Fluids and electrolytes Oguin

Question 1

daily fluid volume required to maintain TBW homeostasis in a a healthy adult

Answer 1

25 - 35 ml/kg per day

2~3 Liters per day

Question 2

ICF concentrations of sodium/potassium/calcium

Answer 2

ICF Na = 10
ICF K = 150
ICF Ca = 1

Mag = 40 
Chloride = 103

Question 3

EVC concentrations of sodium/potassium/calcium

Answer 3

ECF Na = 140
ECF K = 4.5
ECF Ca = 5

ECF Mag = 2
ECF chloride = 117

Question 4

First drug given in hyperkalemia

Answer 4

Calcium gluconate

to STABILIZE CARDIAC MEMBRANES

Question 5

things that move potassium intracellularly

Answer 5

insulin, albuterol, hyperventilation,

Question 6

Patients with ESRD don’t always demonstrate

Answer 6

EKG changes as their potassium shifts

Question 7

primary determinant of both capillary and interstitial oncotic pressure

Answer 7

albumin

Question 8

under euvolemic conditions, net fluid filtration is equal

Answer 8

lympathic flow

Question 9

things that can damage the endothelial glycocalyx

Answer 9

tons of crystalloid administration, uncontrolled long term DM2, hyperglycemia, infection, stress, critical illness

Question 10

daily water fluctuation

Answer 10

0.2% TBW

Question 11

UO is not reliable in the OR because

Answer 11

Stress response causes the release of ADH, so pt is euvolemic but not peeing.

OR

insufflation of abdomen can decrease uo

Question 12

crystalloid solutions are preferable for

Answer 12

conditions of dehydration.

TBW loss leading to plasma hypertonicity

Question 13

administration of isotonic crystalloids leads to the hydration of

Answer 13

the entire ECV restoring water and electrolyte homeostasis to both intravascular and interstitial spaces for normal cellular processes.

Question 14

IMMEDIATE restoration of circulating volume =

Answer 14

crystalloids

Question 15

crystalloids are preferred for

Answer 15

immediate restoration of circulating volume

• preservation of microcirculatory flow

decrease in hormone mediated vasoconstriction

correction of plasma hyper viscosity

lack of allergenic potential

ease of metabolism and renal clearance

Question 16

because of their low molecules weight, crystalloids

Answer 16

crystalloid solutions contribute to the hemodilution of plasma proteins and loss of capillary oncotic pressure

Question 17

intravascular repletion with crystalloids is

Answer 17

immediate BUT transient, bc crystalloids will hydrate all of the. ECV meaning 75-80% of administered volumes will go to interstitial space

Question 18

osmolality of 0.45% NaCl

Answer 18

154 mOsm/ L

Question 19

osmolality of D5W

Answer 19

253 mOsm/L in bag, less in body r/t metabolism of dextrose

Question 20

osmolality of NaCl 0.9%

Answer 20

308 mOsm/L

Question 21

osmolality of LR

Answer 21

273 mOsm/L in bag,

less in body because body metabolizes lactate

Question 22

Osmolality of Plasmalyte A

Answer 22

294 mOsm/L

Question 23

Osmolality of NaCl 3%

Answer 23

1026 mOsm/L

Question 24

Osmolality of D5 NaCl 0.9%

Answer 24

560 mOsm/L

Question 25

Osmolality of D5 NaCl 0.45%

Answer 25

405 mOsm/L, probably less in body

Question 26

Osmolality of D5LR

Answer 26

525 mOsm/L probably less in body

Question 27

Isotonic Colloids

Answer 27

Albumin 5% Voluven 6% Hespan 6%

Question 28

Osmolality of albumin 5%

Answer 28

300 mOsm/L

Question 29

Osmolality of Voluven 6%

Answer 29

296 mOsm/L

Question 30

Osmolality of Hespan 6%

Answer 30

309 mOsm/L

Question 31

Osmolality of Dextran 10%

Answer 31

350 mOsm/L only hypertonic colloid?

Question 32

Composition of LR | sodium/potassium/chloride/lactate

Answer 32

``` LR sodium: 130 Potassium: 4 Chloride: 110 Lactate: 28 ``` calcium: 3 osmolality: 273! - slightly hypotonic, more so because the body will metabolize lactate

Question 33

Composition of 0.9% NaCl

Answer 33

``` Composition of 0.9% NaCl Sodium = 154 Potassium = 0 Chloride = 154 Mag = 0 ``` osmolality ; 308

