FLUID, ELECTROLYTE AND ACID BASE BALANCE

Question 1

Water distribution in human body

Answer 1

Total body water: 45 L

1. )1/3 EXTRACELLULAR: 15 L
2. )2/3 INTRACELLULAR: 30 L

Question 2

1/3 EXTRACELLULAR: 15 L

Answer 2

A.)INTERSTITIAL FLUID: 8.5 L

B.)PLASMA: 3.5 L

C.)LYMPH: 1.5 L

D.)TRANSCELLULAR: 1.5 L

Question 3

Fluid intake

Answer 3

1. )EXOGENOUS: 2-3 L/24 HOURS
2. )ENDOGENOUS: NORMALLY LESS THAN 500ML/24 HOURS

Question 4

EXOGENOUS: 2-3L/24 HOURS

Answer 4

Why the water requirements of infants & children are greater than those of adults?

1. )The larger surface area per unit of body weight
2. )The greater metabolic activity due to growth
3. )The comparatively poor concentrating ability of kidney

Question 5

ENDOGENOUS: NORMALLY LESS THAN 500ML/24 HOUR

Answer 5

When are the endogenous fluid intake released?

1. )Released during the oxidation of ingested food
2. )Released during the starvation by water released breakdown tissues

Question 6

Fluid output

Answer 6

1. )SKIN: 600-1000ML/24 HOURS
2. )LUNGS: 400ML/24 HOURS
3. )URINE: APPROXIMATELY 1500ML/24 HOURS
4. )FAECES: 60-150ML/24 HOURS

[NORMAL URINE OUTPUT: 0.5-1ML/KG/HOUR]

]NORMAL URINE OUTPUT PER DAY: 700-1500ML/24 HOURS]

Question 7

Fluid output problems

Answer 7

1. )OLIGURIA: <300ML/24 HOURS
2. )ANURIA: COMPLETE ABSENCE OF URINE

Question 8

Water depletion

Answer 8

Water depletion can be due to:

1. )DIMINISHED INTAKE
2. )PURE WATER DEPLETION

Clinical features:

A.)WEAKNESS

B.)INTENSE THIRST

C.)SUNKEN EYES

D.)DRY MUCOUS MEMBRANES

E.)DECREASED URINE OUTPUT

F.)LOW BP & PULSE PRESSURE

G.)CONFUSION

CVP[CENTRAL VENOUS PRESSURE]: 3-8CM H2O

Treatment:

1. )NORMAL SALINE
2. )5% DEXTROSE SOLUTIONS
3. )APPROPRIATE WATER REPLACEMENT FORMULAS

Question 9

Water intoxication

Answer 9

Water intoxication can be due to:

1. )TURP SYNDROME(TRANSURETHRAL RESECTION OF THE PROSTATE) IN BENIGN PROSTATIC HYPERPLASIA-HYPONATREMIA
2. )SIADH(SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION)
3. )COLORECTAL WASHOUTS WITH PLAIN WATER INSTEAD OF SALINE

Clinical features:

A.)DROWSINESS & WEAKNESS

B.)NAUSEA & VOMITING OF CLEAR FLUID

C.)PASSING LARGE AMOUNT OF DILUTE URINE

D.)CONVULSIONS & COMA

Treatments:

1. )STOP INTAKE OF WATER
2. )TRANSFER TO ICU
3. )TREAT WITH DIURETICS OR HYPERTONIC SALINE

[NOTE: RAPID CHANGES IN SERUM SODIUM CONCENTRATION LEADS TO NEURONAL DEMYELINATION]

Question 10

Water balance of a healthy adult (70kg)

Answer 10

Water intake:

1. )BEVERAGE: 1200ML
2. )FOOD: 1000ML
3. )OXIDATION: 300ML

Water output:

1. )URINE: 1500ML
2. )SKIN: 500ML
3. )LUNGS: 400ML
4. )FAECES: 100ML

[NOTE: SKIN & LUNGS HAVING INSENSIBLE LOSS OF WATER OUTPUT]

Question 11

Normal values of serum electrolytes

Answer 11

1. )SODIUM(NA+): 133-144MMOL/L
2. )POTASSIUM(K+): 3.5-5.3MMOL/L
3. )CHLORIDE(CL-): 90-110MMOL/L
4. )BICARBONATE(HCO3-): 25MMOL/L
5. )CALCIUM(CA2+): 8-10MG/DL

Question 12

Sodium balance

Answer 12

SODIUM- PRINCIPLE CATION OF ECF

NORMAL VALUE(SERUM): 133-144MMOL/L

DAILY INTAKE: 1MMOL/KG [NACL]

CONTROL BY: ADRENAL GLANDS

Question 13

Hyponatremia

Answer 13

SERUM SODIUM: <120MMOL/L

Causes:

