Fluids and Electrolytes Flashcards
(108 cards)
1
Q
major extracellular electrolytes
A
Sodium (142 mEq/L), Chloride (103 mEq/L), Calcium (2.4 mEq/L)
Bicarb (28 mEq/L)
2
Q
major intracellular electrolytes
A
Potassium (140mEq/L), Magnesium (58 mEq/L), Phosphate (74 mEq/L)
3
Q
% extracellular body water
A
1/3 (33%)
4
Q
% intracellular body water
A
2/3 (67%)
5
Q
% body water for an adult male
A
60%
6
Q
% body water for an adult female
A
50%
7
Q
% body water for an elderly male
A
50%
8
Q
% body water for an elderly female
A
45%
9
Q
what weight should be used to estimate total body water in obesity
A
ideal body weight
10
Q
insensible water gains
A
water oxidation of metabolism (250mL)
11
Q
total water gain in healthy adult
A
1.5-2.5 Liters
12
Q
sensible water gains
A
oral fluid intake (800 mL to 1.5 L) and water from solid foods (500-700mL)
13
Q
total water loss in healthy adult
A
1.5-2.5 liters
14
Q
sensible water loss
A
urine output (800-1.5 L) and GI output (0-250mL)
15
Q
insensible water loss
A
skin (600-900mL) and lungs
16
Q
Where does fluid gain occur during digestion
A
saliva, food/drink, bile, pancreatic fluid, small bowel fluid, gastric fluid
17
Q
how much water is reabsorbed total from digestion
A
6.5 Liters
18
Q
how much fluid is created daily from saliva
A
1.5 Liters
19
Q
how much water is gained total from digestion
A
8.5 liters
20
Q
the stomach typically produces _____ L of fluid
A
2 liters
21
Q
how much fluid is reabsorbed in the colon
A
1.9 liters (out of 2)
22
Q
a patient has tented/dry skin, with dry mucous membranes, has increased heart beat (tachycardia), decreased blood pressure and urinary sodium above 20 they are likely
A
dehydrated
23
Q
how to calculate fluid maintenance (adults and children over 5 years old)
A
4,2,1 or 100,50,20 method
24
Q
calculate fluid maintenance for a 60 kg male (4,2,1 method)
A
4mL x 10 kg = 40mL/hr
2mL x10 kg = 20mL/hr
1mL x 40kg = 40mL/hr
Total 100mL/hr x 24 hours = 2.4 Liters
25
calculate fluid maintenance for a 60 kg male (100,50,20 method)
100mL x 10 kg = 1000mL
50mL x 10kg = 500 mL
20mL x 40 kg= 800 mL
Total = 2300mL/day
26
Fever, excessive sweating , hyperventilation and hyperthyroid _____ fluid needs
increase
27
abnormal shifts of fluid from the intravascular space (blood vessels) into the interstitial fluids (the tissues)
Edema
28
common causes of edema
decreased cardiac output, hypotension, decreased urine output
29
when you have edema, you are considered in a state of water
loss
30
conditions that can cause 3rd spacing
bowel obstruction, peritonitis, acute pancreatitis, ascites in liver/renal function, trauma
31
isotonic IV fluids
Normal Saline with Dextrose or balanced crystalloids (LR, plasmalyte)
32
should post op major abdominal surgical patients have liberal or restricted fluids in the 1st 24 hours post op
liberal fluids to prevent AKI
33
water deficit calculation
(Current Na - Desired Na / Desired Na) x %body water x body weight (kg)
34
Causes of primary hypervolemia
poor renal function leading to sodium retention and extracellular fluid expansion to preserve blood pressure
35
causes of secondary hypervolemia
CHF, cirrhosis, excessive IV administration
36
symptoms of hypervolemia
weight gain, edema, ascites, pulmonary effusion, rales, distended jugular veins
37
the primary extracellular cation is
sodium
38
the primary anion of the ECF is
chloride
39
the primary cation of the ICF is
potassium
40
the primary anion of the ECF is
phosphate
41
non-electrolyte components of body fluids that do not dissociate in solution are
glucose, urea and creatinine
42
when levels of cations and anions are in equal amounts is called
electroneutrality
43
electroneutrality is maintained by
buffering systems
44
a patient that has high loses via NG suction of about 2L a day would likely benefit from the replacement of ___ to maintain homeostasis
chloride
45
if a patient has high losses from diarrhea they would likely benefit from the replacement of ____ to maintain homeostasis
bicarb, alkaline solutions
46
the most common cause of hypernatremia
inappropriate/inadequate provision of fluids
47
increased blood glucose of hypertonic sodium free IV fluids can cause
hypertonic hyponatremia