Question 34

Composition of Plasmalyte A

Answer 34

``` Sodium = 140-141 Potassium = 5 Chloride = 98 Phosphate = 1 Magnesium = 3 ```

Question 35

D5W is given in

Answer 35

patients receiving insulin, sometimes neonates even then typically D51/2NS

Question 36

D5W provides

Answer 36

170-300 calories / 1000 mL for energy

Question 37

Typical use of 3% or 5% NaCl is in

Answer 37

treatment of hyponatremia USED FOR LOW VOLUME RESUSCITATION

Question 38

Risks associated with hypertonic 3%/5% NaCl

Answer 38

Hyperchloremia, hypernatremia, cellular dehydration, potential for osmotic demyelination syndrome

Question 39

DEXTRAN

Answer 39

synthetic colloid. Made with sugars. Use is largely abandoned. Black box warning: acute renal failure r/f noncardiac pulmonary edema interference with crossmatching anaphylaxis

Question 40

evaporative loss for superficial trauma (orofacial)

Answer 40

1-2 mL/kg per hr

Question 41

evaporative loss for minimal trauma

Answer 41

2-4 mL/kg per hr

Question 42

evaporative loss for moderate trauma (major non abdominal)

Answer 42

4-6 mL/kg per hr

Question 43

evaporative loss for severe trauma

Answer 43

6-8 mL/kg per hr

Question 44

things that cause an intracellular shift that lead to HYPOKALEMIA (3)

Answer 44

alkalosis, insulin, beta 2 agonist

Question 45

Presentation of hypokalemia (4) <3.5

Answer 45

skeletal muscle cramps weakness paralysis worsens Digoxin toxicity

Question 46

iatrogenic hyperkalemia >5.5

Answer 46

succhs

Question 47

Presentation of hyperkalemia >5.5

Answer 47

cardiac dysthymias

Question 48

EKG changes with hyperkalemia >5.5

Answer 48

Early: PR long, T wave peaked, QT short Middle: P flat, QRS wide Late: QRS becomes sine wave -> VF.

Question 49

Presentation Hyponatremia <135

Answer 49

N/V skeletal muscle weakness mental status changes -> seizures, coma cerebral swelling

Question 50

must avoid rapid correction of sodium to prevent

Answer 50

osmotic demyelination syndrome

Question 51

Presentations of hypernatremia >145

Answer 51

thirst, mental status changes -> seizures, coma | cerebral dehydration

Question 52

treatment for hypermagnesemia

Answer 52

calcium chloride

Question 53

levels of hypermagnesemia

Answer 53

Loss of DTR : 4 - 6.5 meq/L or 10-12 mg/dL Respiratory Depression: 6.5 - 7.5 mEq/L or >18mg/dL cardiac arrest: >10 mEq/L or >25 mg/dL

Question 54

decreased coronary blood flow is associated with

Answer 54

alkalosis

Question 55

decreased contractility is associated with

Answer 55

acidosis

Question 56

Increased pulmonary vascular resistance is associated with

Answer 56

acidosis

Question 57

solutions that contain calcium are incompatible with

Answer 57

blood products

Question 58

colloids act by producing

Answer 58

intravascular volume expansion by directly increasing plasma oncotic pressure AND interacting with the endothelial glycocalyx to decrease trans capillary filtration

Question 59

dextran has a half life of roughly

Answer 59

6 to 12 hours. much longer than crystalloids

Question 60

dextran causes nephrotoxicity by

Answer 60

1. indirect hyperosmotic renal injury | 2. direct renal tubular damage as a result of accumulation

Question 61

dextran was popular in vascular surgery because

Answer 61

it has coagulopathic effects, antithrombin effects , platelet inhibition

Question 62

stress activates

Answer 62

hypothalamus-pituitary axis-release of cortisol

Question 63

release of catchecholaimes

Answer 63

increased HR, increased SVR, increased microcirculatory vasoconstriction, release of aDH, reabsorption of water, potassium excretion

Question 64

prophylactic volume administration in euvolemic patients

Answer 64

is an antiquated practice with substantial risk of disrupting the endothelial glycocalyx and contributing to pathological fluid overload

Question 65

If a patient is receiving maintenance fluid

Answer 65

there is no NPO deficit but consider other losses

Question 66

adult estimated blood volume

Answer 66

70 mL / kg | 75 - 85 mL/ kg

Question 67

MAP, CVP, andUO do not

Answer 67

have good predictive value at measuring fluid responsiveness

Question 68

ERAS aim:

Answer 68

Utilize individualized hemodynamic end points to support oxygen transport balance by minimizing oxygen demand and optimizing CO, tissue oxygenation, capillary and macrovascualr flow, oxygen and nutrient delivery and end organ perfusion.

Question 69

failure to recognize preload independence in hypotensive patients is often the mechanism for

Answer 69

inappropriate fluid administration

Question 70

CDPA preservative

Answer 70

citrate - binds with calcium dextrose for glycolysis phosphate buffer acidosis adenosine helps RBC synethesize ATP

Question 71

Citrate toxicity occurs with

Answer 71

multiple units, leads to hypocalcemia, monitor ionized calcium

Question 72

most common infectious complication

Answer 72

cytomegalovirus

Question 73

most common cause of transfusion related death

Answer 73

TRALI transfusion related acute lung injury platelets and FFP have the highest risk *