Fluids, electrolytes, and acid-base 2

Question 1

Choose the statements that MOST accurately describe colloids. (select 3).
a. albumin can cause hyperchloremia metabolic acidosis
b. they are proinflammatory
c. Hetastarch dose should not exceed 20 mL/kg
d. albumin causes hypocalcemia
e. Dextran reduces blood viscosity
f. Colloids are associated with better outcomes than crystalloids

Answer 1

c. Hetastarch dose should not exceed 20 mL/kg
d. albumin causes hypocalcemia
e. Dextran reduces blood viscosity

Question 2

___________ remain in the intravascular space, while _______ distribute from the plasma to the ECF

Answer 2

Colloids; crystalloids

Question 3

Albumin binds ______________, and resuscitation with albumin may reduce

Answer 3

calcium; ionized calcium concentration

Question 4

Extensive sodium chloride administration can produce

Answer 4

hyperchloremic metabolic acidosis

Question 5

____________ are associated with anaphylactoid reactions, and they impair the ability to cross-match blood

Answer 5

Dextrans

Question 6

How long do colloids increase plasma volume for?

Answer 6

3-6 hours

Question 7

Dextran 40 reduces ____________ & improves __________ in vascular surgery

Answer 7

blood viscosity and improve microcirculatory flow

Question 8

___________ is the only colloid that is derived from human blood products

Answer 8

Albumin

Question 9

There is an FDA black box warning on synthetic colloids due to

Answer 9

risk of renal injury

Question 10

Rate the coagulopathy of colloids from most to least.

Answer 10

Dextran > Hetastarch > hextend

Question 11

Colloids such as dextran, hetastarch, and hextend should not exceed ___________ due to coagulopathy

Answer 11

20 mL/kg

Question 12

What is the replacement ratio of colloids?

Answer 12

1:1

Question 13

What is the replacement ratio of crystalloids:

Answer 13

3:1

Question 14

Do colloids or crystalloids expand the ECF?

Answer 14

crystalloids

Question 15

Do colloids or crystalloids only expand plasma volume?

Answer 15

colloids

Question 16

Match each etiology of hyperkalemia with its BEST clinical example.
pseudohyperkalemia
transcellular shift
cellular injury
acidosis
tumor lysis syndrome
hemolysis of lab sample

Answer 16

pseudohyperkalemia- hemolysis of lab sample
transcellular shift- acidosis
cellular injury- tumor lysis syndrome

Question 17

Normal serum potassium valvues are

Answer 17

3.5-5.5 mEq/L

Question 18

Potassium regulates the ______________

Answer 18

resting membrane potential

Question 19

Hypokalemia _____________ membranes

Answer 19

hyperpolarizes

Question 20

Hyperkalemia ___________ membranes

Answer 20

depolarizes

Question 21

The most important regulator of potassium homeostasis is the

Answer 21

kidney

Question 22

Decreased glomerular filtration _______- serum potassium

Answer 22

increases

Question 23

Hypokalemia (< 3.5 mEq/L) is caused by

Answer 23

poor intake, GI loss, renal loss, or redistribution (K+ shifts into cells)

Question 24

Hyperkalemia (> 5.5 mEq/L) is caused by

Answer 24

increased total body potassium and redistribution (K+ shifts out of cells)

Question 25

Treatment of hyperkalemia includes

Answer 25

cardiac membrane stabilization redistribution elimination

Question 26

Cardiac membrane stabilization is accomplished by

Answer 26

giving IV calcium

Question 27

Elimination is accomplished by

Answer 27

potassium wasting diuretics kayexalate dialysis

Question 28

Redistribution is accomplished by

Answer 28

insulin + D50, hyperventilation, bicarbonate, beta-2 agonists `

Question 29

The most abundant intracellular cation is

Answer 29

potassium

Question 30

Potassium is the most important ion during

Answer 30

repolarization of neural tissue and muscle cells

Question 31

Hypokalemia presents as

Answer 31

skeletal muscle cramps weakness paralysis

Question 32

EKG findings with hypokalemia include

Answer 32

long PR & QT interval flat T wave U wave

Question 33

Hyperkalemia presents as

Answer 33

cardiac rhythm disturbances

Question 34

EKG findings with hyperkalemia include

Answer 34

5.5-6.5= peaked T waves 6.5-7.5= P wave flattening, PR prolongation 7.0-8.0- QRS prolongation 8.5 or greater: QRS--> sine wave--> VF

Question 35

How fast can potassium be administered via peripheral line?

Answer 35

10 mEq/ hr

Question 36

How fast can potassium be administered via central line?

Answer 36

20 mEq/hr

Question 37

List 5 ways potassium is lost via the GI tract.

Answer 37

1. vomiting/diarrhea 2. nasogastric suctioning 3. Zollinger-Ellison syndrome 4. Jejunoileal bypass 5. kayexelate

Question 38

When administering 3% saline for hyponatremia, the serum sodium concentration should be permitted to increase no faster than:

Answer 38

2 mEq/L/hr.

Question 39

What is the normal serum sodium value?

Answer 39

135-145 mEq/L

Question 40

The primary determinant of serum osmolarity is

Answer 40

sodium

Question 41

Sodium homeostasis is regulated by hte

Answer 41

GFR, RAAS, and antinatretic peptides

Question 42

Treating hyponatremia too quickly causes fluid to shift from ____________ to _________. WHich can produce___________

Answer 42

the ICF to the ECF; central pontine myelinolysis

Question 43

Treating hypernatremia too quickly causes fluid to shift from the ___________ to ___________-. This can produce _________________

Answer 43

ECF to the ICF; cerebral edema

Question 44

What is the most important ion during depolarization of neural tissue and muscle cells?

Answer 44

sodium

Question 45

You should consider delaying surgery if the serum sodium concentration is

Answer 45

less than 130 mEq/L

Question 46

Hyponatremia and hypernatremia can be divided into these three categories:

Answer 46

decreased total body Na+ content normal total body Na+ content increased total body Na+ content

Question 47

Reasons for decreased total body Na+ content in the setting of hyponatremia includes:

Answer 47

diuretics salt-wasting disease hypoaldosteronism

Question 48

Reasons for normal total body Na+ content in the setting of hyponatremia includes:

Answer 48

SIADH hypothyroidism water intoxication perioperative stress

Question 49

Reasons for increased total body Na+ content in the setting of hyponatremia includes

Answer 49

CHF cirrhosis

Question 50

Reasons for decreased total body Na+ content in the setting of hypernatremia includes

Answer 50

osmotic diuresis N/V adrenal insufficiency

Question 51

Reasons for normal total body Na+ content in the setting of hypernatremia includes

Answer 51

diabetes insipidus renal failure diuretics

Question 52

Reasons for increased total body Na+ content in the setting of hypernatremia includes

Answer 52

hyperaldosteronism increased sodium intake

Question 53

Sodium plasma concentrations of 130-135 will cause

Answer 53

no signs to mild signs

Question 54

Sodium plasma concentration of 125-129 will cause

Answer 54

N/V malaise

Question 55

Sodium plasma concentration of 115-124 will cause

Answer 55

headache, lethargy, altered LOC

Question 56

Sodium plasma concentration of 115 or less will cause

Answer 56

seizures, coma, cerebral edema, respiratory arrest

Question 57

Treatment for hyponatremia includes

Answer 57

H2O restriction IVF selection based on tonicity diuretics

Question 58

Treatment for hypernatremia inclues

Answer 58

Na+ restriction IVF selection based on tonicity diuretics