Fluid Management & Blood Therapy

Question 1

Etiology hypokalemia

Answer 1

<3.5 mEq/L
Poor intake
GI LOSS: vomitting, diarrhea, NG suction, Kayexalate
Renal loss- dieurtics, metabolic Alkalosis, licorice
Intracellular shift: Beta-2agonist, insulin alkalosis

Question 2

Etiology hyperkalemia

Answer 2

>5.5 mEq/L
Poor excretion: renal failure, K sparing diuretics
Extracellular Shift: Acidosis
Iatrogenic: Succinylcholine
Misc. Tumor Lysis

Question 3

Presentation/symptoms Hypokalemia

Answer 3

Skeletal muscle cramps=> weakness=> paralysis

Worsens dioxin toxicity

Question 4

Presentation/symptoms hyperkalemia

Answer 4

Cardiac rhythm disturbances

Question 5

EKG findings Hypokalemia

hint: short long flat

Answer 5

PR interval- short
QT interval- Long
T wave- flat
U wave visible

Question 6

EKG findings Hyperkalemia

Answer 6

Early:
PR=> long
QT=> short
T wave => peaked tall
Middle: 
P wave=> flat
QRS wide
Late:
QRS=>sine wave=> VF

Question 7

Treatment for Hypokalemia

Answer 7

K+ supplementation

Question 8

Treatment for Hyperkalemia

Answer 8

Calcium (Stabalizes cardiac membrane)
insulin + D50
Hyperventilation
Bicarbonate
Albuterol
Potassium wasting diuretics
Dialysis

Question 9

Etiology of Hyponatremia

<135mEq

Answer 9

May exist in various states of hydration hypovolemic, isovolemic, hypervolemic, so you must evaluate plasma osmolarity and ECF volume to determine cause.
Ex. SIADH, CHF, Cirrhosis, TURP syndrome, Cushing’s

Question 10

Etiology Hypernatremia >145 mEq/L

Answer 10

Hyernatremia may exist in various states of hydration (Hypovolemic, isovolemic, hypervolemic), so you must evaluate plasma osmolarity and ECF volume to determine cause.
Ex: Diabetes inspidus, impaired thirst, NaHCO3 admin

Question 11

Presentation/ symptoms

Hyponatremia

Answer 11

N/V
Skeletal muscle weakness
Mental status changes=> seizures => coma
Cerebral edema cell swelling

Question 12

Presentation/ symptoms Hypernatremia

Answer 12

Thirst
Mental status changes=> seizures=> coma
Cerebral dehydration (Cell shrinkage)

Question 13

Treatment for Hyponatremia

Answer 13

Treatment depends on specific cause.
The goal is to restore Na+ balance by manipulating serum osmolality fluid balance with H2O restriction IVF selection based on toxicity and diuretics

Question 14

Treatment for hypernatremia

Answer 14

Treatment depends on specific cases.
Gal is to restore balance Na+ by manipulating serum osmolality and fluid balance with Na++ restriction, IVF selection based on tonicity and diuretics

Question 15

Etiology Hypocalcemia <8.5 mg/dL

Answer 15

Hypoparathyroidism 
Vitamin D deficiency 
Renal Osteodystrophy
Pancreatsis
Sepsis

Question 16

Hydercalcemia >10.5 mg/dL

Answer 16

Hyperparathyroidism 
Cancer
Thyrotoxicosis
Thiazide diuretics
Immobilization

Question 17

Presentation/ symptoms Hypocalcemia

Answer 17

Skeletal muscle cramps
Nerve irritability => paresthesia and tetany
Chvostek sign
Trousseau sign
largyospasm
Mental status changss => seizures

Question 18

Presentation/ symptoms Hypercalcemia

Answer 18

Nausea
abdominal pain
hypertension
psychosis
Mental status changes- seizures

Question 19

Hypocalemia treatment

Answer 19

Calcium Vitamin D

Question 20

Treatment for Hypercalcemia

Answer 20

0.9 NaCl
Loop diuretic (Furosemide)

Question 21

EKG finding Hypocalcemia

Answer 21

QT long

Question 22

EKG finding Hypercalcemia

Answer 22

QT interval short

Question 23

Etiology of Hypomagnesemia < 1.3 mEq/L

Answer 23

poor intake
alcohol abuse
diuretics
Critcal illness
common with hypokalemia

Question 24

Etiology of Hypermagnesemia >2.5 mEq

Answer 24

Excessive administration
Renal failure
Adrenal insufficiency

Question 25

Presentation/ symptoms of hypomag

Answer 25

Skeletal muscle weakness | Arrhythmias torsades de pointes

Question 26

Presentation/ symptoms of hypermag

Answer 26

Loss of deep tendon reflex 4-6.5 mEq/L or 10-12 mg/dL Respiratory depression 6.5-7.5 mEq/L or 18mg/dL cardiac arrest >10 mEq/L or > 25 mg/dL Potentiation of neuromuscular blockade (succ & NDNMB

