Fluids and Electrolytes Chapter18 P107-123 Flashcards Preview

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Flashcards in Fluids and Electrolytes Chapter18 P107-123 Deck (175)
1

What are the two major body fluid compartments?
P107

1. Intracellular
2. Extracellular

2

What are the two subcompartments of extracellular fluid?
P107

1. Interstitial fluid (in between cells)
2. Intravascular fluid (plasma)

3

What percentage of body weight is in fluid?
P107 (picture)

60%

4

What percentage of body fluid is intracellular?
P108

66%

5

What percentage of body fluid is extracellular?
P108

33%

6

What is the composition of body fluid?
P108

Fluids = 60% total body weight:
Intracellular = 40% total body weight
Extracellular = 20% total body weight
(Think: 60, 40, 20)

7

How can body fluid distribution by weight be remembered?
P108

“TIE”:
T = Total body fluid = 60% of body weight
I = Intracellular = 40% of body weight
E = Extracellular = 20% of body weight

8

On average, what percentage of body weight does blood
account for in adults?
P108

≈7%

9

How many liters of blood
are in a 70-kg man?
P108

0.07 x 70 = 5 liters

10

What are the fluid requirements every 24 hours for each of the following substances:
1. Water
P108

≈30 to 35 mL/kg

11

What are the fluid requirements every 24 hours for each of the following substances:
2. Potassium
P108

≈1 mEq/kg

12

What are the fluid requirements every 24 hours for each of the following substances:
3. Chloride
P108

≈1.5 mEq/kg

13

What are the fluid requirements every 24 hours for each of the following substances:
4. Sodium
P108

≈1–2 mEq/kg

14

What are the levels and sources of normal daily water loss?
P108

Urine—1200 to 1500 mL (25–30 mL/kg)
Sweat—200 to 400 mL
Respiratory losses—500 to 700 mL
Feces—100 to 200 mL

15

What are the levels and sources of normal daily electrolyte loss?
P108

Sodium and potassium = 100 mEq
Chloride = 150 mEq

16

What are the levels of sodium and chloride in sweat?
P109

≈40 mEq/L

17

What is the major electrolyte in colonic feculent fluid?
P109

Potassium—65 mEq/L

18

What is the physiologic response to hypovolemia?
P109

Sodium/H2O retention via renin → aldosterone, water retention via ADH, vasoconstriction via angiotensin II and
sympathetics, low urine output and tachycardia (early), hypotension (late)

19

THIRD SPACING
What is it?
P109

Fluid accumulation in the interstitium of tissues, as in edema, e.g., loss of fluid into the interstitium and lumen of a paralytic bowel following surgery (think of the intravascular and intracellular spaces as the first two spaces)

20

THIRD SPACING
When does “third-spacing” occur postoperatively?
P109

Third-spaced fluid tends to mobilize back into the intravascular space around POD #3 (Note: Beware of fluid overload once the fluid begins to return to the intravascular
space); switch to hypotonic fluid and decrease IV rate

21

THIRD SPACING
What are the classic signs of third spacing?
P109

Tachycardia
Decreased urine output

22

THIRD SPACING
What is the treatment?
P109

IV hydration with isotonic fluids

23

THIRD SPACING
What are the surgical causes of the following conditions:
Metabolic acidosis
P109

- Loss of bicarbonate: diarrhea, ileus, fistula, high-output ileostomy, carbonic anhydrase inhibitors
- Increase in acids: lactic acidosis (ischemia), ketoacidosis, renal failure, necrotic tissue

24

THIRD SPACING
What are the surgical causes of the following conditions:
Hypochloremic alkalosis
P109

NGT suction, loss of gastric HCl through vomiting/NGT

25

THIRD SPACING
What are the surgical causes of the following conditions:
Metabolic alkalosis
P110

Vomiting, NG suction, diuretics, alkali ingestion, mineralocorticoid excess

26

THIRD SPACING
What are the surgical causes of the following conditions:
Respiratory acidosis
P110

Hypoventilation (e.g., CNS depression), drugs (e.g., morphine), PTX, pleural effusion, parenchymal lung disease,
acute airway obstruction

