Flashcards in Chapter 2: Fluids and Electrolytes Deck (10):
A 46yo woman underwent total thyroidectomy for multinodular goiter. On the second post-op morning she complains of circumoral tingling and numbness at her fingertips. The most likely additional finding in this pt will be:
A 30yo woman underwent total parathyroidemectomy for hyperPTH and 2 hyperplastic adenomas are removed. One half of the right inferior gland was implanted in the sternocleidomastoid muscle. On POD#1, she complains of generalized muscle scramps and she is slightly confused. What is the most likely diagnosis?
A 63yo woman had a celiotomy for a recurrent bowel obstruction. One week post-op she develops a high output enterocutaneous fistula. Subsequent evaluation indicated the fistula involves her distal small bowel. The most appropriate fluid for replacing the loss from fistula is:
A 38yo woman recovering from a laproscopic cholecystectomy returns to the office 5days after surgery complaining of RUQ pain. She is midly jaundiced. Subsequent workup suggests a bile leak, and a percutaneous drain is placed after ERCP is unsuccessful. Over the next 24 hours, almost 600 mL of bile-colored fluid is collected from the drain. The electrolyte composition of the fluid in the drain is closest to:
Na+ 130 mEq/L; Cl- 100 mEq/L; K 4.0 mEq/L, Bicarbonate 25 mEq/L
A 68yo woman underwent a subtotal gastric resection for a distal gastric cancer. Her stomach was reconstructed with a gastrojejunostomy. On POD3, large amt of bilious drainage is noted coming from a drain placed in her RUQ (800 mL in the last 24 hrs). The most likely represents which of the following?
A biliary leak from the duodenal stump
A 2week old boy is brought to the ED b/c of two days of nonbilious vomiting, lethargy, and low urine output. The boy is somnolent. His abdomen is nontender. Ultrasonography shows a hypertrophied pylorus. The most likely metabolic derangement is:
Hypochloremic hypokalemic metabolic alkalosis
A 17yo girl with anorexia nervosa was admitted to the hospital for total parental nutritional support. Two days after the start of her treatment, she experiences proximal muscle w/n and visual defects. This pt most likely has:
A 34yo man is admitted from the ED for surgery for a perforated appendicitis. He has diatbetes that he controls w/ oral medications. During the preop workup he is noted to have a severely elevated serum glucose and his serum sodium level is 124 mEq/L. The hyponatremia should not be treated initially b/c with hyperglycemia:
Measured serum sodium concentration decreases as a result of dilution in response to the osmolar gradient created by the increase in serum glucose
A 28yo man is admitted following a motorcycle crash in which he sustained a fractured left tibia, multiple left rib fractures, and a head injury. One week after the injury he is suspected of having SIADH because of depedent edema and a persistent low urine output in spite of normal vital signs . He has a serum sodium of 130 mEq/L, and his Hb and hct have slowly decreased to 9.2 gm/dl and 28% respectively. The most appropriate treatment of the suspected SIADH at this time should be:
Water restriction to less than 1000 mL/day