1. )VOMITING
2. )DIARRHOEA
3. )BOWEL OBSTRUCTION
4. )FISTULAE

Clinical Features:

A.)CONFUSION

B.)DISORIENTATION

C.)LETHARGY

If severe;

D.)SEIZURES

E.)COMA

Question 14

Different types of hyponatremia

Answer 14

1. )HYPOVOLEMIC HYPONATREMIA
2. )HYPERVOLEMIC HYPONATREMIA
3. )EUVOLEMIC HYPONATREMIA

Question 15

Different types of hyponatremias and their treatment procedures

Answer 15

1.)HYPOVOLEMIC HYPONATREMIA

Causes:

• GI FLUID OR BLOOD LOSS

Treatment:

REPLACE VOLUME USING A CRYSTALLOID SOLUTION [0.9%NACL OR RL]

Question 16

Different types of hyponatremias and their treatment procedures

Answer 16

2.)HYPERVOLEMIC HYPONATREMIA

Causes:

• CHF, CIRRHOSIS, NEPHROTIC SYNDROME

Treatments:

A.)TREAT THE DISORDER

B.)SODIUM(NA+) RESTRICTION

C.)DIURETICS + WATER RESTRICTION

Question 17

Different types of hyponatremias and their treatment procedures

Answer 17

3.)EUVOLEMIC HYPONATREMIA

Cause:

-SIADH

Treatment:

WATER RESTRICTION TO <1L/DAY

Question 18

Different types of hyponatremias and their treatment procedures

Answer 18

RULE OF THUMB:

1. )RELATIVELY SLOW CORRECTION: 0.5MMOL/L/HOUR
2. )RAPID CORRECTION: PONTINE DEMYELINATION

Question 19

Different types of hypernatremias

Answer 19

1. )EUVOLEMIC HYPERNATREMIA
2. )HYPOVOLEMIC HYPERNATREMIA
3. )HYPERVOLEMIC HYPERNATREMIA

Question 20

Different types of hypernatremias, their causes and treatment procedures

Answer 20

1.)EUVOLEMIC HYPERNATREMIAS

[PURE WATER LOSS]

Causes:

A.)SWEATING

B.)FEVER

C.)TACHYPNOEA

D.)DIABETES INSIPIDUS

Treatment:

WATER REPLACEMENT WITH 5% DEXTROSE SOLUTION

Question 21

Different types of hypernatremias, their causes and treatment procedures

Answer 21

2.)HYPOVOLEMIC HYPERNATREMIAS

[WATER DEFICIT IN EXCESS OF SODIUM DEFICIT]

Causes:

A.)BURNS

B.)FISTULAS

Treatments:

RESTORE ECF VOLUME BY 5% DEXTROSE OR 0.45% NORMAL SALINE

Question 22

Different types of hypernatremias, their causes and treatment procedures

Answer 22

3.)HYPERVOLEMIC HYPERNATREMIA

[SODIUM GAIN IN EXCESS OF WATER GAIN]

Causes:

A.)EXCESSIVE 0.9% SALINE ADMINISTRATION

B.)ADRENAL HYPERFUNCTION

Treatments:

1. )DIURETICS
2. )DIALYSIS IN PRESENCE OF RENAL FAILURES

Question 23

Signs of hypernatremias

Answer 23

1. )PUFFINESS OF THE FACE
2. )PITTING OEDEMA-SACRAL REGION
3. )4.5L OF EXCESS FLUID

Question 24

Potassium balance

Answer 24

NORMAL RANGE: 3.5-5.3MMOL/L

POTASSIUM IS ALMOST ENTIRELY INTRACELLULAR (98%)

NORMAL ADULT GETS 1.0MMOL/KG OF POTASSIUM(K+)

RICH SOURCES:

A.)FRUIT

B.)MILK

C.)HONEY

Question 25

Potassium depletion

Answer 25

THE AUGMENTED POTASSIUM EXCRETION OF TRAUMA-DEGREE OF TISSUE DAMAGE IS DIRECTLY PROPORTIONAL TO LOSS, IS GREATEST DURING THE FIRST 24 HOURS AND LASTS FOR 3/4 DAYS HYPOKALEMIA REVEALS AFTER 48 HOURS

Question 26

Types of hypokalemia

Answer 26

1. )SUDDEN HYPOKALEMIA 2. )GRADUAL HYPOKALEMIA

Question 27

Different types of hypokalemias and their causes

Answer 27

1.)SUDDEN HYPOKALEMIA Causes: A.)DIABETIC COMA B.)TREATED BY INSULIN C.)PROLONGED INFUSION OF SALINE

Question 28

Different types of hypokalemias and their causes

Answer 28

2.)GRADUAL HYPOKALEMIA Causes: A.)DIURETICS B.)DIARRHOEA C.)IBD D.)VILLOUS TUMOURS E.)EXTERNAL FISTULAE(GI) [MNEMONICS: DDIVE]

