Fluids and Electrolytes

Question 1

Acidosis

Answer 1

An acid–base imbalance characterized by an increase in H+ concentration

Question 2

Ascites

Answer 2

A type of edema in which fluid accumulates in the peritoneal cavity

Question 3

Active transport

Answer 3

Physiologic pump that moves fluid from an area of lower concentration to one of higher concentration; active transport requires ATP for energy

Question 4

Alkalosis

Answer 4

An acid–base imbalance characterized by a reduction in H+ concentration

Question 5

Diffusion

Answer 5

The process by which solutes move from an area of higher concentration to one of lower concentration; does not require energy

Question 6

Homeostasis

Answer 6

Maintenance of a constant internal equilibrium in a biologic system that involves positive and negative feedback mechanisms

Question 7

Hydrostatic Pressure

Answer 7

The pressure created by the weight of fluid against the wall that contains it.

Question 8

Hypertonic Solution

Answer 8

A solution with an osmolality higher than that of serum. Moves fluid out of cells into the vasculature.

Question 9

Hypotonic Solution

Answer 9

A solution with an osmolality lower than that of serum. Causes fluids to move from interstital spaces into cells. More water, less electrolytes.

Question 10

Isotonic Solution

Answer 10

A solution with the same osmolality as serum and other body fluids. Expands ECF volume.

Question 11

Osmolality

Answer 11

The number of milliosmoles (the standard unit of osmotic pressure) per kilogram of solvent; expressed as milliosmoles per kilogram (mOsm/kg)

Question 12

Osmolarity

Answer 12

The number of milliosmoles (the standard unit of osmotic pressure) per liter of solution; expressed as milliosmoles per liter (mOsm/L); describes the concentration of solutes or dissolved particles

Question 13

Osmosis

Answer 13

The process by which fluid moves across a semipermeable membrane from an area of low solute concentration to an area of high solute concentration; the process continues until the solute concentrations are equal on both sides of the membrane

Question 14

Tonicity

Answer 14

Fluid tension or the effect that osmotic pressure of a solution with impermeable solutes exerts on cell size because of water movement across the cell membrane (hypotonic, hypertonic, isotonic)

Question 15

Third spacing

Answer 15

When fluid moves out of either the intracellular and extracellular spaces and into areas that don’t maintain homeostasis (Ex. edema)

Question 16

How many compartments do extracellular fluid have? What are they?

Answer 16

1. Intravascular
2. Interstitial: surrounds the cells
3. Transcellular: various, often smaller spaces

Question 17

Sodium Concentration Range

Answer 17

135-145 mEq/L

Question 18

Potassium Concentration Range

Answer 18

3.5-5.0 mEq/L

Question 19

Chloride Concentration Range

Answer 19

98-106 mEq/L

Question 20

Bicarbonate Concentration Range

Answer 20

24-31 mEq/L

Question 21

Calcium Concentration Range

Answer 21

8.5-10.5 mg/dL

Question 22

Phosphorus Concentration Range

Answer 22

2.5-4.5 mg/dL

Question 23

Magnesium Concentration Range

Answer 23

1.8-3.0 mg/dL

Question 24

Osmostic Pressure

Answer 24

Amount of pressure needed to stop the flow of water, determined by the concentration of solutes.

Question 25

Oncotic Pressure

Answer 25

Pressure extended by proteins.

Question 26

Osmotic Diuresis

Answer 26

Increase in the urine output caused by the excretion of substances.

Question 27

Osmoles

Answer 27

Particles in our bodies that affect the movement of water

Question 28

Hyponatremia

Answer 28

Serum sodium less than 135 mEq/L

Question 29

Causes of Hypoatremia

Answer 29

Imbalance of water, losses by vomiting, diarrhea, sweating, diuretics, adrenal insufficiency, certain medications, SIADH

Question 30

Hypernatremia

Answer 30

Serum sodium greater than 145 mEq/L. Occurs when there is a gain in sodium or an excessive loss of water.

Question 31

Hypokalemia

Answer 31

Potassium serum levels less than 3.5 mEq/L

Question 32

Causes of hypokalemia

Answer 32

GI lossses, medications, alterations of acid-base balance, etc

Question 33

Manifestations of hypokalemia

Answer 33

ECG changes, dysrhythmias, dilute urine, thirst, muscle weakness etc.

Question 34

Hyperkalemia

Answer 34

Serum potassium greater than 5.0 mEq/L

Question 35

Causes of hyperkalemia

Answer 35

Impaired renal function, rapid administration of potassium, hypoaldosteronism, medications, tissue trauma, acidosis

Question 36

Manifestations of hyperkalemia

Answer 36

Cardiac changes and dysrhythmias, muscle weakness, paresthesias, anxiety, GI manifestations

Question 37

Hypocalcemia

Answer 37

Serum level less than 8.5 mg/dL

Question 38

Cause of hypocalcemia

Answer 38

Hypoparathyroidism, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, kidney injury, medication