Question 27

EKG findings with Hypomagnesium

Answer 27

Not significant unless very low- | long QT

Question 28

EKG findings with hypermagnesium

Answer 28

Not significant unless very high heart block

Question 29

Treatment for hypomag

Answer 29

give magnesium

Question 30

Treatment for hypermag

Answer 30

calcium chloride

Question 31

Influences Fluid Dynamics Renin-angiotensin-aldosterone-system Antidiuretic hormone (ADH) Atrial natriuretic peptide

Answer 31

1. Reabsorption of sodium (and water) 2. Reabsorption of water 3. Stimulated by stretch receptors in the atria - -Stimulates kidneys to release sodium and water, thereby reducing intravascular volume - -Inhibits renin and ADH

Question 32

Assessment of Fluid Volume Status Preop evaluation Assessing for fluid volume status

Answer 32

1. Skin turgor, mucous membrane, peripheral edema 2. Lung sounds Vital signs Urine output HCT Urine specific gravity BUN/Creatinine Acid-base balance (ABG)

Question 33

Acidosis and cardiac effects

Answer 33

Increased P50(Right=release) Decreased contractility Increased risk of dysrthymias

Question 34

Alkalosis and cardiac effects

Answer 34

Decreased 50 left=love Decrease coronary blood flow increase dysrthymias

Question 35

Acidosis CNS effects

Answer 35

Increase cerebral blood flow | Increase ICP

Question 36

Alkalosis CNS effects

Answer 36

Decrease cerebral blood flow | Decreased ICP

Question 37

Acidosis pulmonary effects

Answer 37

Increase pulmonary vascular resistance

Question 38

Acidosis pulmonary effects

Answer 38

Decreased pulmonary vacuolar resistance

Question 39

Acidosis on electrolyte

Answer 39

causes hyperkalemia

Question 40

Alkalosis on electrolyte

Answer 40

Hypokelemia | Decreased ionized calcium

Question 41

Intravenous fluid therapy: Crystalloids Hypotonic solutions uses and examples

Answer 41

Replaces water loss called maintenance fluids examples: D5W

Question 42

Intravenous fluid therapy Isotonic solutions (Normal Osmolarity 285-295 mOsm/L) uses and examples

Answer 42

Replaces water and electrolyte loss called replacement fluids examples: LR, NS

Question 43

Intravenous fluid therapy Hypertonic solutions uses and examples

Answer 43

For hyponatremia or shock | examples: D5 1/2NS (405 mOsm/L), 3% NS (1026 mOsm/L)

Question 44

Examples of hypotonic solution

Answer 44

d5w, 0.45% NaCl | cell swells

Question 45

Examples of Isotonic solutions

Answer 45

LR 0.9 Nacl plasmalyte A Colloids: 5% albumin Voluven6% Hespen 6%

Question 46

Examples of hypertonic solutions

Answer 46

D5LR 3% NaCl cell will shrink Colloids Dextran 10%

Question 47

Describe Normal saline and its ingredients

Answer 47

0.9% NaCl in Water Isotonic solution (~308 Mosm/L) Typical solution for diluting PRBCs (cannot use Ca++ containing crystalloids)

Question 48

In large volumes, NaCl produces high Cl- content, which leads to

Answer 48

dilutional hyperchloremic acidosis

Question 49

The primary role of NS in modern anesthetic practice is in the administration of small volumes to neurosurgical patients. As a result of its mild hyperosmolality, 0.9% saline is the preferred fluid for patients at risk for cerebral edema. NS may also be indicated in fluid management of patients with anuria and end-stage renal disease who cannot excrete the potassium content of more balanced crystalloid solutions.

Answer 49

The primary role of NS in modern anesthetic practice is in the administration of small volumes to neurosurgical patients. As a result of its mild hyperosmolality, 0.9% saline is the preferred fluid for patients at risk for cerebral edema. NS may also be indicated in fluid management of patients with anuria and end-stage renal disease who cannot excrete the potassium content of more balanced crystalloid solutions.