Chapter 9 - Fluids and Electrolytes Flashcards Preview

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Flashcards in Chapter 9 - Fluids and Electrolytes Deck (59):
2

% body that is water?

2/3 (men); infants with a little more, women with a little less

3

% TBW that is intracellular?

2/3

4

% of TBW that is extracellular?

1/3

5

% of extracellular water that is interstitial?

2/3

6

% of extracellular water that is in plasma?

1/3

7

What determines the plasma/interstitial compartment osmotic pressures?

Proteins

8

What determines the intracellular/extracellular osmotic pressure?

Na

9

Composition of 0.9 NS?

Na 154, Cl 154

10

Composition of LR?

Na 130, K 4, Ca 2.7, Cl 109, bicarb 28

11

Normal plasma osmolarity?

280-295

12

What is the best indicator of adequate volume replacement?

Urine output

13

What are the insensible fluid lossess in a day?

10ml/kg/day; 75% skin, 25% respiratory

14

Why switch to D5 1/2 NS after 24h?

5% dextrose will stimulate insulin release, resulting in amino acid uptake and protein synthesis (prevents protein catabolism)

15

How much glucose will D51/2NS @ 125 provide?

150g glucose per day

16

Amount of fluid secreted by the stomach?

1-2L/day

17

Amount of fluid secreted by the biliary system?

500-1000ml/day

18

Amount of fluid secreted by the pancreas?

500-1000ml/day

19

Amount of fluid secreted by the duodenum?

500-1000ml/day

20

What is the normal K+ requirement?

0.5-1 mEq/kg/day

21

What is the normal Na+ requirement?

1-2 mEq/kg/day

22

Which secretion has the highest concentration of K+ in the body?

Saliva

23

Fluid replacement for gastric losses?

D51/2NS w/ 20 of K

24

Fluid replacement for pancreatic, biliary, small intestine losses?

LR with HCO3-

25

Fluid replacement for large intestine losses?

LR with K+

26

At what rate should GI losses be replaced?

cc/cc

27

Treatment for hyperkalemia?

Calcium gluconate (membrane stabilizer), sodium bicarb (causes alkalosis, KI enters cell in exchange for H), 10U insulin and 1 amp of 50% dextrose, kayexalate, dialysis

28

EKG findings with hypokalemia?

Loss of T waves

29

Symptoms of hypernatremia?

Restlessness, irritability, ataxia, seizures

30

How do you calculate the free water deficit?

0.6 x pt's wt (kg) x [(Na+/140)-1]

31

How do you calculate the water requirement?

(Desired change in Na over 1 days x TBW)/(Desired Na+ after giving water requirement)

32

Rate at which you should change Na?

No more than 0.7 mEq/h (16 mEq/day)

33

Symptoms of hyponatremia?

Headaches, delirium, seizures, nausea, vomiting

34

How do you calculate the sodium deficit?

0.6 x (weight in kg) x (140 - Na)

35

Treatment for hyponatremia?

Water restriction, then diuresis, then NaCl replacement

36

Why correct hyponatremia slowly?

To avoid central pontine myelinosis (no more than 1 mEq/h

37

Most common malignant cause of hypercalcemia?

Breast cancer

38

Treatment for hypercalcemia?

NS @ 200-300/hr, lasix; NO LR or thiazide diuretics

39

Symptoms of hypocalcemia?

Hyperreflexia, Chvostek's sign, perioral tingling and numbness, Trousseau's sign, prolonged QT

40

What is the protein adjustment for calcium?

For ever 1g decrease in protein, add 0.8 to Ca

41

Which patients get hypermagnesemia?

Burn, trauma, renal dialysis pts

42

Treatment for hypermagnesemia?

Calcium

43

What is the anion gap?

Na - (HCO3 + Cl); normal <10-15

44

What causes anion gap acidosis?

Methanol, Uremia, Diabetic ketoacidosis, Paraldehydes, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates

45

What causes normal gap acidosis?

Due to loss of Na/HCO3- (ileostomies, small bowel fistulas)

46

Treatment of metabolic acidosis?

Treat underlying cause; keep pH >7.2 with bicarb, severely decreased pH can affect myocardial contractility

47

What causes metabiolic alkalosis?

Usually a contraction alkalosis; NGT (hypochloremic, hypokalemic and paradoxical aciduria)

48

What causes the paradoxical aciduria of metabolica alkalosis?

Na+/H+ excanger activated in effort to reabsorb water, plus K+/H+ exchanger in an effort to reabsorb K+ leads to H+ in the urine

49

What causes hypokalemia in metabolic alkalosis?

Loss of water causes kidney to reabsorb Na in exchange for K, losing K

50

What is the best test for azotemia?

FeNa = (urine Na/Cr)/(plasma Na/Cr)

51

What is the FeNa, urine Na, and BUN/Cr ratio in a prerenal patient?

FeNa 20

52

Why is myoglobin toxic to renal cells?

Converted to ferrihemate in acide environment

53

What is the treatment of myoglobinuria?

Alkalinize urine

54

What is tumor lysis syndrome?

Release of purines and pyramidines which leads to increased PO4 and uric acid as well as decreased Ca

55

Treatment for tumor lysis syndrome?

Hydration, allopurinol, diuretics, alkalinization of urine

56

Metabolism of Vitamin D?

Made in skin (UV rays) from 7-dehydrocholesterol --> to liver for (25-OH) --> to kidney for (1-OH)

57

What does the active form of Vitamin D do?

Increases calcium-binding protein, leading to increased intestinal Ca absorption

58

What are the effects of chronic renal failure on Vit D and Ca?

Decreased active vitmain D (dec. 1-OH hydroxylation) leading to decreased Ca reabsorption from gut

59

Why does chronic renal failure cause anemia?

Low erythropoietin

60

What are the effects of increased Angiotensin II from decreased ECV?

Increase CO, increased peripheral resistance; increased sympthetic nerve activity; increased aldosterone; decreased renal blood flow, decreased GFR