48
when glucose is high, sodium will be artificially low because
hyperglycemia is a hypertonic state intracellular water shifts out from inside the cell into the vascular space causing dilutional hyponatremia
49
for ever 100mg/dL increase in serum glucose from normal, serum Na decreases by
1.6 mEq/L
50
the most common cause of hyponatremia is
excess water provision
51
sodium is largely regulated by this organ _____ and this hormone_____
kidney, aldosterone (vasopressin)
52
aldosterone hormone causes ____ to be reabsorbed in the distal renal tubule in response to a change in sodium/volume status
sodium
53
serum ____ is essential to assess the cause and treatment of low sodium
osmolality
54
fatigue, weakness and muscle twitching are signs of symptomatic
hyponatremia
55
Normal Saline (IV) provides ____ sodium per liter
154 mEq/L
56
Hypernatremia is always associated with a __ state. Free water moves from the ICF to the ECF causing dehydration
hypertonic
57
dry mucous membranes, hypotension, oliguria, tachycardia and decreased skin turgor are symptoms of
dehydration
58
calculate the free water deficit of a 70 kg man with a serum sodium of 158
5.4 L (to 140mEq/L) 1.6 L (to 152 mEq/L)
59
Phosphorous is the primary ____ anion
intracellular
60
Phosphorous maintains the _____ cellular fluid, normal muscle/nervous function and important in metabolic pathways
intracellular
61
nervous system dysfunction, respiratory failure, decreased levels of 2,3-diphosphoglycerate and muscle weakness can be caused by
hypophosphatemia
62
reasons for elevated phosphorous
renal failure, metastatic calcification of soft tissue/blood vessels cellular destruction from trauma, cytotoxic medications, severe rhabdomyolysis
63
Optimal total serum phos and calcium should be a
55
64
the most common clinical manifestation of hyperphosphatemia is ___ caused by hypocalcemia d/t calcium phosphate precipitation
tetany
65
a patient with hypokalemia should also be assessed for what electrolyte
hypomagnesemia (magnesium regulates intracellular potassium)
66
when hypokalemia co-exists with hypokalemia and hypomagnesemia replete which first
magnesium
67
the following electrolyte disturbance can cause a deficit of hydrogen ions in the ECF precipitating in alkalosis
hypokalemia (potassium is on the inside of the cell normally, if low, protons will pump in potassium to correct causing a deficit of hydrogen ions into the ECF)
68
this electrolyte is integrating maintaining cell volume , hydrogen ion concertation, enzyme function, neuromuscular /cardiac function and cell growth
potassium
69
clinical manifestations of hypokalemia
cardiac arrhythmia, muscle weakness, ileus, EKG changes and paralysis
70
renal failure, rhabdomyolysis and acidosis can all cause
hyperkalemia
71
common causes of hypomagnesemia (3)
inadequate GI absorption, refeeding syndrome and DKA
72
DKA lowers serum hypomagnesemia because
1. increased renal excretion during diuresis from high blood glucose
2. shifting of magnesium into the cells by insulin
73
when maintained slightly above normal serum concentrations, which of the following electrolytes reduces the amount of potassium required in critically ill patients
magnesium
74
a patient getting a standard enteral feeding constantly has a magnesium level of 3.0 mEq/L. A prudent first step would to be
ensure that medications with supplemental magnesium have been held
75
causes of hypermagnesemia
renal failure ,excessive use of laxatives' as they contain large amounts of magnesium (milk of magnesia)
76
low levels of serum calcium stimulates the release of this hormone which increases bone resorption, stimulates renal conservation of calcium and activates vitamin D (in turn increasing the absorption of calcium in the GIT)
parathyroid hormone
77
in response to elevated levels of serum calcium, the ____ releases ___ hormone which inhibits bone resorption
thyroid, calcitonin
78
Adjust the calcium for a patient with an albumin of 2.4 and calcium of 6.9
8.2
79
in the absence of excessive exogenous provision of calcium in a patient with normal renal function, the most common cause (s) of hypercalcemia are
hyperparathyroidism and bone cancer
80
