Module 1 - Fluids, Electrolytes, and Acid-Base Balance Flashcards

(136 cards)

1
Q

Total body water is __ % of total body weight

A

60

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2
Q

Intracellular fluid is __% of total body water

A

67

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3
Q

Extracellular fluid is __% of total body water

A

33

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4
Q

Plasma is ___% total body water

A

6.6

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5
Q

Interstitial fluid is ___% of total body water

A

26.4

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6
Q

Plasma and interstitial fluid make up ??

A

extracellular fluid

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7
Q

What is blood plasma?

A

Yellow liquid component of blood that suspends whole blood cells, proteins, glucose, clotting factors, electrolytes, hormones and CO2

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8
Q

What is blood serum?

A

Blood plasma WITHOUT the clotting factors (fibrinogen, prothrombin)

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9
Q

Na+ and Cl- are high _____ of the cell

A

outside

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10
Q

K+ is high _____ the cell

A

inside

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11
Q

Why are fluids important?

A
  • To maintain homeostasis (euvolemia)

- To replenish the fluids lost through normal physiologic activities

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12
Q

What are insensible losses? Examples?

A

Losses we can’t see or measure:

  • perspiration
  • respiration
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13
Q

What are sensible losses?

Examples?

A

Losses we can see and measure:

  • urination
  • feces
  • wound drainage
  • GI losses
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14
Q

To maintain fluid balance, the average person requires ________mL of water per day

A

2000-3000

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15
Q

Hypertonic

A

[solute] > serum

*draws fluid out of the cell and into the intravascular space

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16
Q

Isotonic

A

[solute] = serum

*fluid stays in the intravascular space

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17
Q

Hypotonic

A

[solute] < serum

*fluid shifts out of the intravascular space and into the cell

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18
Q

Hypertonic solution is __% NaCl

A

3% NaCl (513 mmol/L)

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19
Q

Isotonic solution is __% NaCl

A

0.9% NaCl (154 mmol/L)

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20
Q

Hypotonic solution is __% NaCl

A

0.45% NaCl (77 mmol/L)

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21
Q

Serum contains ______ mmol/L of Na+

A

145

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22
Q

See slide 9 for calculating serum osmolality

A

ok

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23
Q

Why do we care about calculating serum osmolality?

A
  • Highly concentrated solutions are irritating to veins (phlebitis) or can damage tissue
  • Depending on concentration, may require central line access (a larger vessel)
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24
Q

Replacing fluids:

Resuscitation

A

patient is clearly volume depleted

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25
Replacing fluids: | Maintenance
patient is NPO (nothing by mouth), poor oral intake
26
What is the recommended fluid replacement for resuscitation?
Give fluid bolus of 500 mL crystalloid (Na+ 130-154 mmol/L) over 15 minutes (can repeat up to 2000mL)
27
What is the recommended fluid replacement for maintenance ?
Normal daily fluid and electrolyte requirements: - 25-30mL/kg/day water - 1 mmol/L/kg/day Na+, K+, Cl- - 50 - 100 g/day of glucose *Works out to approximately 100-120 mL/hr
28
What are electrolytes?
substances that ionize when'd dissolved in solvents such as water
29
What do electrolytes do?
- Maintain the body's fluid balance and osmolality - Maintain the body's pH balance - Maintain proper fcn of cells
30
Na+ is most abundant in ______ fluid (maintained by Na+/K+ ATPase pump)
extracellular
31
______ results in water entering cells
Hyponatremia
32
_____ results in water getting drawn out of cells
Hypernatremia
33
Abnormal sodium levels usually indicate a problem with _____ balance
water
34
Sodium balance is mainly controlled by the ________ with the help of aldosterone, ADH and atrial natriuretic peptide
KIDNEY
35
Describe what happens if sodium level is low (or low blood pressure)
- Anti-diuretic hormone is released from posterior pituitary gland - Aldosterone is released - Kidney reabsorbs Na+ and water
36
Describe what happens if sodium level is high (or high blood pressure)
- Atrial natriuretic hormone is released from the heart | - Kidney excretes Na+ and water
37
What levels constitute mild hyponatremia?
130-135 mmol/L
38
What levels constitute moderate hyponatremia?
125 - 129 mmol/L
39
What levels constitute severe hyponatremia?
< 125 mmol/L
40
Symptoms of hyponatremia?
- asymptomatic - impaired attention - gait changes (trouble walking) - falls - N/V - altered mental status - seizures - respiratory arrest = death
41
What type of medication can cause low sodium and low volume?
Diuretics (dump Na+ and water)
42
What types of medication can cause low sodium but normal volume?
- NSAIDs - SSRIs - illicit drugs - carbamazepine - cyclophosphamide
43
Treatment for low sodium/low volume?
0.9% NaCl to rehydrate patient and correct Na+
44
Treatment for low sodium/normal volume?
fluid restriction, diuresis (loop diuretics)
45
Treatment for low sodium, too much fluid?
fluid restriction, diuresis (loop diuretics)
46
Formula for sodium deficit?
Sodium deficit = [0.6 x weight(kg)] x (desired Na+ - actual Na+)
47
For sodium correction: Correct no more than ________
9 mmol/L/day
48
What level constitutes severe hypernatremia?
> 160 mmol/L
49
Symptoms of hypernatremia?
- thirst - lethargy - restlessness - irritability - ataxia - tremors - seizures - coma
50
Treatment for hypovolemic hypernatremia?
fluids (D5W or 0.2% NaCl in D5W)
51
Treatment for euvolemic hypernatremia?
vasopressin (ADH) *THIS DOESN'T MAKE SENSE WTF
52
Treatment for hypervolemic hypernatremia?
Diuretics (get rid of Na+ and water) or dialysis
53
Potassium is most abundant in ______ fluid
intracellular
54
What is potassium important for?
proper conduction of action potentials (muscle excitability)
55
potassium is __% renally eliminated
90
56
_____ pushes K+ inside cells
insulin
57
______ activate Na+/K+ ATPase
B-agonists (epinephrine)
58
______ dump K+, keep Na+ and water
aldosterone
59
What is metabolic alkalosis ?
decreased K+ levels
60
What is metabolic acidosis ?
increased K+ levels
61
What levels constitute mild hypokalemia?
3.1-3.5
62
Symptoms of mild hypokalemia?
often asymptomatic
63
What levels constitute moderate hypokalemia?
2.5 - 3.0
64
Symptoms of moderate hypokalemia?
cramping, weakness, malaise, myalgias
65
What levels constitute severe hypokalemia?
< 2.5
66
Symptoms of severe hypokalemia?
ECG changes
67
What causes hypokalemia?
- excessive GI loss (vomiting, diarrhea, NG suction) - decreased intake (malnourished) - excessive renal loss (diuretics) - acid-base balance (metabolic alkalosis)
68
Hypokalemia can cause ______ toxicity
Digoxin
69
What levels constitute mild hyperkalemia?
5.5 - 6.0 mmol/L
70
What levels constitute moderate hyperkalemia?
6.1 - 7.0 mmol/L
71
What levels constitute severe hyperkalemia?
> 7.1 mmol/L
72
Symptoms of mild hyperkalmia
usually asymptomatic
73
Symptoms of moderate hyperkalemia?
cardiac arrhythmias
74
Symptoms of severe hyperkalemia?
- cardiac arrhythmias - weakness - paralysis - respiratory failure - sudden cardiac arrest
75
Causes of hyperkalemia?
- excessive intake (supplements, salt substitutes) - impaired renal function - redistribution to extracellular fluid - psudeohyperkalemia (hemolysed blood sample) - DRUGS (K+ sparing diuretics, ACEi, ARBs) - missed dialysis session
76
Treatment of hyperkalemia?
calcium gluconate, insulin & dextrose, salbutamol, dialysis
77
Caution with intravenous potassium?
K+ can cause arrhythmias and death
78
Max rate of K+ for peripheral line
20 mmol/hr
79