27

THIRD SPACING
What are the surgical causes of the following conditions:
Respiratory alkalosis
P110

Hyperventilation (e.g., anxiety, pain, fever, wrong ventilator settings)

28

THIRD SPACING
What is the “classic” acidbase finding with significant
vomiting or NGT suctioning?
P110

Hypokalemic hypochloremic metabolic alkalosis

29

THIRD SPACING
Why hypokalemia with NGT suctioning?
P110

Loss in gastric fluid—loss of HCl causes
alkalosis, driving K⁺ into cells

30

THIRD SPACING
What is the treatment for hypokalemic hypochloremic
metabolic alkalosis?
P110

IVF, Cl⁻/K⁺ replacement

31

THIRD SPACING
What is paradoxic alkalotic aciduria?
P110

Seen in severe hypokalemic, hypovolemic, hypochloremic metabolic alkalosis with paradoxic metabolic alkalosis of serum and acidic urine

32

THIRD SPACING
How does paradoxic alkalotic aciduria occur?
P110

H⁺ is lost in the urine in exchange for Na⁺ in an attempt to restore volume

33

THIRD SPACING
With paradoxic alkalotic aciduria, why is H⁺ preferentially lost?
P110

H⁺ is exchanged preferentially into the
urine instead of K⁺ because of the low
concentration of K⁺

34

THIRD SPACING
What can be followed to assess fluid status?
P110

Urine output, base deficit, lactic acid, vital signs, weight changes, skin turgor, jugular venous distention (JVD), mucosal membranes, rales (crackles), central venous
pressure, PCWP, chest x-ray findings

35

THIRD SPACING
With hypovolemia, what changes occur in vital signs?
P110

Tachycardia, tachypnea, initial rise in diastolic blood pressure because of clamping down (peripheral vasoconstriction) with subsequent decrease in both
systolic and diastolic blood pressures

36

THIRD SPACING
What are the insensible fluid losses?
P111

Loss of fluid not measured:
a) Feces—100 to 200 mL/24 hours
b) Breathing—500 to 700 mL/24 hours
(Note: increases with fever and tachypnea)
c) Skin—≈300 mL/24 hours, increased with fever; thus, insensible fluid loss is not directly measured

37

THIRD SPACING
What are the quantities of daily secretions:
Bile
P111

≈1000 mL/24 hours

38

THIRD SPACING
What are the quantities of daily secretions:
Gastric
P111

≈2000 mL/ 24 hours

39

THIRD SPACING
What are the quantities of daily secretions:
Pancreatic
P111

≈600 mL/ 24 hours

40

THIRD SPACING
What are the quantities of daily secretions:
Small intestine
P111

≈3000 mL/day

41

THIRD SPACING
What are the quantities of daily secretions:
Saliva
P111

≈1500 mL/24 hours
(Note: almost all secretions are reabsorbed)

42

THIRD SPACING
How can the estimated levels of daily secretions from bile,
gastric, and small-bowel sources be remembered?
P111

Alphabetically and numerically: BGS and 123 or B1, G2, S3, because Bile, Gastric, and Small bowel produce roughly 1 L,
2 L, and 3 L, respectively!

43

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises normal saline (NS)?
P111

154 mEq of Cl⁻
154 mEq of Na⁺

44

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises 1/2 NS?
P111

77 mEq of Cl⁻
77 mEq of Na⁺

45

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises 1/4 NS?
P111

39 mEq of Cl⁻
39 mEq of Na⁺

46

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises lactated Ringer’s (LR)?
P111

130 mEq Na⁺
109 mEq Cl⁻
28 mEq lactate
4 mEq K⁺
3 mEq Ca⁺

47

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What comprises D5W?
P111

5% dextrose (50 g) in H(2)O

48

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What accounts for tonicity?
P112

Mainly electrolytes; thus, NS and LR are both isotonic, whereas 1/2 NS is hypotonic to serum

49

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
What happens to the lactate in LR in the body?
P112

Converted into bicarbonate; thus, LR cannot be used as a maintenance fluid because patients would become alkalotic

