Fluid, Electrolytes, Acid-Base Disorders & Renal Disease Flashcards
(46 cards)
A 72-year-old male undergoing abdominal surgery exhibits a sudden decrease in blood pressure accompanied by tachycardia. The nurse anesthesiologist notes the patient’s
preoperative labs indicated slightly elevated serum osmolality (295 mOsm/kg) and normal sodium levels. In response to the hypotension, vasopressin is administered. Considering the patient’s osmolal status, what is the most likely immediate effect of vasopressin administration in this scenario?
Decreased serum osmolality due to vasopressin-induced water retention and vasoconstriction, improving blood pressure
A patient with severe hypovolemia due to gastrointestinal loss is receiving fluid resuscitation in the perioperative setting. The nurse anesthesiologist opts for a balanced
crystalloid solution. Considering the pathophysiological principles of water and electrolyte homeostasis, what is the most likely rationale behind choosing a balanced crystalloid
solution over normal saline?
To prevent hyperchloremic metabolic acidosis
A 55-year-old man with a history of chronic alcoholism is admitted for emergency surgery due to a ruptured appendix. He appears dehydrated, and his lab results show elevated serum osmolality. As a Nurse Anesthesiologist, you are concerned about the administration of mannitol for intraoperative management of potential cerebral edema due to his osmolal state. Which of the following is the MOST appropriate management strategy for this patient?
Assess the patient’s preexisting serum osmolality and consider alternatives to mannitol
A 72-year-old female patient is admitted with symptoms of hyponatremia, and initial tests confirm a serum sodium concentration of 128 mmol/L. She has a history of chronic heart failure and presents with signs of fluid overload. The hyponatremia is deemed hypervolemic. As her Nurse Anesthesiologist, you are considering her fluid management strategy. Which of the following is the MOST appropriate initial treatment approach?
Restrict fluid intake and consider administration of a loop diuretic
During the perioperative management of a patient with acute symptomatic hyponatremia, which of the following strategies is MOST critical to avoid the risk of osmotic demyelination syndrome?
Limiting the correction of serum sodium concentration to not exceed 1-1.5 mEq/L/hr with a daily max increase of 12 mEq/L
A 40-year-old male patient with a history of psychogenic polydipsia presents with euvolemic hyponatremia. Serum sodium concentration is measured at 130 mmol/L. He is
scheduled for an elective surgical procedure. Which of the following management strategies should be PRIORITIZED before surgery?
Gradual correction of hyponatremia by restricting fluid intake and monitoring serum sodium levels closely
A 53-year-old woman with a history of chronic, mild hyponatremia, secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), was admitted for the management of acute gastroenteritis. During her emergency room treatment, she received a rapid infusion protocol intended for acute hyponatremia. Several hours post-infusion, she exhibits neurological signs including brisk deep tendon reflexes, altered mental status, and difficulty speaking. Her recent serum sodium levels show a significant increase from her baseline. The patient’s current presentation could be indicative of several complications.
Which of the following is the MOST appropriate next step in managing this patient’s condition?
Initiate desmopressin and infuse hypotonic saline to cautiously lower the serum sodium concentration monitoring for signs of cerebral edema while preparing for diagnostic imaging to evaluate
A 78-year-old man with a history of hypertension and recent severe gastroenteritis is admitted with signs of acute hypernatremia, with a serum sodium concentration of 162
mEq/L. Neurological examination reveals restlessness, muscle twitching, and disorientation. His medical history includes the chronic use of loop diuretics for blood pressure management. Given the rapid onset and the severity of his hypernatremia, which of the following management strategies should be initiated first?
Administer hypotonic saline
During preoperative assessment, a 55-year-old man scheduled for elective surgery exhibits signs of muscle weakness and cramps. His serum potassium is found to be 3.1 mmol/L. He denies the use of diuretics or any history of renal disease but mentions episodes of nocturnal muscle cramps and frequent daytime thirst. Which of the following approaches should be prioritized to manage his hypokalemia?
Initiate oral potassium supplementation and evaluate for causes of hypokalemia including potential undiagnosed primary hyperaldosteronism given his symptoms and history
In managing a patient with euvolemic hypernatremia due to untreated diabetes insipidus, which of the following interventions is MOST appropriate to correct the hypernatremia while minimizing the risk of developing cerebral edema?
