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Principles semester 2 > Fluid's electrolytes, acid-base physiology > Flashcards

Fluid's electrolytes, acid-base physiology Flashcards

exam 1

1
Q

Henderson-Hasselbaclch euation

A

CalculatespH
relationship pH, PaCO2, serum bicarbonate

pH = 6.1+log (HCO3)/0.03 x PaCO2

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2
Q

solubility coefficitent in blood of CO2

A

0.03

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3
Q

pKa of carbonic acid

A

6.1

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4
Q

Normal pH

A

7.35-7.45

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5
Q

What divides intravascular fluid (IVF) ad interstitial space (ISF)

A

capillary membrane

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6
Q

Starling forces role

A

determine motion across the membrane in the microcirculation

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7
Q

Starling forces (4)

A

1.Capillary Pressure
2. ISF pressure
3. ISF colloid osmotic pressure
4. Plasma colloid osmotic pressure

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8
Q

Most significant starling force is

A

plama colloid osmotic pressure

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9
Q

Plasma colloid osmotic pressure is determined by

A

plasma protien concentration and serves to maintain the circulating fluid volume within the intravascular space

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10
Q

How can you increase or decrease plasma protien concentration depending on

A

type and volume of IV Fluids

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11
Q

Fluid movement betwenen intravascular space and interstitial space is determined by: (2)

A
  1. Starling forces
  2. glycocalyx (protective layer on interior wall of blood vessel) (gatekeeper of what can pass from vessel into interstitial fluid)
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12
Q

Lymphatic system role

A

fluid scavenger- removes unwanted things that enter interstitium

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13
Q

Hypovolemia is most often from

A

Loss of ECF leading to decreased circulating volume

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14
Q

How to treat hypovolemia

A

isotonic crystalloids (NS, LR) because they are most similar to ECF

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15
Q

Serum osmlality and osmolarity measure

A

balance between water and solutes in blood

evaluates hyponatremia etiology

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16
Q

Normal serum osmolality

A

275-295 mmol/kg

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17
Q

Normal plama osmolarity

A

280-290 mOsm/L

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18
Q

Tonicity compares

A

osmolarity of a solution relative to osmolarity of the plasma

transfer of water move in direction of less solute concentration

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19
Q

Isotonic

A

same as plasma, not water transfer

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20
Q

Hypotonic

A

water enters and cell swells (leaves plasma)

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21
Q

Hypertonic

A

Water exits and cell shrinks (enters plasma)

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22
Q

Normal sodium level

A

135-145

23
Q

How fast should you correct hyponatremia? Why?

A

Slowly! 1-2 mEq/L per hour

Too aggressive correction (especially chronic) can lead to neurologic complication and coma d/t osmotic demyelination (myelinolysis)

24
Q

What is the principle electrolyte in ICF?

A

Potassium

25
Q

Why is potassium kept in ICF

A

d/t resting membrane potential of the cell

26
Q

Disease that cause potassium disturbances are often disorders disrupting

A

resting membrane potential

27
Q

normal potassium blood level

A

3.5-5.5

28
Q

Hyperventilation and potassium

A

Hyperventilation causes alkalosis = hypokalemia

29
Q

Treatment for loss of P wave and widening QRS (hyperkalemia)

A

Calcium chloride
SOdium bicarbonate

30
Q

Calcium chloride MOA

A

membrane stabilization

31
Q

Sodium bicarbonate MOA

A

shifts potassium intracellularly

32
Q

Peaked T wave therapy/tx (hyperkalemia):

A

glucose and insulin

33
Q

glucose/insulin MOA (hyperkalemia)

A

shifts potassium intracellularly

34
Q

Normal serum calcium

A

8.5-10.5

35
Q

Mostly likely cause of hypocalcemia intraoperatively

A

hyperventilation and mass transfusion

36
Q

Normal blood magnesium range

A

1.3-2.5 mEq/L

37
Q

Patient fluid replacement should be treated according to

A

principles of goal-directed therapy that compensate for individual needs

38
Q

Know and replace (in fluid replacement):

A

Fluid deficit, fluid losses during surgery, intravascular volume lost
until transfusion is warranted

39
Q

Gold standard for determining volume status

A

Maxamizing cardiac flow parameters as a surrogate for oxygen delivery improves outcomes

pulse pressure variation

40
Q

How to calculate hourly fluid maintenance requirement (rule)

A

4:2:1

41
Q

Explain 4:2:1 rule

A

first 10 kg: 4mL/10kg/hr
next 10 kg: 2ml/10kg/hr
Each 1 kg above 20 kg add 1mL/kg/hr

42
Q

Calculating fluid deficeit

A

(IV fluid hourly rate x surgical hours) +NG suction or - bowel prep

43
Q

Blood loss: crystalloid replacement ratio

A

3:1

44
Q

Blood loss: Colloid replacement ratio

A

1:1

45
Q

Normal saline can cause

A

hyperchloremic metabolic acidosis

46
Q

LR can cause

A

metabolic alkalosis s/t metabolism of lactate

47
Q

Why can’t you use LR with blood?

A

Calcium will bind to citrate in blood and occlude line

48
Q

Dextrose-containing solutions should be avoided in patients with___. Why?

A

neurologic injuries

may cause hyper glycemia, cerebral acidosis, osmotic diuresis

49
Q

Which part of the startling curve best correlates with preload dependence?

A

upcurve

50
Q

artificial colloid administration is associated with

A

coagulopathy and clinical bleeding, most frequently in cardiac surgery patients receiving hydroxyethyl starch

51
Q

All colloids share these potential downsides (4):

A
  1. volume overload
  2. coagulopathy (especially hetastarch)
  3. anaphylactoid reactions
  4. interstitial edema
52
Q

Traditionally favored colloid in neurosurgical pts:

however:

A

Albumin

However, SAFE trial suggested higher mortality rate associated with albumin as compared to saline

53
Q

difference bewteen colloids and crystalloids (“long term” expansion)

A

long term expansion by colloids is a myth - risk of edema is no different btwn colloids and crystalloids

no evidence that resuscitation with colloids reduces the risk of death compared to resuscitation with crystalloids (trauma and surgery)

Colloids are more expensive than crystalloids

54
Q
A

Principles semester 2 (17 decks)

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