50

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Gastric (NGT)
P112

D5 1/2 NS + 20 KCl

51

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Biliary
P112

LR+/-sodium bicarbonate

52

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Pancreatic
P112

LR+/-sodium bicarbonate

53

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Small bowel (ileostomy)
P112

LR

54

COMMON IV REPLACEMENT FLUIDS (ALL VALUES ARE PER LITER)
IVF replacement by anatomic site:
Colonic (diarrhea)
P112

LR+/-sodium bicarbonate

55

CALCULATION OF MAINTENANCE FLUIDS
What is the 100/50/20 rule?
P112

Maintenance IV fluids for a 24-hour period:
100 mL/kg for the first 10 kg
50 mL/kg for the next 10 kg
20 mL/kg for every kg over 20 (divide by 24 for hourly rate)

56

CALCULATION OF MAINTENANCE FLUIDS
What is the 4/2/1 rule?
P112

Maintenance IV fluids for hourly rate:
4 mL/kg for the first 10 kg
2 mL/kg for the next 10 kg
1 mL/kg for every kg over 20

57

CALCULATION OF MAINTENANCE FLUIDS
What is the maintenance for a 70-kg man?
P112

Using 100/50/20:
100 x 10 kg = 1000
50 x 10 kg = 500
20 x 50 kg = 1000
Total = 2500
Divided by 24 hours = 104 mL/hr maintenance rate

Using 4/2/1:
4 x 10 kg = 40
2 x 10 kg = 20
1 x 50 kg = 50
Total = 110 mL/hr maintenance rate

58

CALCULATION OF MAINTENANCE FLUIDS
What is the common adult maintenance fluid?
P113

D5 1/2 NS with 20 mEq KCl/L

59

CALCULATION OF MAINTENANCE FLUIDS
What is the common pediatric maintenance fluid?
P113

D5 1/4 NS with 20 mEq KCl/L (use 1/4 NS because of the decreased ability of children to concentrate urine)

60

CALCULATION OF MAINTENANCE FLUIDS
Why should sugar (dextrose) be added to maintenance
fluid?
P113

To inhibit muscle breakdown

61

CALCULATION OF MAINTENANCE FLUIDS
What is the best way to assess fluid status?
P113

Urine output (unless the patient has cardiac or renal dysfunction, in which case central venous pressure or wedge pressure is often used)

62

CALCULATION OF MAINTENANCE FLUIDS
What is the minimal urine output for an adult on
maintenance IV?
P113

30 mL/hr (0.5 cc/kg/hr)

63

CALCULATION OF MAINTENANCE FLUIDS
What is the minimal urine output for an adult trauma
patient?
P113

50 mL/hr

64

CALCULATION OF MAINTENANCE FLUIDS
How many mL are in 12 oz (beer can)?
P113

356 mL

65

CALCULATION OF MAINTENANCE FLUIDS
How many mL are in 1 oz?
P113

30 mL

66

CALCULATION OF MAINTENANCE FLUIDS
How many mL are in 1 tsp?
P113

5 mL

67

CALCULATION OF MAINTENANCE FLUIDS
What are common isotonic fluids?
P113

NS, LR

68

CALCULATION OF MAINTENANCE FLUIDS
What is a bolus?
P113

Volume of fluid given IV rapidly (e.g., 1 L over 1 hour); used for increasing intravascular volume, and isotonic fluids should be used (i.e., NS or LR)

69

CALCULATION OF MAINTENANCE FLUIDS
Why not combine bolus fluids with dextrose?
P113

Hyperglycemia may result

70

CALCULATION OF MAINTENANCE FLUIDS
What is the possible consequence of hyperglycemia in
the patient with hypovolemia?
P114

Osmotic diuresis

71

CALCULATION OF MAINTENANCE FLUIDS
Why not combine bolus fluids with a significant amount of
potassium?
P114

Hyperkalemia may result (the potassium in LR is very low: 4 mEq/L)

72

CALCULATION OF MAINTENANCE FLUIDS
Why should isotonic fluids be given for resuscitation
(i.e., to restore intravascular volume)?
P114

If hypotonic fluid is given, the tonicity of the intravascular space will be decreased and H(2)O will freely diffuse into the
interstitial and intracellular spaces; thus, use isotonic fluids to expand the intravascular space

73

CALCULATION OF MAINTENANCE FLUIDS
What portion of 1 L NS will stay in the intravascular
space after a laparotomy?
P114

In 5 hours, only ≈200 cc (or 20%) will remain in the intravascular space!

