Fluids/Acid Base

Question 1

What is the distribution of water in the human body?

Answer 1

intracellular - 2/3 of TBW

extra: 1/3 of TBW

Question 2

What is the normal urine output in infants? adults?

Answer 2

infants: 1mL/kg/hr
adults: 0.5-1mL/kg/hr

Question 3

What are 3 reasons for oliguria?

Answer 3

low blood flow to kidney -check heart
kidney prob
post renal obstruciton

Question 4

What is the distribution for extra?

Answer 4

plasma: 1/12 of TBW
interstitial: 1/4 of TBW

Question 5

What is the distribution of plasma?

Answer 5

85% is venous

15% is arterial

Question 6

What are the 4 diff types of fluid replacement?

Answer 6

normal saline
d51/2NS
D5W
lactated ringers

Question 7

What is used to increase intravascular vol?

Answer 7

normal saline

lactated ringers

Question 8

When is lactated ringers contraindicated w/increasing intravascular vol?

Answer 8

NOT maintenance

pt has hyperkalemia

Question 9

What is used to dilute med?

Answer 9

D5W

Question 10

What can used to correct hypernatremia?

Answer 10

D5W

Question 11

Pt has mental status changes, poor turgor, and oliguria? What other sx? Cx?

Answer 11

hypovolemic

sx: apathy, orhtostatic hypotension, tachycardia, hypothermia
cx: internal/external bleeding, V/D, sepsis, polyuria (DKA), third spacing

Question 12

How to dx hypovolemia?

Answer 12

monitor urine output and wt

labs: HIGH serum Na, LOW urine Na
kidneys: BUN/Cr >20:1

Question 13

How to tx hypovolemia?

Answer 13

increase intravascular vol

maintain urine output: 0.5-1mL/kg/hr

Question 14

What PE to expect from hypovolemia?

Answer 14

wt gain
edema
JVD
INCREASE CVP AND PCWP
RALES

Question 15

What can cause hypervolemia?

Answer 15

CHF
nephrotic sx
cirrhosis
ESRD

Question 16

Tx hypervolemia?

Answer 16

restrict fluids

Question 17

What does aldosterone do? ADH?

Answer 17

aldosterone increases reuptake of Na

ADH increases reuptake of H20

Question 18

Where is Na -ECF or ICF?

Answer 18

ECF

Question 19

What haps when there is a high intake of Na consumption?

Answer 19

increase in ECF

Question 20

Where is Na reabsorbed in the nephron?

Answer 20

proximal tubule

Question 21

Aldosterone increases Na reabsorption and ___ secretion from ____?

Answer 21

potassium secretion

form teh late distal tubules

Question 22

Hypothalamus has __ to control H20?

Answer 22

osmoreceptors

Question 23

Hypo/hyper natremia is caused by?

Answer 23

too much or too little water

Question 24

Hypo/hyper volemia is caused by?

Answer 24

too much or too little Na

Question 25

What is the value of hyponatremia?

Question 26

What to do w/ head trauma pts - na levels? Why?

Answer 26

normal or hypernatremic b/c if hyponatremic the water will move INTO brain cells --> increased ICP

Question 27

How can hyponatremia be classified?

Answer 27

hypotonic euvolemic isotonic hypertonic

Question 28

How can hypotonic hyponatramia be classified?

Answer 28

hypovolemic euvoemic hypervolemic

Question 29

What is hypovolemic hypotonic hyponatremia?

Answer 29

low fluids and low Na | low urine Na output 20 - no Na but on top of that body is forcing water out (diuretic) + Na

Question 30

What is euvolemic hypotonic hyponatremia?

Answer 30

ECF is ok but low Na - SIADH - drinking too much water

Question 31

What is hypervolemic hypotonic hyponatremia?

Answer 31

too much water but OK Na - CHF - nephrotic sx

Question 32

What is isotonic hyponatremia?

Answer 32

increase in plasma that lowers plasma Na concentration but the amt of sodium in plasma is NORM -> d/t elevated protein or lipis

Question 33

What is hypertonic hyponatremia?

Answer 33

osmotic shift of water OUT of cells --> hyperglycemia increase osmotic pressure so water shifts from cells INTO ECT --> diluting Na

Question 34

What sx to look for if suspecting hypotnatremia?

Answer 34

NEUROLOGICAL DEFECTS - brain cell swelling - HA - muscle twitching - hyperactive deep tendon reflexes

Question 35

Hyponatremia -Pt has high serum osmolality?

Answer 35

hypertonic hyponatremia - hyperglycemia - mannitol

Question 36

Hypontaremia - pt has normal serum osmolality?

Answer 36

pseudohyponatremia | -check for high lipids

Question 37

Hyponatremia - pt has "true hypontremia" + low Na in body?

Answer 37

measure urine Na | -20: diuretic, low aldosterone

Question 38

Hyponatremia - pt has true hyponatremia and normal Na?

Answer 38

SIADH

Question 39

Hyponatremia - pt has true hyponatremia and high Na?

Answer 39

CHF | nephrotic dz

Question 40

How to tx isotonic an dhypertonic hyponatremias?

Answer 40

tx underlying disorder

Question 41

How to tx hypotonic hyponatremia?

Answer 41

mild-no water mod: loop diuretics severe: hypertonic saline - not too fast to avoid central pontine dmyelination

Question 42

What number is hypernatremia?

Answer 42

>145