Fluids, electrolytes, Acid-Base disorders

Question 1

Normal urine output in an adult

Answer 1

0.5 to 1 mL/kg/hr

Question 2

Standard maintenance fluid

Answer 2

D51/2NS with 20 mEq of KCl/L of fluid

Question 3

When do you not use LR solution

Answer 3

Hyperkalemia b/c it contains potassium

Question 4

What does a Swan-ganz catheter do

Answer 4

Measure CVP and PCWP

Question 5

How to measure maintenance fluids amount

Answer 5

100-50-20 rule for 24 hr total, or 4-2-1 rule for per hr

Question 6

Most common cause of edema

Answer 6

Renal sodium retention

Question 7

What to do with patients with head trauma and hyponatremia

Answer 7

Keep the sodium higher up so they don’t get cerebral edema

Question 8

Hypotonic hyponatremia

Answer 8

Hypovolemic: Low urine sodium (20: diuretics, decreased Aldosterone (ACEIs), ATN)

Question 9

Pseudohyponatremia

Answer 9

More plasma solids decreases Na concentration but the amount is the same. caused by anything that causes elevated protein or lipids.

Question 10

Glucose and sodium relation in plasma

Answer 10

For ever 100 mg/dL increase in blood glucose above normal, serum sodium decreases 3 Meq/L. sodium content is the same though.

Question 11

Most common cause of hypercalcemia in O/P

Answer 11

Hyperparathyroidism: 85% parathyroid adenoma 15% hyperplasia&raquo_space;» carcinoma

Question 12

EKG findings for hyperCa

Answer 12

Short QT, T wave widening, first degree AV block

Question 13

Bone disease and hyperCa

Answer 13

osteitis fibrosa cystica

Question 14

PTHrP-SCC secreting cancers

Answer 14

SCC, renal cell cancer, breast, gyn cancers

Question 15

Calcitriol secreting cancer

Answer 15

Lymphoma

Question 16

Lithium and Ca effect

Answer 16

HyperCa

Question 17

Do granulomatous diseases increase Ca

Answer 17

Yes, they increased 1,25 OH vit D (TB< sarcoid, histo, coccidio, lymphoma)

Question 18

Familial Hypocalciuric Hypercalcemia (FHH)

Answer 18

AD inheritance, benign, hypocalciuria, mild-mod increase in Mg

Question 19

What thyroid disorder causes hypercalcemia

Answer 19

Thyrotoxicosis

Question 20

Other causes of HyperCa

Answer 20

Malignancies, medications, immobilization (increased bone resorption), Pagets disease

Question 21

Osteolytic cancers

Answer 21

Breast, lung, renal

Question 22

SPEP/UPEP disease

Answer 22

Multiple myeloma

Question 23

Polyclonal hypergammaglobulinemia and family of diseases

Answer 23

Rheumatologic (RA, SLE)

Question 24

How would you treat HyperCa

Answer 24

1. Increase excretion: Add Na to diet and volume expand (NSS)
2. Inhibit bone resoprtion: IV bisphosphonates, calctinonin
3. Treat underlying dz
4. Dialysis as last resort

Question 25

What is the formula for getting corrected Ca

Answer 25

Corrected Calcium = (0.8 * (Normal Albumin - Pt's Albumin)) + Serum Ca For every one below 4 for the patient's albumin, add 0.8 to the calcium. This is because the Ca test only measures bound Ca?

Question 26

Causes of u/l LE edema

Answer 26

DVT, cellulitis, ruptured baker's cyst, lymphatic obstruction, venous insufficiency

Question 27

Causes of b/l LE edema

Answer 27

Nephrotic syndrome, liver failure, malnutrition, malabsorption, burns, angioedema, sepsis, venous obstruction, icirrhosis, CHF, renal failure, pregnancy

Question 28

Nonpitting edemas

Answer 28

Myxedema, lymphedema

Question 29

What cardiac drug class causes edema

Answer 29

CCBs

Question 30

How to treat CCB edema?

Answer 30

ACEi, better than diuretics

Question 31

Is venous insufficiency a volume overload state?

Answer 31

Nope, so don't use diuretics in the long term

Question 32

Most common cause of outpatient LE edema

Answer 32

Chronic venous insufficiency

Question 33

Top 5 causes of LE edema

Answer 33

CHF, venous insufficiency, NSAIDs, increased PAP 2nd to OSA, Idiopathic

Question 34

What happens when you are hyponatremic in normal urine

Answer 34

UNa<10 mEq/L

Question 35

SIADH diagnostic criteria

Answer 35

1. SerumOsmSerumOsm 3. UNa>20 mEq/L 4. Absence of hypovolemia 5. Normal renal, adrenal, and thyroid function 6. No obvious traumatic stimulus known to activate neuroendocrine stress. 7. Absence of other causes of HypoNa

Question 36

Does SIADH correct with NS infusion?

Answer 36

No

Question 37

Formula to calculate serum osmolarity

Answer 37

(2xNa)+(BUN/2.8)+(Glucose/18)

Question 38

Contraction alkalosis

Answer 38

....

Question 39

Treatment for hypokalemic, hypochloremic metabolic alkalosis

Answer 39

Hydration with sodium chloride and potassium replacement

Question 40

Correcting contraction alkalosis

Answer 40

Normal saline

Question 41

What causes contraction alkalosis

Answer 41

Aldosterone secretion in response to low BP leads to increased potassium secretion and bicarb reabsorption which causes the alkalosis and low K.

Question 42

Role of chloride in fixing metabolic alkalosis

Answer 42

Chloride allows bicarb to be excreted so once you replenish the chloride the kidneys should be able to fix the acid-base problem

Question 43

Chloride-sensitive metabolic alkalosis always has

Answer 43

ECF volume contraction

Question 44

Chloride-resistant alkalosis?

Answer 44

...

Question 45

What does Addison disease cause for acid-base disturbance

Answer 45

Non-anion gap, hyperK, hypoNa met. acidosis

Question 46

Does hypoalbuminemia affect ionized calcium?

Answer 46

No

Question 47

Na and K in diuretic use

Answer 47

Low in serum, high in urine

Question 48

Cause of refractory hypokalemia (electrolyte distrubance)

Answer 48

Hypomagnesemia

Question 49

Quickest way to lower potassium

Answer 49

Insulin/glucose

Question 50

Cushing's syndrome causes what elec. abnormalities

Answer 50

HypoK and HypoNa

Question 51

Loop diuretic elec. effect

Answer 51

HypoK, met. alk., prerenal renal failure

Question 52

Winter's formula

Answer 52

Respiratory compensation for met. acidosis. pCO2=1.5(HCO3)+8

Question 53

How to tell if it is Resp. acidosis and met. compensation or met. acidosis and resp. acidosis

Answer 53

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