74

CALCULATION OF MAINTENANCE FLUIDS
What is the most common trauma resuscitation fluid?
P114

LR

75

CALCULATION OF MAINTENANCE FLUIDS
What is the most common postoperative IV fluid after
a laparotomy?
P114

LR or D5LR for 24 to 36 hours, followed by maintenance fluid

76

CALCULATION OF MAINTENANCE FLUIDS
After a laparotomy, when should a patient’s fluid be
“mobilized”?
P114

Classically, POD #3; the patient begins to “mobilize” the third-space fluid back into the intravascular space

77

CALCULATION OF MAINTENANCE FLUIDS
What IVF is used to replace duodenal or pancreatic fluid
loss?
P114

LR (bicarbonate loss)

78

ELECTROLYTE IMBALANCES
What is a common cause of electrolyte abnormalities?
P114

Lab error!

79

ELECTROLYTE IMBALANCES
What is a major extracellular cation?
P114

Na⁺

80

ELECTROLYTE IMBALANCES
What is a major intracellular cation?
P114

K⁺

81

HYPERKALEMIA
What is the normal range for potassium level?
P115

3.5–5.0 mEq/L

82

HYPERKALEMIA
What are the surgical causes of hyperkalemia?
P115

Iatrogenic overdose, blood transfusion, renal failure, diuretics, acidosis, tissue destruction (injury/hemolysis)

83

HYPERKALEMIA
What are the signs/ symptoms?
P115

Decreased deep tendon reflex (DTR) or areflexia, weakness, paraesthesia, paralysis, respiratory failure

84

HYPERKALEMIA
What are the ECG findings?
P115

Peaked T waves, depressed ST segment, prolonged PR, wide QRS, bradycardia, ventricular fibrillation

85

HYPERKALEMIA
What are the critical values?
P115

K⁺ >6.5

86

HYPERKALEMIA
What is the urgent treatment?
P115

- IV calcium (cardioprotective), ECG monitoring
- Sodium bicarbonate IV (alkalosis drives K⁺ intracellularly)
- Glucose and insulin
- Albuterol
- Sodium polystyrene sulfonate (Kayexalate) and furosemide (Lasix)
- Dialysis

87

HYPERKALEMIA
What is the nonacute treatment?
P115

Furosemide (Lasix), sodium polystyrene sulfonate (Kayexalate)

88

HYPERKALEMIA
What is the acronym for the treatment of acute symptomatic hyperkalemia?
P115

“CB DIAL K”:
Calcium
Bicarbonate

Dialysis
Insulin/dextrose
Albuterol
Lasix

Kayexalate

89

HYPERKALEMIA
What is “pseudohyperkalemia”?
P115

Spurious hyperkalemia as a result of
falsely elevated K⁺ in sample from
sample hemolysis

90

HYPERKALEMIA
What acid-base change lowers the serum potassium?
P116

Alkalosis (thus, give bicarbonate for hyperkalemia)

91

HYPERKALEMIA
What nebulizer treatment can help lower K⁺ level?
P116

Albuterol

92

HYPOKALEMIA
What are the surgical causes?
P116

Diuretics, certain antibiotics, steroids, alkalosis, diarrhea, intestinal fistulae, NG aspiration, vomiting, insulin, insufficient supplementation, amphotericin

93

HYPOKALEMIA
What are the signs/symptoms?
P116

Weakness, tetany, nausea, vomiting, ileus, paraesthesia

94

HYPOKALEMIA
What are the ECG findings?
P116

Flattening of T waves, U waves, ST segment depression, PAC, PVC, atrial fibrillation

95

HYPOKALEMIA
What is a U wave?
P116 (picture)

(see picture)

96

HYPOKALEMIA
What is the rapid treatment?
P116

KCl IV

97

HYPOKALEMIA
What is the maximum amount that can be given through a peripheral IV?
P116