Question 39

Hypercalcemia

Answer 39

Serum level greater than 10.5 mg/dL

Question 40

Causes of hypercalcemia

Answer 40

Malignancy and hyperparathyroidism, bone loss related to immobility, diuretics

Question 41

Clinical manifestations of hypercalcemia

Answer 41

Polyuria, thirst, muscle weakness, intractable nausea, abdominal cramps, severe constipation, diarrhea, peptic ulcer, bone pain, ECG changes, dysrhythmias

Question 42

Hypomagnesemia

Answer 42

Serum level less than 1.8 mg/dL

Question 43

Manifesations of Hypomagnesmia

Answer 43

Apathy, depressed mood, psychosis, neuromuscular irritability, muscle weakness, tremors, ECG changes and dysrhythmias

Question 44

Hypermagnesemia

Answer 44

Serum level greater than 3.0 mg/dL

Question 45

Causes of hypermagnesemia

Answer 45

Kidney injury, diabetic ketoacidosis, excessive administration of magnesium, extensive soft tissue injury

Question 46

Manifestations of hypermagnesemia

Answer 46

Hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias, and cardiac arrest

Question 47

Hypophosphatemia

Answer 47

Phosphorus Serum level below 2.5 mg/dL

Question 48

Causes of Hypophosphatemia

Answer 48

Alcoholism, refeeding of patients after starvation, pain, heat stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, low magnesium, low potassium, diarrhea, vitamin D deficiency, use of diuretic and antacids

Question 49

Manifestations of Hypophosphatemia

Answer 49

Neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bonevpain, increased susceptibility to infection

Question 50

Hyperphosphatemia

Answer 50

Phosphorus Serum level above 4.5 mg/d

Question 51

Causes of Hyperphosphatemia

Answer 51

Excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, chemotherapy

Question 52

Manifestations of Hyperphosphatemia

Answer 52

Soft-tissue calcifications, symptoms occur due to associated hypocalcemia

Question 53

Hypochloremia

Answer 53

Chlorine Serum level less than 98 mEq/L

Question 54

Causes of Hypochloremia

Answer 54

Addison disease, reduced chloride intake, GI loss, diabetic ketoacidosis, excessive sweating, fever, burns, medications, metabolic alkalosis

Question 55

Manifestations of Hypochloremia

Answer 55

Agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma

Question 56

Hyperchloremia

Answer 56

Chlorine Serum level more than 106 mEq/L

Question 57

Causes of Hyperchloremia

Answer 57

Excess sodium chloride infusions with water loss, head injury, hypernatremia, dehydration, severe diarrhea, respiratory alkalosis, metabolic acidosis, hyperparathyroidism, medications

Question 59

Hypovolemia

Answer 59

Dehydration or fluid volume deficit

Question 60

Fluid volume deficit

Answer 60

Loss of ECF including both serum electrolytes and water are lost in same proportion.

Question 61

Dehydration

Answer 61

Dehydration is the rapid loss of body weight due to the loss of water.

Question 62

Risk Factors for Dehydration

Answer 62

Abnormal renal losses Altered intake Hyperventilation Diabetic ketoacidosis

Question 63

Clinical Causes for Fluid Volume Deficit

Answer 63

Abnormal GI loss: vomiting, nasogastric suctioning, diarrhea ▪ Abnormal skin loss: diaphoresis ▪ Abnormal renal losses: diuretic therapy, diabetes insipidus renal disease, adrenal insufficiency osmotic diuresis ▪ Third spacing: peritonitis, intestinal obstruction, ascites, burns ▪ Hemorrhage

Question 64

Typical Vital Signs for FVD

Answer 64

Hyperthermia, tachycardia, weak pulses, hypotension, tachypnea

Question 65

Fluid Volume Excess

Answer 65

Edema o JVD (distended neck veins) o Crackles on lung auscultation o Productive cough o Weight gain o Lethargy o CNS disturbances/changes

Question 66

Colloids

Answer 66

Increase vascular space without excess fluid. * Example: someone who has third spacing meaning more fluid in the interstitial space than intravascular space. Providing this fluid will draw that fluid back into the vasculature.

Question 67

Types of colloids

Answer 67

Albumin, blood, plasma, Dextran 40

Question 68

When to give colloids

Answer 68

1. To increase osmostic gradient 2. Increase intravacular volume without giving an excessive amount of volume to patient 3. Hemorrhage 4. When regulatory organs are compromised

Question 69

Crystalloids types

Answer 69

Isotonic, hypotonic, hypertonic

Question 70

When will a isotonic solution be used?

Answer 70

In hypovolemic states, shock, mild Na deficit, resuscitative efforts, and hypercalcemia etc | 0.9% NaCl is considered normal saline.

Question 71

When are hypotonic solutions used?

Answer 71

To treat hyperotnic dehydration, Na+ and Cl- depletion, and gastric fluid loss | 0.45% NaCl

Question 72

When are hypertonic solutions used?

Answer 72

Used to decrease cellular swelling. | 3% and 5% NaCl

Question 73

When to give crystalloids?

Answer 73

Patients requring fluid resuscitation and other situations depending on the tonicity of the patient.

Question 74

When to be cautious with fluid resucitation?

Answer 74

Organ dysfunction lifke kidney failure, heart failure, pulmonary edema, head trauma, children, and the elderly.