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1
Q

Total Body Water

A

Men 60%
Women 50%

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2
Q

Extracellular Fluid

A

TBW x 33%

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3
Q

Intracellular Fluid

A

TBW x 67%

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4
Q

Intravascular Fluid

A

ECF x 25%

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5
Q

Interstitial Fluid

A

ECF x 75%

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6
Q

Respiratory Quotient

A

.71 = fat oxidation
.82 = protein oxidation
.85 = mixed substrate utilization
1.0 = carb oxidation

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7
Q

Respiratory Alkalosis

A

pH >7.45, low pCO2 from hyperventilation

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8
Q

Causes of Respiratory Alkalosis

A

Hyperventilation - CNS hyperactivity, Anxiety/pain, Pregnancy, Salicylate, Hep Encephalopathy, Catecholamines

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9
Q

Respiratory Acidosis

A

pH <7.35, high pCO2 from hypoventilation or increased CO2 production

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10
Q

Causes of Respiratory Acidosis

A

Hypoventilation/increased CO2 production - CNS depression, Neuromuscular, Pulm disease, Obese hypoventilation, OVERFEEDING

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11
Q

Metabolic Alkalosis

A

pH >7.45, Increased HCO3-, hypoventilation = increased pCO2

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12
Q

Metabolic Acidosis

A

pH < 7.35, decreased HCO3-, hyperventilation = dec pCO2

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13
Q

Causes of Metabolic Alkalosis

A

V - Vomiting/NG suction
O Overcorrection of hypercapnia
M Mineralcorticoid excess (inc aldosterone)
I Iatrogenic (NaHCO3-)
T Total volume loss (diuretic/renal)
Others - Severe hypokalemia, licorice

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14
Q

Anion Gap

A

AG = Na-Cl+HCO3-
Normal = 9
For every 1g/dL dec in albumin, 2.5 added to AG

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15
Q

NAGMA

A

Normal Anion Gap Metabolic Acidosis
H Hyperalimentation/TPN/EN
A Acetazolamide
R Renal Tubular Acidosis
D Diarrhea

U Ureterostomies
P Pancreatic fistulas

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16
Q

AGMA

A

Anion Gap Metabolic Acidosis
M Methanol
U Uremia
D DKA/Alcoholic KA/Starvation KA
P Paracetamol, acetaminophen, phenformin/paraldehyde
I Iron, Isoniazid, Inborn errors
L Lactic acidosis
E Ethanol, Ethylene glycol
S Salicylates, ASA, aspirin

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17
Q

Electrolyte Disorder Management

Study These Flashcards
A

Excess
-Remove outside sources
-D/C meds/agents
-Facilitate removal
-Treat other conditions

Deficient
-Available admit routes
-GI tract function
-Renal function
-Fluid status
-Concurrent lyte changes
-Product availability

18
Q

Hyponatremia

Study These Flashcards
A

Na <135, Clinically relevant <130, CNS dysfunction < 125, Death < 120

Hypertonic - Inc BG, mannitol = correct to get true Na
Isotonic - rarely observed
Hypotonic - 3 types

19
Q

Hypotonic Hyponatremia

Study These Flashcards
A

Hypovolemic - Na loss> water loss
-Na loss = GI, skin, third spacing, SAH
-Water loss = renal loss/diuretic
TREAT - isotonic fluids (NS/LR)

Euvolemic - Retain fluid d/t ADH
-SIADH, hypothyroid, polydipsia, head/CNS trauma, PNA
TREAT - Fluid restrict, symptomatic = add NaCl

Hypervolemic - fluid retention
- renal failure, CHF, cirrhosis
TREAT - Na and fluid restriction

Do not correct more than 10-12 meq/dL per 24 hrs

20
Q

Free Water Deficit

Study These Flashcards
A

TBW x [1-(140/Na)]
Underestimates by 1-2.5L

21
Q

Content of 1 L NS

Study These Flashcards
A

ECF gets 1000ml: interstitial - 750ml, intravascular 250ml

22
Q

Insensible Fluid Loss

Study These Flashcards
A

1 L via skin/lungs

23
Q

Hypernatremia

Study These Flashcards
A

Na>145, death >160

Hypovolemic - fluid loss
Euvolemic - concentration of Na
Hypervolemic - increased water and Na

Do not correct more than 10/day if chronic/unknown duration. 2/L/hr to 145 if acute