Gradual water replacement orally or via 5% dextrose in water IV, with careful monitoring of serum sodium
During a transurethral resection of the prostate (TURP) procedure that extended beyond 90 minutes, a 68-year-old man under general anesthesia exhibits signs consistent with the onset of TURP syndrome, including hypertension, acute onset of confusion, and evidence of fluid overload. His current serum sodium concentration is reported as 118 mEq/L, and the operative team has been using a glycine irrigating solution. Given the critical nature of his condition, which of the following management strategies is MOST appropriate to address the immediate life-threatening aspects of his presentation?
Cease further absorption of the irrigating fluid by concluding the surgical procedure if possible initiate administration of hypertonic saline cautiously to address severe hyponatremia and consider loop diuretics for symptoms of volume overload
A 59-year-old woman with a recent history of severe vomiting and diarrhea presents with profound weakness and palpitations. An EKG shows U waves and flattened T waves, indicative of hypokalemia, confirmed by a serum potassium level of 2.8 mmol/L. Her medical history is notable for chronic atrial fibrillation, for which she takes digoxin. Given the complexity of her presentation, which of the following management strategies most appropriately addresses both the acute management of her hypokalemia and her increased risk for digoxin toxicity?
Administer IV potassium chloride to correct the hypokalemia rapidly, alongside continuous cardiac monitoring an assess her digoxin levels and renal function to guide further dosing adjustments
A 65-year-old man with chronic kidney disease on hemodialysis presents for emergency surgery with a serum potassium level of 6.8 mEq/L and ECG changes indicative of
hyperkalemia, including peaked T waves. Given the urgency of his surgical need and the acute management required for his hyperkalemia, which of the following strategies should be implemented first?
Administer calcium gluconate IV to stabilize cardiac membranes, followed by insulin with glucose to promote potassium shift intracellularly, and prepare for immediate dialysis if necessary
During preoperative assessment for elective surgery, a 58-year-old woman with a history of hypertension controlled with ACE inhibitors is found to have a serum potassium level of 6.2 mEq/L. No ECG changes are noted. Given her stable cardiac status but elevated potassium, which of the following management plans is MOST appropriate?
Discontinue the ACE inhibitor temporarily administer kayexalate to reduce serum potassium and consider saline diuresis to enhance potassium elimination while monitoring for any development of ECG changes
A 72-year-old woman presents to the post-anesthesia care unit following a total thyroidectomy. She reports perioral numbness and exhibits Chvostek’s sign. Her serum calcium is reported as 7.2 mg/dL, with an albumin level of 3.0 g/dL. Given the surgical history and clinical presentation indicative of hypocalcemia, which of the following is the
MOST appropriate management plan?
Administer IV calcium gluconate monitor serum calcium albumin levels closely and calculate corrected calcium levels to guide further supplementation
During a routine health examination, a 65-year-old male with chronic kidney disease stage 3 is found to have a serum calcium level of 8.0 mg/dL and an albumin level of 3.5 g/dL. He reports occasional muscle cramps but no other symptoms. Which of the following interventions should be considered FIRST to manage his hypocalcemia?
Calculate the correct calcium level to accurately assess his hypocalcemia, and if confirmed, start oral calcium and Vitamin D supplementation to address potential underlying causes
A 72-year-old woman with chronic obstructive pulmonary disease (COPD) is admitted to the ICU for exacerbation and is receiving parenteral nutrition. She develops signs of
hypomagnesemia, including muscle twitching and weakness, despite no evident renal losses. Her current serum magnesium level is 0.7 mEq/L. Given the clinical context and the need for rapid correction of her hypomagnesemia to prevent further neuromuscular complications, which of the following is the MOST appropriate initial treatment?
Administer IV Mag Sulfate as a bolus quickly to elevate her serum Mag level, and then continue a slower infusion to replenish total body mag stores closely monitoring for signs of hypermagnesemia
During the preoperative evaluation for elective abdominal surgery, a 64-year-old man with a history of alcoholism and malnutrition presents with refractory hypokalemia and
hypocalcemia, despite ongoing supplementation. Laboratory tests reveal a serum magnesium level of 1.0 mEq/L. Recognizing the central role of magnesium in potassium and calcium homeostasis, which of the following interventions should be prioritized to effectively manage his electrolyte abnormalities?