10 mEq/hour

98

HYPOKALEMIA
What is the maximum amount that can be given through a central line?
P116

20 mEq/hour

99

HYPOKALEMIA
What is the chronic treatment?
P116

KCl PO

100

HYPOKALEMIA
What is the most common electrolyte-mediated ileus in
the surgical patient?
P116

Hypokalemia

101

HYPOKALEMIA
What electrolyte condition exacerbates digitalis toxicity?
P117

Hypokalemia

102

HYPOKALEMIA
What electrolyte deficiency can actually cause hypokalemia?
P117

Low magnesium

103

HYPOKALEMIA
What electrolyte must you replace first before replacing K⁺?
P117

Magnesium

104

HYPOKALEMIA
Why does hypomagnesemia make replacement of K⁺ with hypokalemia nearly impossible?
P117

Hypomagnesemia inhibits K⁺ reabsorption from the renal tubules

105

HYPERNATREMIA
What is the normal range for sodium level?
P117

135–145 mEq/L

106

HYPERNATREMIA
What are the surgical causes?
P117

Inadequate hydration, diabetes insipidus, diuresis, vomiting, diarrhea, diaphoresis, tachypnea, iatrogenic (e.g., TPN)

107

HYPERNATREMIA
What are the signs/ symptoms?
P117

Seizures, confusion, stupor, pulmonary or peripheral edema, tremors, respiratory paralysis

108

HYPERNATREMIA
What is the usual treatment supplementation slowly over
days?
P117

D5W, 1/4 NS, or 1/2 NS

109

HYPERNATREMIA
How fast should you lower the sodium level in hypernatremia?
P117

Guideline is

110

HYPERNATREMIA
What is the major complication of lowering the sodium
level too fast?
P117

Seizures (not central pontine myelinolysis)

111

HYPONATREMIA
What are the surgical causes of the following types:
Hypovolemic
P117

Diuretic excess, hypoaldosteronism, vomiting, NG suction, burns, pancreatitis, diaphoresis

112

HYPONATREMIA
What are the surgical causes of the following types:
Euvolemic
P118

SIADH, CNS abnormalities, drugs

113

HYPONATREMIA
What are the surgical causes of the following types:
Hypervolemic
P118

Renal failure, CHF, liver failure (cirrhosis), iatrogenic fluid overload (dilutional)

114

HYPONATREMIA
What are the signs/ symptoms?
P118

Seizures, coma, nausea, vomiting, ileus, lethargy, confusion, weakness

115

HYPONATREMIA
What is the treatment of the following types:
Hypovolemic
P118

NS IV, correct underlying cause

116

HYPONATREMIA
What is the treatment of the following types:
Euvolemic
P118

SIADH: furosemide and NS acutely, fluid restriction

117

HYPONATREMIA
What is the treatment of the following types:
Hypervolemic
P118

Dilutional: fluid restriction and diuretics

118

HYPONATREMIA
How fast should you increase the sodium level in
hyponatremia?
P118

Guideline is

119

HYPONATREMIA
What may occur if you correct hyponatremia too quickly?
P118

Central pontine myelinolysis!

120

HYPONATREMIA
What are the signs of central pontine myelinolysis?
P118

1. Confusion
2. Spastic quadriplegia
3. Horizontal gaze paralysis

121

HYPONATREMIA
What is the most common cause of mild postoperative
hyponatremia?
P118

Fluid overload

122

HYPONATREMIA
How can the sodium level in SIADH be remembered?
P118

SIADH = Sodium Is Always Down
Here = Hyponatremia

123

“PSEUDOHYPONATREMIA”
What is it?
P118

Spurious lab value of hyponatremia as a result of hyperglycemia, hyperlipidemia, or hyperproteinemia

124

HYPERCALCEMIA
What are the causes?
P119

“CHIMPANZEES”:
Calcium supplementation IV
Hyperparathyroidism (1° /3° ) hyperthyroidism
Immobility/Iatrogenic (thiazide diuretics)
Mets/Milk alkali syndrome
Paget’s disease (bone)
Addison’s disease/Acromegaly
Neoplasm (colon, lung, breast, prostate, multiple myeloma)
Zollinger-Ellison syndrome (as part of MEN I)
Excessive vitamin D
Excessive vitamin A
Sarcoid