24
Q

Hypovolemic Hypernatremia

Study These Flashcards
A

Cause - fluid loss
Diuretics, inc BG, azotemia
Diarrhea, sweating

TREAT - Hypotonic fluids 1/2 NS, D5W

25
Euvolemic Hypernatremia
Cause - concentration of Na Diabetes insipidus, CNS issue - dec ADH Nephrogenic/renal impairment Water loss in urine TREAT - replace water, correct Ca and K+
26
Hypervolemic Hypernatremia
Cause - inc fluid and Na Iatrogenic, mineralcorticoids (inc aldosterone, Cushing's, adrenal cancer) TREAT - correct disorder, diuretics, replace water
27
Hypokalemia
K+ <3.6 Causes Renal loss - diuretics, cortisones, Mg lowering drugs Stool loss - sorbitol, polystyrene, patiromer/phenophtalein ECF->ICF shift - insulin, caffeine, verapamil, B2 adrenergic, epi/pseudophedrine, albuterol TREAT - oral (best)/IV (need CVC) -20-100 meq to treat, 10-30 to maintain
28
Hyperkalemia
K+ >5, asymptomatic until 5.5 Causes CKD/ESRD - diuretics NSAIDS, Tacrolimus Inc PO - K+ supps, salt subs, pRBC, Pen G ICF -->ECF - beta blocker, succinylcholine, digoxin toxicity, NaHCO3-, D50+insulin, albuterol TREAT - Lasix, polystyramine, patiromer, HD Ca gluconate to prevent cardiac, goal to shift or increase loss
29
Hypomagnesemia
Mg < 1.8, Inc NM issues/tetany If Mg low, also K+ and Ca Reduces insulin sens/secretion, glucose uptake, dec Lipoprotein lipase Causes Dec PO - MN, Mg free IV/PN, AUD, ostomy, SBS, intestinal bypass Inc loss - Tubular necrosis/acidosis, Bartter syndrome, Inc aldosteronism, loop thiazides/diuretics ECF-->ICF - refeeding, DKA, MI, hyperthyroid TREAT - oral/IV (best): oral is slow absorption, need to keep IV < 1g/hr OR 8 meq/hr, dec dose for renal
30
Hypermagnesemia
Mg >2.8, issues at >4.8 Causes - CKD TREAT - IV CaCl/Ca gluconate for severe, inc Mg to reverse cardiac/NM effects, remove sources of Mg (drugs, IV, PN), dec Mg in diet, loop thiazide diuretics
31
Hypocalcemia
Ca< 8.6 OR ionized Ca < 1.12 Causes - 2/2 low alb, low vit D/inc phos, low PTH, CRRT, hungry bone Common in critically ill/sepsis/rhabdo/large vol transfusion, biphosphonate use, calcitonin, furosemide, foscarnet, LT phenobarb/pheny TREAT - if < 7.5/<.9 use IV Ca gluconate/cl over 10 min (not with vent/pressors/critically ill d/t inc mort/ARF/shock) If Mg also low, replete to correct Ca If phos also high, use phos binders Chronic def - oral Ca+Vit D
32
Hypercalcemia
Ca >10.2, ionized >1.3 Causes - Inc PTH, cancer with bone mets, inc vit A or D, milk/ca carbonate intake with renal/adrenal insufficiency, TB, lithium/thiazides, immobilizations TREAT - mild - hydration/ambulation, severe - IV NS at 200-300 ml/hr then 40-80 IV lasix Calcitonin can be used, HD/biphosphonates can be used for long term maintenance
33
Hypophosphatemia
Phos <2.7, mod/severe (<1.5) Causes - AUD, critically ill, resp/met alkalosis, DKA, phos binders, refeeding TREAT - mild: oral, but SE of loose BMs/absorption Mod/severe: IV K or Na Phos (KPhos unless K+ >4 or renal issues) Dec dose for renal issues < 7mmol/hr or else risk of thrombophlebitis or soft tissue deposition
34
Hyperphosphatemia
Phos > 4.5 Causes - CKD, massive trauma/cytotoxic agents, inc catabolism, hemolysis, rhabdo, malignant hyper therm, resp/met acidosis, phos laxatives Calcification: Ca x Phos > 55 TREAT - dec phos intake, inc alum/Ca binders, HD, volume repletion in normal renal fx
35
GLP-1
Distal gut Reduced app/energy intake Delays gastric emptying Enhances post radial insulin release
36
Leptin
Gastric mucosa, neurons in brain Low levels increase energy intake and decrease energy expenditure
37
Ghrelin
Stomach Increases food intake
38
CCK
L cells of the gut, nerves in distal ileum and colon, neurons in brain Inhibits gastric emptying Reduces food intake
39
Primary Fuel Sources in Starvation
Fed - Glycolysis/TCA 2-3 hrs - Glycogenolysis from hepatic glycogen (stores depleted after 24 hrs) 4-6 hrs - Gluconeogenesis from AA stores 48+ hrs - free fatty acid oxidation broken down to ketone bodies
40
Osmolarity of PN Components
Dextrose - 5mosm/g AA - 10mosm/g Electrolytes- 1mosm/meq
41
Holliday-Segar Method
estimates caloric expenditure in fixed weight categories assumes that for each 100 calories metabolized, 100 mL of H2O will be required. This method is not suitable for neonates <14 days old. first 10 kg - 100 mL/kg/d second 10 kg - 50 mL/kg/d each additional kg - 20 mL/kg/d (≤ 50 kg.) OR 15 mL/kg (> 50 kg.).
42

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