Fluid And Electrolytes Imbalance

Question 1

Factors requiring fluid therapy

Answer 1

Disease preventing oral intake - peritonitis, surgery

Intestinal resection

Surgical and medical conditions - intestinal obstruction, diarrhea, vomiting

Question 2

Percentage of total body water of adult male from weight

Answer 2

60%

Question 3

Percentage of total body water of adult female from weight

Answer 3

50%

Question 4

Determinants of total body water

Answer 4

Age
Sex
Degree of obesity

Question 5

2 compartments of water distribution

Answer 5

Intracellular - 40% or 2/3 of TBW (28L)
Extracellular - 20% or 1/3 of TBW ( 14L)

Question 6

Extracellular division in TBW

Answer 6

Intravascular
Extravascular

Question 7

Amount of potassium in the cells

Answer 7

140 mmol per liter

Question 8

Amount of sodium in extracellular

Answer 8

135-145 mmol/l

Question 9

Most important cations and onions in the intracellular compartment

Answer 9

Potassium 140
Magnesium 15
phosphate 26
proteins 9

Question 10

Most important onions and cations in the extracellular compartment

Answer 10

Sodium 135-145
chloride 95-105
bicarbonate24-29

Question 11

Water gained and lost every day in tropical and temperate regions

Answer 11

3400 mL
2700ml

Question 12

Amounts of water necessary in fluid therapy in the tropic and temperate regions in surgical patients who is expected not to pass stool

Answer 12

Reduced to 3L in tropics
2300ml in temperate

Question 13

How do we compensate in flu therapy for high temperature Leading to more sweating

Answer 13

12% of the daily requirement in fluid added added for every 1°C rise

Question 14

Sodium lost in the tropics and temperate regions

Answer 14

Tropics - 130-140mmol
Temperate - 90-120mmol

Question 15

Potassium lost in the tropics and temperate regions

Answer 15

Tropics - 60mmol
Temperate - 70mmol

Question 16

Sodium replacement therapy in tropics and temperate regions

Answer 16

Tropical - 130
Temp.- 80-110

Question 17

Potassium replacement therapy in tropics and temperate regions

Answer 17

Tropical - 50
Temp.- 60

Question 18

Amount of glucose given daily to surgical patients to reduce gluconeogenesis and minimize acidosis

Answer 18

2 L of 5% glucose daily

Question 19

Type of sugar given because it can be infused in concentration of up to 30% peripherally and provide more energy

Answer 19

Sorbitol

Question 20

Amount of glucose given exogenously if IV therapy is prolonged

Answer 20

5 g/ kilogram / day

Question 21

Amount of vitamin C required daily for supplementation

Answer 21

100 to 200 mg

Question 22

Summarized daily requirement in the tropic of surgical patient

Answer 22

3 L of water
130 mmol of sodium
50 mmol potassium
100 g of carbohydrates

Question 23

Which IV solution can provide the daily requirement in the tropical surgical patient

Answer 23

1 L of ringers lactate
2 L of 5% dextrose
50mmol of potassium chloride

Or

3L badoes maintenance solution

Question 24

which patients are not eligible for badoes maintenance solution

Answer 24

Patient with liver disease or acidosis
neonate

Question 25

How to calculate water infusion rates

Answer 25

4 mL/kg/hr for first 10 kg + 2 mL/kg/hr for the next 10 kg + 1 mL/kg/hr for remaining body weight

Question 26

Sodium infusion / day calculation

Answer 26

1 or 2 mmol /kg/day

Question 27

Daily requirements in surgical patient in temperate regions

Answer 27

2.5 L of water 80-100mmol of sodium 60 mmol of potassium 100 g of carbohydrates

Question 28

Solution given for fluid replacements in surgical patient of temperate region

Answer 28

Half liter of NS 2 L of 5% dextrose 3 g of potassium chloride vitamin B and C

Question 29

DISEASE with rapid dehydration

Answer 29

Acute intestinal obstruction peritonitis diarrhea

Question 30

Dx with slow dehydration

Answer 30

Gastric outlet Obstruction

Question 31

Causes of dehydration

Answer 31

Vomiting or nasal gastric aspiration diarrhea internal fluid shift as in burns , peritonitis , , paralytic ileus, mechanical intestinal obstruction , pancreatitis Enterocutaneous fistula excessive sweating polyuria

Question 32

Main clinical features of dehydration

Answer 32

Dry inelastic skin ,loss of turgor dry mouth Sunken eyes collapsed veins tachycardia scanty highly concentrated urine Metabolic alkalosis (gastric juice loss) or acidosis ( diarrhea ) shock with hypotension and sweating

Question 33

Bio chemistry of dehydration

Answer 33

High hematocrit ,hemoglobin ,blood urea reduced sodium,potassium and chloride levels in serum concentrated urine , high osmolality Low or absent sodium normal or elevated potassium

Question 34

Goal of urine output in treatment of dehydration

Answer 34

30-50 mL per hour

Question 35

Amount of fluid needed in shock

Answer 35

3.5 L

Question 36

Clinical features of water overload

Answer 36

Added breath sounds central venous pressure higher increased intracranial pressure symptoms like headache, nausea ,vomiting ,weakness ,lethargy, confusion ,drowsiness ,convulsions symptoms of cardiac failure like tachypnea, tachycardia, hypoxia, pulmonary and peripheral edema ,distended jugular vein pulmonary congestion on cxr

Question 37

Treatment of water of overload

Answer 37

Diuretics - furosemide , ethacrynic acid Mannitol