Max concentration of K+ for peripheral line
80 mmol/L
80
Max rate of K+ for central line
40 mmol/hr
81
Max concentration of K+ for central line?
200 mmol/L
82
Cl- is a major ______ anion
extracellular
83
What regulates chloride balance?
sodium and bicarbonate
84
What level is severe hypochloremia?
< 75 mmol/L
85
Causes of severe hypochloremia?
- severe loss of GI fluids - metabolic alkalosis (too much bicarb) *holding onto bicarbonate which is an anion, therefore chloride is excreted and lost - renal losses (loss of sodium, chloride follows) - drugs (i.e. PPIs lower stomach acidity)
86
What level is severe hyperchloremia?
> 125 mmol/L
87
Causes of hyperchloremia
- sodium and water retention | - metabolic acidosis (too many H+ ions) *bicarb is excreted, H+ is retained therefore Cl- is retained
88
Most magnesium resides in the ______ space or in bone
intracellular
89
Levels of severe hypomagnesemia?
< 0.5 mmol/L
90
Symptoms of hypomagnesemia
neuromuscular hyperirritability (tremors, tetany, arrhythmias, seizures)
91
Causes of hypomagnesemia?
- reduced intestinal absorption (malnutrition, alcoholism, malabsorption syndromes) - increased urinary/fecal losses (diarrhea, loop and thiazide diuretics) - intracellular shifts
92
Levels of mild-moderate hypermagnesemia
1-1.5 mmol/L
93
Symptoms of mild-moderate hypermagnesemia?
usually asymptomatic
94
Levels of hypermagnesemia?
> 1.5 mmol/L
95
Symptoms of severe hypermagnesemia?
nausea, headache, drowsiness, hypocalcemia, deep tendon reflexes absent, hypotension, bradycardia, ECG changes, paralysis, death
96
Causes of hypermagnesemia?
- chronic kidney disease (unable to eliminate) - excess magnesium intake - addison's disease (not enough mineralocorticoids) - lithium
97
Treatment of hypermagnesemia?
- stop excessive intake - IV calcium - dialysis
98
Calcium found in _____ fluid
extracellular
99
How much calcium is free?
45% of total calcium
100
What is the formula for Corrected calcium?
Ca corrected = Ca serum + 0.02*(40-albumin)
101
Level o fever hypocalcemia?
< 1 mmol/L
102
Symptoms of hypocalcemia?
Muscles: myalgia, numbness, tingling, tetany, hyperreflexia Cardiac: arrhythmias, hypotension CNS: seizures
103
Causes of severe hypocalcemia?
- vitamin D deficiency - hypoparathyroidism - renal disease - malabsorption or pancreatitis - hypomagnesemia - drug causes (bisphosphantes, calcitonin, furosemide)
104
Level of mild hypercalcemia?
2.6-3.0 mmol/L
105
Symptoms of mild hypercalcemia?
usually asymptomatic, constipation
106
Level of moderate-severe hypercalcemia?
> 3.0 mmol/L
107
Symptoms of moderate-severe hypercalcemia?
nausea, abdominal pain, constipation, kidney stones, polydipsia, polyuria, dehydration, hypertension, shortened QT intervals, stupor, coma
108
Causes of hypercalcemia?
- hyperparathyroidism - malignancy - drug causes (tamoxifen, lithium, thiazide diuretics, vitamin D)
109
Treatment of hypercalcemia?
- treat underlying disorder - reduce calcium intake - cinacalcet - parathyroidectomy
110
Phosphorus found primarily in ______ space
intracellular
111
Level for mild-moderate hypophosphatemia
0.3 - 0.8 mmol/L
112
Symptoms of mild-moderate hypophosphatemia
usually asymptomatic
113
Level for severe hypophosphatemia
< 0.3 mmol/L
114
Symptoms of severe hypophosphatemia
rhabdomyolysis, hemolysis, platelet dysfunction, cardiac/respiratory failure, encephalopathy, seizures
115
Causes of hypophosphatemia
- inadequate intake - increased excretion - intracellular shift
116
Level for mild-moderate hyperphosphatemia
1.6 - 2.3 mmol/L
117
Symptoms of hyperphosphatemia?
usually asymptomatic
118
Level for severe hyperphosphatemia
2.4 mmol/L
119
Symptoms for severe hyperphosphatemia
Gi disturbance, lethargy, urinary obstruction (renal stones), red eye, pruritus
120
Causes of hyperphosphatemia?
- excessive intake | - decreased elimination (renal disease)
121
Treatment of hyperphosphatemia?
- phosphate binders (calcium carbonate, sevelamer, lanthanum) - increase urinary excretion (acetazolamide, dialysis)
122
What are arterial blood gasses used to determine?
- oxygenation status | - acid-base status
123
pH determines?
how acidic/basic is the blood
124
pCO2 determines?
what the lungs are doing
125
HCO3 determines?
how much bicarb is in the blood
126
____% of total CO2 is bicarbonate
95
127
Acidemia
arterial pH < 7.35
128
Alkalemia
arterial pH > 7.45
129
Acidosis
a process that will result in academia if left unopposed (usually caused by decreased HCO3 and/or increased pCO2)
130
Alkalosis
a process that will result in alkalemia if left unopposed (usually caused by increased HCO3 and/or decreased pCO2)
131
Metabolic alkalosis
increased HCO3 | *lungs try and retain pCO2
132
Metabolic acidosis
decreased HCO3 | *lungs try to blow off more pCO2
133
Respiratory alkalosis
decreased pCO2 | *kidneys try to excrete bicarbonate
134
Respiratory acidosis
increased pCO2 | *kidneys try to retain bicarbonate
135
What is normal anion gap?
8-16 mmol/L
136
formula for anion gap
Anion gap = Na+ - [Cl- + HCO3-]