Flashcards in Perioperative Fluid and Electrolytes Deck (81):
1
what is Total Body Water (TBW)?
60% of total body weight
2
TBW is broken down into IntraCellular Volume ___ and ExtraCellular Volume (ECV)____.
40%
20 %
3
Blood volume is ___ % of TBW
7%
4
Extracellular contains primarily what?
Na
Cl
HCO3
5
intracellular fluid is mainly waht?
K
PO4
SO4
6
most important osmotically active colloid in ECV and is normally 4g/L in serum vs. only 1g/L in interstitial fluid.
Albumin
7
normal level of Na
140
8
Normal level of Cl
100
9
Normal level of K
4.0 mg/dl
10
normal level of albumin
4.0 g/L
11
what is the normal water loss per day
2.5-3 L / day
12
what is the breakdown of water losses per day
urine 1-1.5 L
150 cc GI
1 L insensible losses (sweat, respiration)
13
We generally required how many mEq/Kg/day of Na and Cl?
1-2 mEq/Kg/day
14
we generally require less than __ mEq/Kg/day of K
1 mEq/Kg/day
15
what is the 4-2-1 rule?
Appropriate maintenance fluids
4 ccs per hour for the first 10 kg of weight
2 cc's per hour for the next 10 kgs
1 cc per hour for every kg beyond that
16
what is in normal saline?
created the right concentration of salt in water at the same concentration as their blood (330 mEq/L)
17
why does D5 1/2 NS not lyse the cells?
added 50 grams of sugar is enough to bring it up to same osmolarity as the blood
18
what does lactated ringer's contain.
4 K
2 Ca
28 lactate
(much closer analog of normal body's makeup)
19
for high volumes should you use LR or NS?
LR
20
what fluids do you use for life saving measures?
NS
LR
21
what are some scenarios where you lose more fluids?
fever
vomiting
diarrhea
NGT
fistulas
bleedings
drains
long open abd cases
third spacing
22
where is albumin found
4 mg/dl in blood
1 in extracellular fluids
23
what is the problem with giving albumin
a lot of it is in the interstitial space and is higher there
when the inflammation stops, the albumin is trapped in that space, so it is hard to unload the water in the third space
24
what are the goals with fluid resucitation
normal BP
HR in double digits
urine out put of 1/2 cc/kg/hr
for child low end of normal is 1 cc/kg/hr
25
He says that pt X is diabetic but has been placed on D5 NS and his sugars are high...would you change it to just NS please?
No, need some sort of glucose so they don't undergo gluconeogenesis. giving dextrose allows them to avoid this (only 600 calories a day) keeps them from breaking down muscle.
26
Nurse says that pt Y has a BMP with a glucose of 488. What would you like him to do?
Ask if patient is awake (need to know if in DKA)
have them recheck their glucose on other arm (often did a draw above the IV site
27
a drop a D5NS would read what on a glucometer?
5000
28
a high K is associated with what?
arrhythmias and cardiac death
29
what is a common reason for a high K reading?
hemolysis of blood during draw
30
what is hypernatremia usually due to?
typically from loss of water without salts e.g. burns, fever, hyperventilation.
31
what is hyponatremia usually due to?
loss of water with salts e.g. diuretics, NGT, vomiting, hypoproteinism (cirrhosis, nephrotic syndrome, malnutrition)
32
should you correct hypernatremia or hyponatremia quickly or slowly?
slowly, or you can give permanent locked-in syndrome
33
how do you figure out how much Na a patient needs
(140- plasma Na) X TBW
34
for the amount of Na a patient needs, you should administer how much in the first 24 hours?
1/2
35
what typically causes hypokalemia?
GI losses
NGT
renal losses
prolonged NPO
36
what should you think about adding for a patient who is NGT or vomitting?
K+ 20 mEq/ bag of IVF
37
primary danger of low K+
cardiac arrhythmias (surgery canceled if below 3.0)
also postop ileus
38
how do you correct low K+
oral or IV K+ (10 mEq/ hr) (will burn IV site)
can give 20 w/ a central line
39
Low K+ can show ____ T waves
flattened
40
what can cause refractory hypokalemia?
low Mg ( so check this if you give K+ and it isn't fixed)
41
K- sparing diuretic?
spirolactone (give to cirrhotic patients)
42
what causes hyperkalemia?
overadministration
poor renal excretion
transceullular shift
43
what does hyperkalemia cause?
cardia carrhythmias
spiked T waves
sudden death
44
Txs for hyperkalemia
Calcium (for the cardiac arrhythmias)
45
what txs of hyperkalemia translocate potassium into cells in 30-60 minutes
glucose
insulin
soidum
bicarb
46
what is a treatment for hyperkalemia that binds and hastens excretion of K+ secreted into colon
rectally or orally administered potassium-binding resins
47
what is calcium important for?
nerve conduction
muscle contraction
coagulation
48
where is calcium only absorbed
duodenum
49
what is the main controller of Ca level
parathyroid
50
what causes high calcium
hyperparathyroid or malignancy
51
symptoms of high calcium
fatigue
muscle
weakness
depression
anorexia
52
Tx for hypercalcemia
give a ton of NS hydration and lasix (pee out extra calcium via chloride)
sometime calcitonin or bisphosphonates
53
what common cancer metastasize to the bone
BLT on a kosher pickle
breast
lung
thyroid
kidney
prostate
54
what is the name of the drug for lasix
furosemide (taken at 8 am and 2 pm)
Lasts 6 (LASIX)
55
what is hypocalcemia due to
post parathyroid surgery
pancreatitis
low albumin (calcium binds to albumin)
56
symptoms of low calcium
numbness/ tingling around mouth
muscle spasms and can lead to tetany
57
how do you treat low calcium
PO/IV calcium
58
what is the taget level for magnesium?
2.0
59
phosphate is high in what condition?
renal failure, should limit intake (limit milk, dairy, ice cream)
60
almost any electrolyte abnormality can be treated w/ what?
dialysis
61
indications for dialsysis
Acidosis
Hyperkalemia
Volume overload / difficulty breathing
Symptomatic Uremia
62
what is symptomatic uremia
uncontrollable itching
deposits in skin
63
what is the ABG format order
pH/pCO2/pO2/HCO3/Base deficit
64
what does the little p in pH mean
-log
measuring concentration of hydrogen ions
lower the number, high concentration of ions
65
what does the little p in pCO2 stand for?
partial pressure
66
what is a base deficit
how much base you need to bring it up to 7.4
67
a very negative number in base deficit indicates what
acidosis
68
what is a normal pCO2?
40
69
A pCO2 change of 10 = a pH change of what?
0.08
70
if pCO2 is >40 then there is a _________
respiratory acidosis
71
if pCO2 is <40 then there is a __________
respiratory alkalosis
72
what can cause respiratory acidosis
sedation, head injury, dec. resp drive.
73
what can cause respiratory alkalosis
pain, fever, sepsis, intentional hyperventilation on vent
74
most common causes (for surgery) of metabolic acidosis?
hypoperfusion of tissues leading to lactic acidosis
renal impariment (inability to get rid of acids)
75
pO2 is good for determining _______ O2 in the blood
dissolved
76
If PO2 is 30, then percent saturation is _____
60%
77
If PO2 is 60 then percent saturation is _____
90%
78
If PO2 is 45, then percent saturation is _____
75% (typical for venous)
79
to make oxygen unload from hemoglobin easier, what conditions are there?
hot
acidic
high CO2
80
when CO2 goes down, what happens in the brain?
minimize cerebral blood flow
81