fluid, electrolytes, acid-base

Question 1

Total body water accounts for ____% body wt?

Answer 1

60%

Question 2

Of the total body water, how much is located intracellularly? Extracellularly?

Answer 2

2/3 and 1/3 (#mental math)

Question 3

Extracellular fluid is composed of _________ and __________________

Answer 3

plasma, interstitial fluid

Question 4

What is a normal fluid intake/day

Answer 4

1500mL

Question 5

What is a normal urine output/day

Answer 5

800-1500mL

Question 6

there are 4 types of fluid replacement. What 2 increase intravascular fluid? What 2 increase intercellular fluid?

Answer 6

Intravascular: NS and Lactated Ringer’s
Intracellular: D51/2NS and D5W

Question 7

Loss of fluid through sweat and respiration is called?

Answer 7

Insensible loss

Question 8

What do labs look like in a dehydrate patient?

Answer 8

high serum Na with BUN/Cr ration >20:1 (hypoperfusion of kidneys) high hct, high osmolarity of blood

Question 9

What is the goal urine output for an adult? Child?

Answer 9

Adult: 0.5 mL/kg/hr
Child: 1mL/kg/hr

Question 10

When giving bolus fluids, should you include dextrose or potassium?

Answer 10

No, this can lead to hyperglycemia or hyperkalemia (Lactated Ringer’s). Give NS bolus and do mixture for maintenance dose

Question 11

How do you calculate maintenance fluids?

Answer 11

Give 4mL/kg for first 10kg, 2mL/kg for next 10kg, and then 1 mL/kg for remainder of weight per hour.
4/2/1 Rule

Ex: 70kg man. 4mL x 10kg + 2mL x 10kg + 1mL x 50kg = 110mL/hour

Question 12

If you increase Na, where do you see an increase in fluid volume?

Answer 12

Extracellular fluid

Question 13

High Na = increased/decreased GFR?

Answer 13

increased

Question 14

Hyponatremia is caused by too much _________ and hypovolemia is caused by too little __________

Answer 14

water, sodium

Question 15

What is the major concern for hypernatremia?

Answer 15

osmotic effects on the brain, water leaves brain cells leaving them dehydrated

Question 16

What factors are involved in balancing calcium?

Answer 16

PTH, calcitonin, vit D, albumin, pH

Question 17

What is the normal Ca+ range?

Answer 17

8.5-10.5mg/dL

Question 18

calcium exists in what 2 forms?

Answer 18

Protein bound (albumin controlled) and Free ionized (PTH controlled)

Question 19

Increased/decreased pH increases the binding of Ca to albumin?

Answer 19

Increased

Question 20

What organs are involved in calcium regulation?

Answer 20

Bone (breakdown, remodeling)
Kidney (Ca reabsoprtion vs phosphate reabsorption)
Gut (activation of vit D)

Question 21

Low calcium results in __________ deep tendon reflexes?

Answer 21

Hyperactive (chvostek and trousseau signs)

Question 22

HYPERcalcemia will __________QT interval and

HYPOcalcemia will _____________QT interval.

Answer 22

hyper = shorten
hypo = lengthen

Question 23

Too much calcium results in what generic nmeumonic?

Answer 23

stones, bones, groans, moans

Question 24

What is the normal K+ range?

Answer 24

3.5 - 5.0

Question 25

T/F. Potassium level is greatly affected by pH

Answer 25

true alkalosis moves K into cells. acidosis moves K out of cells

Question 26

What are some causes of potassium loss?

Answer 26

GI, Renal, insufficient diet, sweating, bactrim

Question 27

How do you treat low K? how important is it?

Answer 27

KCl, treat right away to avoid cardiac arrhythmia

Question 28

How do you treat high K?

Answer 28

IV Ca to stabilize membrane potential (immediately)

Question 29

What electrolyte imbalance is the most dangerous and rapidly fatal?

Answer 29

hyperkalemia

Question 30

What are normal Mg levels?

Answer 30

1.8-2.5mg/dL

Question 31

Where is most of the body's Mg?

Answer 31

bones

Question 32

What other electrolytes are related to Mg levels?

Answer 32

hypomagnesemia makes hypokalemia and hypocalcemia more difficult to tx

Question 33

What complications occur with too much Mg?

Answer 33

arrhythmia, coma, resp failure

Question 34

How do you treat too much Mg?

Answer 34

IV Ca to stabilize heart, intubate, saline+loop

Question 35

What are normal phosphate levels?

Answer 35

3-4.5mg/dL

Question 36

Where is your P stored?

Answer 36

bones

Question 37

What are the 2 most common causes of low phosphate?

Answer 37

ETOH and DKA