Question 29

Clinical features of hypokalemia

Answer 29

1. )RAPID SHALLOW RESPIRATION 2. )LISTLESSNESS(LETHARGIC) 3. )DEPRESSED REFLEXES 4. )SLURRED SPEECHES 5. )MUSCULAR HYPOTONIA 6. )ABDOMINAL DISTENTION[PARALYTIC ILEUS]

Question 30

Diagnosis of hypokalemia by ECG

Answer 30

1. )PROLONGED QT INTERVAL SEGMENT 2. )DEPRESSED ST INTERVAL SEGMENT 3. )FLATTENING / INVERSION OF T WAVE SEGMENT

Question 31

Treatments of hypokalemia

Answer 31

1.)ORAL MAJOR SOURCES: A.)MILK B.)MEAT C.)FRUIT JUICES D.)HONEY MEDICAL SOURCE OF DRUG: POTASSIUM CHLORIDE 2G ORALLY 6TH HOURLY 2. )INTRAVENOUS - RAPID CORRECTION SUCH AS 'DYSRHYTHMIAS' & 'CARDIAC ARREST' MEDICAL SOURCE OF DRUG: 40MMOL POTASSIUM CHLORIDE TO EACH 1 LITRE OF 5% DEXTROSE/DEXTROSE NORMAL SALINE/0.9% SALINE 6-8TH HOURLY

Question 32

Hyperkalemia

Answer 32

Leads to: BRADYCARDIC CARDIAC ARREST

Question 33

Major causes of hyperkalemia

Answer 33

Major causes: 1. )RENAL TUBULAR ACIDOSIS 2. )ADDISON'S DISEASE 3. )CONGESTIVE HEART FAILURE Addison's disease, also known as primary adrenal insufficiency, is a rare long-term endocrine disorder characterized by inadequate production of the steroid hormones cortisol and aldosterone by the two outer layers of the cells of the adrenal glands (adrenal cortex), causing adrenal insufficiency.

Question 34

Drugs that may induce hyperkalemia

Answer 34

Types of drugs: 1. )NSAIDS 2. )AMILORIDE 3. )CYCLOSPORINE 4. )DIGOXIN 5. )TRIMETHOPRIM 6. )SPIRINOLACTONE

Question 35

Treatments for hyperkalemia

Answer 35

1. )CALCIUM GLUCONATE: 10ML OF 10% SOLUTION OVER 2-3 MINUTES WHEN POTASSIUM(K+) \>6.5 2. )INSULIN + GLUCOSE: 10 UNITS REGULAR IV + 50% DEXTROSE 3. )NAHCO3: 90MMOL (2 AMPULES IV PUSH OVER 5 MINUTES) 4. )FUROSEMIDE: 20-40MG IV PUSH 5. )KAYEXALATE + SORBITOL: A.)ORAL: 30G WITH 20% SORBITAL B.)RECTAL: 50G IN 200ML 20% SORBITOL (ENEMA RETAIN 45 MINUTES) 6.)DIALYSIS

Question 36

Calcium balance

Answer 36

PLASMA CONCENTRATION: 2.2-2.5MMOL/L OR 8-10MG/DL EXTRACELLULAR CATION IT EXIST IN 3 FORMS: 1. )BOUND TO PROTEIN 2. )FREE IONISED 3. )FREE NON-IONISED

Question 37

Function of calcium in human body

Answer 37

Functions of calcium includes: 1. )NECESSARY COMPONENT FOR BLOOD 2. )COAGULATION & FOR AFFECTING THE NEURO 3. )MUSCULAR EXCITABILITY

Question 38

Hypercalcemia

Answer 38

CALCIUM LEVELS \>2.9MMOL/L OR \>11.5MG/DL SEVERE HYPERCALCEMIA: 3.7MMOL/L OR \>15MG/DL

Question 39

Causes for hypercalcemia

Answer 39

Causes includes: 1. )MEN SYNDROMES 2. )MULTIPLE MYELOMAS 3. )MALIGNANCIES OF LUNG & KIDNEY 4. )METASTASES OF BREAST CARCINOMA 5. )PARATHYROID ADENOMAS 6. )VITAMIN D INTOXICATION

Question 40

Clinical features of hypercalcemia

Answer 40

Clinical features encompasses: 1. )FATIGUE 2. )DEPRESSION 3. )CONFUSION 4. )NAUSEA 5. )CONSTIPATION 6. )ANEROXIA 7. )POLYURIA 8. )ARRHYTHMIAS In case of medical emergency 9. )COMA 10. )CARDIAC ARREST

Question 41

Treatments for hypercalcemia [Bones, Stones, Abdominal Groans, & Psychic Moans]

Answer 41

Treatments consist of: 1. )HYDRATION WITH SALINE 6L/DAY 2. ) 3. ) 4. ) 5. ) 6. ) 7. )