decreased vitamin D, decreased PTH activity after thyroidectomy/parathyroidectomy, massive soft tissue damage 2/2 trauma ,infection , or multiple blood transfusions 2/2 citrate binding of this element causes _____
calcium, hypocalcemia
81
in the setting of critical illness or injury, a patient has decreased UOP, hypotension, tachycardia, high urinary specific gravity, high osmolality, elevated Cr, poor skin turgor with minimal if any changes in body wt. The clinician should consider this change in body fluid
third spacing
82
Third spacing and critical illness/trauma
traumatic injury results in redistribution of intravascular fluid into the area of injury, therefore decreasing intravascular fluid volume, Sepsis produces generalized capillary leak, causing larger molecules such as proteins to readily pass through membranes, precipitating a disruption of oncotic pressure allowing the ICF to leak out of the cells
83
what are therapies used for standard care to treat third spacing
IV LR/normal saline, blood transfusion, correction of underlying cause
84
the most appropriate enteral formula for a patient with SIADH is
a concentrated formula (low in water)
85
the syndrome of inappropriate antidiuretics hormone (SIADH) is likely to present as
hyponatremia
86
hallmark signs of SIADH
low sodium, increased urine sodium and increased osmolarity
87
Euvolemic body with total body water overload d/t inappropriate concentration of the urine
SIADH
88
elevated serum sodium, flat neck veins, dry mucous membranes are signs of
dehydration
89
the preferred oral rehydration solution should be/contain
isotonic, with sodium and glucose/carbohydrate
90
oral rehydration solutions decrease _____ in short bowel syndrome
dehydration
91
this type of fluid is readily absorbed from the jejunum
sodium chloride
92
saline water is not absorbed well from commercially available rehydration solutions because they are hypotonic true or false
true
93
optimal sodium level (in mmol/L) of sodium in oral rehydration solutions
90mmol/L
94
____ in oral rehydration solutions is an important component because it promotes sodium/water absorption by acting as a transporter
glucose
95
this disorder is represented by hypernatremia with high urine output from 4-12L /day
Diabetes Insipidus
96
electrolyte abnormalities after feeding after starvation is called
refeeding syndrome
97
in the early phase of refeeding syndrome excessive sodium and fluid intake causing
fluid overload, pulmonary edema, cardiac decompensation
98
the three labs depleted in refeeding syndrome
hypomagnesemia, hypophosphatemia, hypokalemia
99
chronic starvation/alcoholism, anorexia/malabsorption, morbid obesity with weight loss and AIDS/Cancer patients are all at risk for
refeeding syndrome
100
A cachectic 42 year old F is re admitted 2 weeks s/p ex lap with post op SBO. She has lost an additional 8% of her body weight since her first admit to the hospital. She undergoes surgical repair of the obstruction and has a naso-enteric feeding tube placed in the OR. Upon initiation of nutrition support which of the following would be a major concern
refeeding syndrome
101
a patient getting normal saline at 75mL/hr with 20mEq KCl/L provides how many mE1 of sodium and _ mEq potassium chloride
154 mEq sodium (154 x 1.8)
| 36 mEq potassium (20 X 1.8 )
102
Lactated Ringers fluid is most similar to ____ fluid
jejunal fluid
103
Electrolytes of the GI tract Jejunum (Na, K, Cl, Bicarb)
Sodium: 95-120 mEq/L
Potassium: 5-15 mEq/L
Chloride: 80-130 mEq/L
Bicarb 10-20 mEq/L
104
Electrolytes of the GI tract Ileum (Na, K, Cl, Bicarb)
Sodium: 110-130 mEq/L
Potassium: 5-15 mEq/L
Chloride: 90-110 mEq/L
Bicarb: 20-30 mEq/L
105
Electrolyte Composition of Lactated Ringers
```
Na: 130 mEq/L
Potassium: 4 mEq/L
Chloride: 109 mEq/L
Lactate: 28 mEq/L
Calcium 2.7-7.7 mEq/L
```
106
1/2 Normal Saline (0.45%) provides ___ mEq of sodium and ___ mEq of chloride
77 mEq sodium
| 77 mEq chloride
107
Normal Saline (0.9%) provides __ mEq/L of sodium and __ mEq/L of chloride
154 mEq sdoium
| 154 mEq chlroide
108
D5W + 1/2 Normal Saline (0.45%) provides ___g/L dextrose, ___ mEq/L Sodium, and ___ mEq/L chloride
50 g/L dextrose
77mEq/L sodium
77mEq/L chloride
