pressure
PH2O: waster pressure, constant (lung humidity: 100% =47 torr)

34

Aa-Gradient calculation, normal, slight shunt, definite shunt values.

PAO2 (alveolar O2 pressure) - PaO2 (ABGs)

Norm: 5-20
Slight shunt: >10
Definite shunt: >20

35

Steps to improve PaO2

1. Assure adequate Va (Vt / rate)
2. Maximize FiO2
3. PEEP
4. Invert I:E

36

Which blood type patient is most likely to produce a hemolytic reaction?

Type O patient - can only receive type O blood

37

What percentage of Hemolytic reactions will result in DIC?

30-50%

38

Hemolytic reaction treatment

-Support hemodynamics (fluids & pressors)
-maintain renal perfusion (fluid & diuretics)
-prevent DIC (maintaining pressure & oxygenation)

39

Circulatory overload post blood administration cause

Blood is colloidal - draws fluid into vascular space

40

Fresh frozen plasma primary indications

-Coumadin therapy reversal
-DIC
-Antithrombin III deficiency (prolonged heparin therapy)
-dilutional coagulopathy (>1 blood volume or 10 units PRBC)
-volume expander

41

FFP commonly given with PRBCs at what rate

1:4 with PRBCs until 10 units PRBCs in then 1:1.

42

FFP dosage

Driven by coags (Pt/PTT) >1.5 - 1.8 x normal

43

FFP and Coumadin

Coumadin interferes with vit K
-Vit K