Quick hits fluids + electrolytes

Question 1

What major ions are in the intracellular space?

Answer 1

K+
Mg+
Phosphate-

Question 2

What major ions are in the extracellular space?

Answer 2

Na+
Ca+
Cl-
HCO3

Question 3

Total body volume? How is it broken down?

Answer 3

Total 42L

Extra - 28L
Intra - 14L (11 interstitial + 3 plasma)

Question 4

What dictates the passive exchange between capillaries and interstitial fluid?

Answer 4

Starling forces

Question 5

What is the difference between osmolarity and osmolality ?

Answer 5

1. Osmolality is osmoles per kilogram of solvent
2. Osmolarity is osmoles per liter of solution

Question 5

How is plasma osmolarity calculated?

Answer 5

Na X 2

Also plays a factor

-Glucose
-BUN

-Uremia also can

Question 6

What does it mean to have high tonicity ? Example?

Answer 6

More solutes

Highest
1. NaCl 3%
2. D5+45
3. Albumin
4. D5W

Question 7

Examples of Hypotonic ?

Answer 7

0.45%
D5W

Question 8

Examples of isotonic?

Answer 8

Plasmalyte
LR
0.9%
Hespan

Question 9

Examples of Hypertonic?

Answer 9

• 3%
• Anything with dextrose except D5W
  -Dextran 10%

Question 10

What two solutions will lower Calcium?

Answer 10

Albumin binds to it

Citrate in blood binds to it

Question 11

What may result with a large volume of 0.9%?

Answer 11

Hyperchloremic metabolic acidosis

Also

Dilutional effect

Question 12

What is the black box warning on synthetic colloids? Which is the highest risk?

Answer 12

Renal injury

Dextran

Question 13

What is the most common electrolyte deficiency ?

Answer 13

Potassium

Question 14

How does hypo/hyperkalemia affect the resting membrane potential ?

Answer 14

Hyperkalemia - Depolarizes membrane

Hypokalemia - depolarizes membrane

Question 15

Treatment for hyperkalemia?

Answer 15

1. Calcium to stablize cardiac membrane
2. Shift K
   - Insulin+D50
   -Hyperventilation
   -Bicarb
   -Beta 2
3. Elimination
   -Kayexalate
   -Diuretics
   -Dialysis

Question 16

Presentation of K 5.5-6.5?

Answer 16

Peaked T waves

Question 17

Presentation of K 6.5-7.5?

Answer 17

P wave flattening

PR prolongation

Question 18

Presentation of K 7.5-8.5 ?

Answer 18

QRS prolongation

Question 19

Presentation of K >8.5?

Answer 19

Sine wave – VF

Question 20

S+S of hypokalemia?

Answer 20

Long QT
Cramps
Flat T wave
U wave

Question 21

What happens if Sodium is shifted too fast from ICF to ECF (treating hyponatremia)?

What about ECF to ICF (treating hypernatremia)?

Answer 21

Central Pontine Myelinolysis

Cerebral edema

Question 22

What sodium level should surgery be delayed?

Answer 22

<130

Question 23

Which hormone raises serum calcium? Which lowers?

Answer 23

Raises - Parathyroid

Lowers - Calcitonin

Question 24

How does acidosis effect calcium levels?

Answer 24

Increases them

Question 25

Signs of hypocalcemia?

Answer 25

Laryngospasm Chvostek Trousseau Nerve irritability Cramps Long QT

Question 26

Signs of hypercalcemia?

Answer 26

Nausea Abdominal pain Psychosis HTN Short QT

Question 27

How is hypercalcemia treated?

Answer 27

0.9% and loop diuretics

Question 28

What is Chvostek sign?

Answer 28

Tapping on the angle of the jaw will cause muscle contraction on the ipsilateral side

Question 29

What is Trousseau Sign?

Answer 29

Upper BP cuff is inflated for 3 minutes If muscle spasms occur in the hand and forearm

Question 30

Most abundant electrolyte in the body?

Answer 30

Calcium - all stored in bones ( we have a lot of bones)

Question 31

Loss of deep tendon reflexes is a sign of?

Answer 31

Hypermagnesemia

Question 32

What are clinical uses of mag?

Answer 32

Pre eclampsia (4g load over 10 minutes) Pain (NMDA antagonism) Acute bronchospasm Cardiac rhythm disturbances

Question 33

Treatment for hypermagnesemia?

Answer 33

Calcium

Question 34

How does hypermagnesemia affect neuromuscular blockade?

Answer 34

Potentiates them

Question 35

Classic sign you should assess in an OB patient for high magnesium?

Answer 35

Loss of deep tendon reflexes

Question 36

How is PVR and ICP affected by acidosis?

Answer 36

Increased

Question 37

How does acidosis affect the myocardium?

Answer 37

Direct depressant

Question 38

Untreated pain in the PACU is most likely to result in what acid-bsae disturbance?

Answer 38

Respiratory alkalosis because the patient is hyperventilating

Question 39

How does a change in PaCO2 affect PH?

Answer 39

For every 10mmbHg increase in PaCo2, PH will increase by .08 (For chronic disease will only increase by .03)

Question 40

What does the anion gap tell you? Normal?

Answer 40

Cause of acidosis <14

Question 41

How can metabolic alkalosis be created?

Answer 41

Increased bicarb (iatrogenic) Loss of nonvolatile acids (NG suction) Increased mineralocorticoid (Cushing's syndrome)

Question 42

What two electrolyte abnormalities are caused by hyperventilation?

Answer 42

Hypocalcemia Hypokalemia