125

HYPERCALCEMIA
What are the signs/ symptoms?
P119

Hypercalcemia—“Stones, bones, abdominal groans, and psychiatric overtones” Polydipsia, polyuria, constipation

126

HYPERCALCEMIA
What are the ECG findings?
P119

Short QT interval, prolonged PR interval

127

HYPERCALCEMIA
What is the acute treatment of hypercalcemic crisis?
P119

Volume expansion with NS, diuresis with furosemide (not thiazides)

128

HYPERCALCEMIA
What are other options for lowering Ca⁺ level?
P119

Steroids, calcitonin, bisphosphonates (pamidronate, etc.), mithramycin, dialysis (last resort)

129

HYPOCALCEMIA
How can the calcium level be determined with
hypoalbuminemia?
P119

(4-measured albumin level) x 0.8, then add this value to the measured calcium level

130

HYPOCALCEMIA
What are the surgical causes?
P119

Short bowel syndrome, intestinal bypass, vitamin D deficiency, sepsis, acute pancreatitis, osteoblastic metastasis, aminoglycosides, diuretics, renal failure,
hypomagnesemia, rhabdomyolysis

131

HYPOCALCEMIA
What is Chvostek’s sign?
P119

Facial muscle spasm with tapping of
facial nerve (Think: CHvostek = CHeek)

132

HYPOCALCEMIA
What is Trousseau’s sign?
P120

Carpal spasm after occluding blood flow in forearm with blood pressure cuff

133

HYPOCALCEMIA
What are the signs/symptoms?
P120

Chvostek’s and Trousseau’s signs, perioral paraesthesia (early), increased deep tendon reflexes (late), confusion, abdominal cramps, laryngospasm, stridor, seizures, tetany, psychiatric abnormalities (e.g., paranoia, depression, hallucinations)

134

HYPOCALCEMIA
What are the ECG findings?
P120

Prolonged QT and ST interval (peaked T waves are also possible, as in hyperkalemia)

135

HYPOCALCEMIA
What is the acute treatment?
P120

Calcium gluconate IV

136

HYPOCALCEMIA
What is the chronic treatment?
P120

Calcium PO, vitamin D

137

HYPOCALCEMIA
What is the possible complication of infused calcium if the IV infiltrates?
P120

Tissue necrosis; never administer peripherally unless absolutely necessary (calcium gluconate is less toxic than
calcium chloride during an infiltration)

138

HYPOCALCEMIA
What is the best way to check the calcium level in the ICU?
P120

Check ionized calcium

139

HYPERMAGNESEMIA
What is the normal range for magnesium level?
P120

1.5–2.5 mEq/L

140

HYPERMAGNESEMIA
What is the surgical cause?
P120

TPN, renal failure, IV over supplementation

141

HYPERMAGNESEMIA
What are the signs/ symptoms?
P120

Respiratory failure, CNS depression, decreased deep tendon reflexes

142

HYPERMAGNESEMIA
What is the treatment?
P120

Calcium gluconate IV, insulin plus glucose, dialysis (similar to treatment of hyperkalemia), furosemide (Lasix)

143

HYPOMAGNESEMIA
What are the surgical causes?
P120

TPN, hypocalcemia, gastric suctioning, aminoglycosides, renal failure, diarrhea, vomiting

144

HYPOMAGNESEMIA
What are the signs/symptoms?
P121

Increased deep tendon reflexes, tetany, asterixis, tremor, Chvostek’s sign, ventricular ectopy, vertigo, tachycardia,
dysrhythmias

145

HYPOMAGNESEMIA
What is the acute treatment?
P121

MgSO4 IV

146

HYPOMAGNESEMIA
What is the chronic treatment?
P121

Magnesium oxide PO (side effect: diarrhea)

147

HYPOMAGNESEMIA
Hypomagnesemia may make it impossible to correct what other electrolyte abnormality?
P121

Hypokalemia (always fix hypomagnesemia with hypokalemia)

