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Medicine Clerkship > FEN > Flashcards

FEN Flashcards

1
Q

what is the 60-40-20 rule?

A

60% of body weight is water,
40% is ICF,
20% is ECF (5% plasma, 15% ISF)

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2
Q

what are the Starling forces?

A

hydrostatic pressure drives fluid into ICF, oncotic pressure sucks it back out

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3
Q

how is blood osmolarity calculated? what is a normal value?

A

2×Na + BUN/2.8 + gluc/18

normally 285-300 mOsm/L

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4
Q

what is normal urine osm? what controlls this?

A

70-1200 mOsm/L

controlled by ADH

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5
Q

fluids to give to:

  • dehydrated
  • trauma
  • std maintenance
  • hypernatremic
A

NS: good for dehydrated pts
LR: good for trauma pts
D5½NS: standard maintenance fluid
D5W: good for hypernatremic pts

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6
Q

how to calculatd MIVF for 24 hrs
vs
1 hr

A

100-50-20 rule: maintenance fluids for 24 hrs
100 mL/kg for first 10 kg, then 50 for next 10 kg, then 20 for each kg over

4-2-1 rule: maintenance fluids for 1 hr
4 mL/kg for first 10 kg, then 2 for next 10 kg, then 1 for each kg over

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7
Q

causes water reabsorption (V2, aquaporins) and vasoconstriction (V1)

A

ADH

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8
Q

aldo effect on electrolytes

A

↑Na, ↓K, ↓H

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9
Q

PTH effect on electrolytes

A

↑Ca, ↓P, ↑vit D

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10
Q

calcitonin effect on electrolytes

A

↓Ca, ↓P

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11
Q

effect of Vit D

A

↑Ca, ↑P

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12
Q

what causes hypernatremia?

tx?

A

water loss due to 6 Ds –
Diuresis, Dehydration, Diabetes insipidus, Docs (iatrogenic), Diarrhea,
Diseases

Tx PO fluids > IV fluids (correct gradually due to risk of cerebral edema)

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13
Q

MCC hyponatremia

management

A

SIADH

Tx water restriction + NS (correct gradually due to risk of central pontine myelinolysis)

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14
Q

etiologies of hyperK

management?

A

renal failure
K-sparing diuretics
release from dead tissue (crush injury, ischemic bowel, etc.)

  • first, confirm w/ repeat blood draw
  • Dx EKG (peaked T waves, sine waves)
  • Tx C BIG K DIE – calcium gluconate, bicarb insulin-glucose, kayexalate, dialysis (if severe)
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15
Q

etiologies of hypoK

management?

A

diarrhea, vomiting, diuretics

KCl (<10 mEq/hr)
*give 10mEq per 0.1 inc

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16
Q

etiologies of hyperCa

management?

A

hyperparathyroidism (MCC outpt), cancer (MCC inpt)

get EKG (short QT)
• Tx “flush and drain” (NS + furosemide), bisphosphonates if mild
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17
Q

etiologies of hyperMg

management?

A

renal failure

Tx IV calcium gluconate + NS + furosemide

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18
Q

etiologies of hypoMg

management?

A

alcoholism (MCC), DKA

Tx mag replacement

19
Q

etiologies of hyperPO4?

management?

A

renal failure

tx: antacids (binds PO4 in GI tract)

20
Q

etiologies of hypoPO4?

management

A

alcoholism (MCC), DKA

phos replacement

21
Q

nausea/vomiting, intestinal colic, weakness

A

hyper K

22
Q

stones (kidney), bones (bone pain, osteitis fibrosa cystica), groans (PUD,
pancreatitis), psychic overtones (depression, anxiety, ∆MS)

A

hyperCa

23
Q

confusion, coma, convulsions

A

hypo Na

24
Q

delirium, ↓DTRs, cardiac arrest

A

hyperMg

25
Q

rickets, osteomalacia

A

hypoPhos

26
Q

thirst and signs of volume depletion (slow) or ∆MS (rapid)

A

hyperNa

27
Q

weakness, muscle cramps, ileus, digoxin toxicity

A

hypoK

**(K and dig compete for same Na/K receptors on heart)

28
Q

neuromuscular irritability (tingling, tetany), arrhythmias, Chvostek and Trousseau signs

A

hypoCa

29
Q

refractory hypo-K

A

hypoMg

30
Q

kidney stones, metastatic calcifications

A

hyperPhos

31
Q

EKG showing short QT vs long QT What electrolyte imbalance?

A

short QT = hyperCa

long QT = hypo Ca

32
Q

EKG changes assc with hyperK and hypoK

A 
hyperK = peaked T waves, sine waves
hypoK = scooped/depressed T waves
33
Q

how to calculate anion gap? nml anion gap?

A

(Na – (Cl + HCO3))

nl 8-12

34
Q

causes of respiratry acidosis

A

hypoventialtion

35
Q

causes of respiratory alkalosis

A

hyerventialtion (pain, fever, sepsis, early ARDS)

36
Q

Causes on anion gap metabolic acidosis

A

MUDPILES – Methanol, Uremia,
DKA, Paraldehyde, Iron, INH,
Lactic acidosis, Ethylene glycol,
Salicylates

37
Q

causes on non-anion gap metabolic acidosis

A

diarrhea, glue sniffing, RTA, hyperchloremia

38
Q

causes of metabolic alkalosis

A

vomiting, diuretics, antacids, hyperaldosteronism

39
Q

how much does pH change for every inc in CO2 by 10

A

dec 0.08

40
Q

how much does pH change for every inc in HCO3 by 10

A

inc 0.15

41
Q

post ictal state, what acid-base balace expect, management?

A

anion gap metabolic acidosis

will usually resolve in its own in 60-90 mins

42
Q

acid-base assc with aspirin overdose

A

early: hyperventialtion w/ resp alk
late: metabolic acidosis

**expect tinnitus and fever

43
Q

what acid-base imbalance a/w iron overload

A

anion gap met acidosis

**expect abd pain, UGIB

Medicine Clerkship (20 decks)

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