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Apex Review > Fluids, electrolytes, and acid-base 2 > Flashcards

Fluids, electrolytes, and acid-base 2 Flashcards

1
Q

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

A

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

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2
Q

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

A

Colloids; crystalloids

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3
Q

Albumin binds ______________, and resuscitation with albumin may reduce

A

calcium; ionized calcium concentration

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4
Q

Extensive sodium chloride administration can produce

A

hyperchloremic metabolic acidosis

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5
Q

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

A

Dextrans

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6
Q

How long do colloids increase plasma volume for?

A

3-6 hours

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7
Q

Dextran 40 reduces ____________ & improves __________ in vascular surgery

A

blood viscosity and improve microcirculatory flow

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8
Q

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

A

Albumin

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9
Q

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

A

risk of renal injury

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10
Q

Rate the coagulopathy of colloids from most to least.

A

Dextran > Hetastarch > hextend

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11
Q

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

A

20 mL/kg

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12
Q

What is the replacement ratio of colloids?

A

1:1

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13
Q

What is the replacement ratio of crystalloids:

A

3:1

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14
Q

Do colloids or crystalloids expand the ECF?

A

crystalloids

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15
Q

Do colloids or crystalloids only expand plasma volume?

A

colloids

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16
Q

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

A

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

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17
Q

Normal serum potassium valvues are

A

3.5-5.5 mEq/L

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18
Q

Potassium regulates the ______________

A

resting membrane potential

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19
Q

Hypokalemia _____________ membranes

A

hyperpolarizes

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20
Q

Hyperkalemia ___________ membranes

A

depolarizes

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21
Q

The most important regulator of potassium homeostasis is the

A

kidney

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22
Q

Decreased glomerular filtration _______- serum potassium

A

increases

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23
Q

Hypokalemia (< 3.5 mEq/L) is caused by

A

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

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24
Q

Hyperkalemia (> 5.5 mEq/L) is caused by

A

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

25
Q

Treatment of hyperkalemia includes

A

cardiac membrane stabilization
redistribution
elimination

26
Q

Cardiac membrane stabilization is accomplished by

A

giving IV calcium

27
Q

Elimination is accomplished by

A

potassium wasting diuretics
kayexalate
dialysis

28
Q

Redistribution is accomplished by

A

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

29
Q

The most abundant intracellular cation is

A

potassium

30
Q

Potassium is the most important ion during

A

repolarization of neural tissue and muscle cells

31
Q

Hypokalemia presents as

A

skeletal muscle cramps
weakness
paralysis

32
Q

EKG findings with hypokalemia include

A

long PR & QT interval
flat T wave
U wave

33
Q

Hyperkalemia presents as

A

cardiac rhythm disturbances

34
Q

EKG findings with hyperkalemia include

A

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

35
Q

How fast can potassium be administered via peripheral line?

A

10 mEq/ hr

36
Q

How fast can potassium be administered via central line?

A

20 mEq/hr

37
Q

List 5 ways potassium is lost via the GI tract.

A
  1. vomiting/diarrhea
  2. nasogastric suctioning
  3. Zollinger-Ellison syndrome
  4. Jejunoileal bypass
  5. kayexelate
38
Q

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

A

2 mEq/L/hr.

39
Q

What is the normal serum sodium value?

A

135-145 mEq/L

40
Q

The primary determinant of serum osmolarity is

A

sodium

41
Q

Sodium homeostasis is regulated by hte

A

GFR, RAAS, and antinatretic peptides

42
Q

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

A

the ICF to the ECF; central pontine myelinolysis

43
Q

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

A

ECF to the ICF; cerebral edema

44
Q

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

A

sodium

45
Q

You should consider delaying surgery if the serum sodium concentration is

A

less than 130 mEq/L

46
Q

Hyponatremia and hypernatremia can be divided into these three categories:

A

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

47
Q

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

A

diuretics
salt-wasting disease
hypoaldosteronism

48
Q

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

A

SIADH
hypothyroidism
water intoxication
perioperative stress

49
Q

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

A

CHF cirrhosis

50
Q

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

A

osmotic diuresis
N/V
adrenal insufficiency

51
Q

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

A

diabetes insipidus
renal failure
diuretics

52
Q

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

A

hyperaldosteronism
increased sodium intake

53
Q

Sodium plasma concentrations of 130-135 will cause

A

no signs to mild signs

54
Q

Sodium plasma concentration of 125-129 will cause

A

N/V
malaise

55
Q

Sodium plasma concentration of 115-124 will cause

A

headache, lethargy, altered LOC

56
Q

Sodium plasma concentration of 115 or less will cause

A

seizures, coma, cerebral edema, respiratory arrest

57
Q

Treatment for hyponatremia includes

A

H2O restriction
IVF selection based on tonicity
diuretics

58
Q

Treatment for hypernatremia inclues

A

Na+ restriction
IVF selection based on tonicity
diuretics

Apex Review (224 decks)

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