148

HYPERGLYCEMIA
What are the surgical causes?
P121

Diabetes (poor control), infection, stress, TPN, drugs, lab error, drawing over IV site, somatostatinoma, glucagonoma

149

HYPERGLYCEMIA
What are the signs/symptoms?
P121

Polyuria, hypovolemia, confusion/coma, polydipsia, ileus, DKA (Kussmaul breathing), abdominal pain, hyporeflexia

150

HYPERGLYCEMIA
What is the treatment?
P121

Insulin

151

HYPERGLYCEMIA
What is the Weiss protocol?
P121

Sliding scale insulin

152

HYPERGLYCEMIA
What is the goal glucose level in the ICU?
P121

80–110 mg/dL

153

HYPOGLYCEMIA
What are the surgical causes?
P121

Excess insulin, decreased caloric intake, insulinoma, drugs, liver failure, adrenal insufficiency, gastrojejunostomy

154

HYPOGLYCEMIA
What are the signs/ symptoms?
P121

Sympathetic response (diaphoresis, tachycardia, palpitations), confusion, coma, headache, diplopia, neurologic deficits, seizures

155

HYPOGLYCEMIA
What is the treatment?
P121

Glucose (IV or PO)

156

HYPOPHOSPHATEMIA
What is the normal range for phosphorus level?
P122

2.5–4.5 mg/dL

157

HYPOPHOSPHATEMIA
What are the signs/symptoms?
P122

Weakness, cardiomyopathy, neurologic dysfunction (e.g., ataxia), rhabdomyolysis, hemolysis, poor pressor response

158

HYPOPHOSPHATEMIA
What is a complication of severe hypophosphatemia?
P122

Respiratory failure

159

HYPOPHOSPHATEMIA
What are the causes?
P122

GI losses, inadequate supplementation, medications, sepsis, alcohol abuse, renal loss

160

HYPOPHOSPHATEMIA
What is the critical value?
P122

1.0 mg/dL

161

HYPOPHOSPHATEMIA
What is the treatment?
P122

Supplement with sodium phosphate or potassium phosphate IV (depending on potassium level)

162

HYPERPHOSPHATEMIA
What are the signs/symptoms?
P122

Calcification (ectopic), heart block

163

HYPERPHOSPHATEMIA
What are the causes?
P122

Renal failure, sepsis, chemotherapy,
hyperthyroidism

164

HYPERPHOSPHATEMIA
What is the treatment?
P122

Aluminum hydroxide (binds phosphate)

165

MISCELLANEOUS
This ECG pattern is consistent with which electrolyte abnormality?
P122 (picture)

Hyperkalemia: peaked T waves

166

MISCELLANEOUS
If hyperkalemia is left untreated, what can occur?
P123 (picture)

Ventricular tachycardia/fibrillation → death

167

MISCELLANEOUS
Which electrolyte is an inotrope?
P123

Calcium

168

MISCELLANEOUS
What are the major cardiac electrolytes?
P123

Potassium (dysrhythmias), magnesium
(dysrhythmias), calcium (dysrhythmias/inotrope)

169

MISCELLANEOUS
Which electrolyte must be monitored closely in patients on digitalis?
P123

Potassium

170

MISCELLANEOUS
What is the most common cause of electrolyte-mediated
ileus?
P123

Hypokalemia

171

MISCELLANEOUS
What is a colloid fluid?
P123

Protein-containing fluid (albumin)

172

MISCELLANEOUS
What is the rationale for using an albuminfurosemide
“sandwich”?
P123

Albumin will pull interstitial fluid into the intravascular space and the furosemide will then help excrete the fluid as urine

173

MISCELLANEOUS
An elderly patient goes into CHF (congestive heart failure) on POD #3 after a laparotomy. What is going on?
P123

Mobilization of the “third-space” fluid into the intravascular space, resulting in fluid overload and resultant CHF (but
also must rule out MI)

174

MISCELLANEOUS
What fluid is used to replace NGT (gastric) aspirate?
P123

D5 1/2 NS with 20 KCl

175

MISCELLANEOUS
What electrolyte is associated with succinycholine?
P123

Hyperkalemia