Administer IV Mag to correct the hypomagnesemia with the expectation that correct of Mag levels will facilitate the resolution of hypocalcemia and hypokalemia
A 56-year-old male with a history of chronic obstructive pulmonary disease (COPD) and on β-adrenergic blockers for hypertension is admitted to the ICU with acute respiratory acidosis. You review the patient prior to potential surgery. Arterial blood gas analysis reveals a pH of 7.28, Paco2 of 55 mm Hg, and bicarbonate of 26 mEq/L. Given the patient’s deteriorating condition and the potential adverse effects of acidosis on his cardiovascular
system, especially considering his use of β-adrenergic blockers and underlying COPD, which of the following is the MOST appropriate initial management strategy?
Admin IV Bicarb to correct acidosis optimize bronchodilator therapy for COPD management and adjust the mechanical vent settings to decrease PaCO2 and improve acidosis
A 63-year-old woman undergoing recovery from abdominal surgery develops metabolic alkalosis with a blood gas showing a pH of 7.52, Paco2 of 45 mm Hg, and bicarbonate of 32 mEq/L. She is experiencing difficulty weaning from mechanical ventilation. Considering the potential consequences of severe systemic alkalosis and her current condition, which of the following management strategies should be prioritized to correct her alkalosis and facilitate
weaning from mechanical ventilation?
Administer acetazolamide to increase renal excretion of bicarb thereby reducing serum bicarb levels and correcting alkalosis while optimizing ventilation settings to prevent further respiratory compensation
A 68-year-old man with a history of chronic obstructive pulmonary disease (COPD) is admitted for elective abdominal surgery. In the postoperative period, he becomes drowsy and is noted to have shallow breathing. Arterial blood gas (ABG) analysis reveals a pH of 7.32, Paco2 of 50 mm Hg, bicarbonate of 29 mEq/L, and PaO2 of 60 mm Hg. The patient is receiving oxygen therapy via nasal cannula at 2 L/min. His serum potassium is 3.5 mEq/L, and chloride is 95 mEq/L. Given these findings, which of the following is the MOST appropriate management to address his condition?
Initiate non-invasive positive pressure ventilation to improve alveolar ventilation decrease PaCO2 gradually, and consider potassium chloride and sodium chloride supplementations to correct potential metabolic alkalosis and electrolyte imbalance
During routine post-operative monitoring, a 60-year-old female with no known history of diabetes but who underwent a prolonged surgery for a bowel obstruction, exhibits signs of confusion and respiratory distress. Her ABG analysis shows a pH of 7.25, Paco2 of 28 mm Hg, bicarbonate of 14 mEq/L, and an anion gap of 30. Her serum glucose level is unexpectedly high at 380 mg/dL. Intravenous fluids containing dextrose were used liberally
during surgery. Her serum potassium is 5.5 mEq/L. Based on these findings, which of the following management approaches should be prioritized?
Begin IV fluid replacement with 0.9% normal saline and insulin therapy to address the hyperglycemia and suspected metabolic acidosis of mixed origin adjusting potassium supplementation based on continuous monitoring
A 73-year-old male with a history of hypertension and chronic heart failure is scheduled for a nephrectomy due to a renal mass. Preoperatively, he is found to have a serum creatinine of 1.8 mg/dL, indicating reduced renal function. Given his renal impairment and the surgical intervention planned, which of the following is the MOST appropriate anesthesia management strategy?
Implement a neuraxial blockade extending from T8 to L4 provide anesthesia and postoperative analgesia, minimize systemic opioid use, and avoid potential hemodynamic fluctuations and associated with general anesthesia that could further compromise renal perfusion
A patient in the ICU with a history of advanced age and CKD is at risk for AKI due to a recent episode of hypovolemia following gastrointestinal bleeding. The patient is currently stable, with improved volume status, but requires ongoing monitoring and management to prevent further renal insult. Considering the key homeostatic roles of the kidneys and the potential impact of medications on renal perfusion and function, which of the following interventions should be prioritized to minimize the risk of AKI?
Avoid the use of NSAIDS for pain managements due to their prostaglandin mediated effects on the renal blood flow options instead for acetaminophen and cautious use of opioids while ensuring adequate hydration and monitoring renal function closely
