Urology - Water and Electrolytes Flashcards by Elen Price

What are the 5 Rs for IV fluid prescription

Resuscitation
Routine Maintenance
Replacement
Redistribution
Reassessment

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What is resuscitation

give IV fluid to patients who are in shock or have hypovolaemia

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what is routine

for patients that are nil by mouth or in coma

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what is replacement

excessive fluid loss - i.e. vominting, diarrhoes

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what is redistribution

Internal fluid loss - pleural effusion, oedema etc, common in sepsis - fluid leak into interstitial compartment

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what is reassessment

always reassess to see if its working or if more is needed

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when is resuscitation needed

for hypovolaemic and are haemodynamically unstable

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what is shock

inadequate perfussion of tissues

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what are the signs of clinical shock

Low SBP (<100mmHg) - cool peripheries
Tachycardia (>90bpm) - high or deteriorating EWS
Tachypnoea (>20rpm) - Responce to PLR
Delayed CRT - confusion/decreased LOC

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what is the optimal fluid and rate for resuscitation

need sodium to match patient
saline or hartmans (130-154mmol/L)
use bolus doeses - 500mL over 15mins
then further doses of 250-500mL up to 2000mL

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what is the difference between hartmans and saline

Hartman’s has potassium 5mmol and bicarb 20mmol. plus others such as calcium and magnesium

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what is the difference between crystaloids and colloids

colloids are starch based - more expensive and has shown to be not as good - NO colloids for recuss

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what is needed to take in over 24hrs for routine management

Sodium ~1-2 mmol/kg/day
Potassium ~1-2 mmol/kg/day
Chloride ~1-2 mmol/kg/day
Glucose 50-100 g/day (= 200-400 kCal)
Water 25-30 ml/kg/day

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fluid volume and rate depends of weight and rate. for Kg of 65-75 what is the volume and rate

2,100mL at 85mL/hr

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what is mainly lost in upper GI

tends to be vomiting - very chloride and potassium rich

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what is lower GI loss

loss of small K+ and Cl-. therefore hartmans is ok

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when do you reasess

after 15mins
24hrs for routine

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what si the normal concentration of HAS used in sepsis and resess

4.2%

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what in 20% HAS used

paracentisis - large vloume of albumin rich is lost

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how much fluid is in 1 packed red cell bag

1 unit is 280mL

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what are some serous issues with transfusions

Febrile, Allergic and Hypotensive Reactions
Haemolytic Transfusion Reactions (Acute/Delayed)
Post-Transfusion Purpura (due to thrombocytopaenia)
Transfusion-Associated Circulatory Overload (TACO)
Transfusion-Associated Dyspnoea (TAD)
Transfusion-Related Acute Lung Injury (TRALI)
Transfusion Transmitted Infections
Graft vs. Host Disease
Uncategorised (e.g. necrotising enterocolitis)

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what is platelt shelf life and composition

pooled or single donor
shelf life - 5-7 days

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how much volume is in Fresh frozen plasma

300mL

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what is in cryoprecipitate

Fibrinogen, Factors VIII and XIII, and von Willebrand Factor

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what is the east of england major haemorrhage protocol

1. Get senior help 2. Guidance as to what should make you suspect massive haemorrhage 3. Initial resuscitation is still with IV fluids: crystalloid or colloid, it doesn’t matter, bleeding out = death otherwise 4. Major Haemorrhage Pack1 = Blood + FFP, Pack 2 = Blood + FFP + Platelets + Cryo 5. Stop the bleeding! (= senior help)

what do you give for hyponatraemia

check is symptomatic - confusion etc treated in ICU give NaCl slowly

what do you give for diabetes

1. Normal saline 2. initial bolus of 500ml-1L, then the first hourly bag do not contain KCl 3. If BP remains low despite initial boluses escalate immediately 4. Every bag after this should have potassium added as long as serum K+ ≤ 5.5:

what do you give for AKI

Sepsis and hypovolaemia – ABCDE care Toxicity – Drugs, poisons, and iodinated contrast media Obstruction – Bladder outflow or ureteric, +/- associated infection Primary Renal Disease – e.g. nephritic and nephrotic syndromes

what % of total body calcium is in bone

99%

what is the noraml serum calcium levels

2.2-2.6mmol/L

what is the corrected serum calcium equation

corrected calcium (mmol/L) = Ca measured (mmol/L) + 0.020 or 0.025 (40 - albumin (g/L)

protein bound calcium is not excreted by the kidneys true or false

true

what is the normal dietary intake of calcium

700-1000mg

what regulates calcium reabsorbption

PTH Vitamin D Calcitonin

what is some of the functions of calcium

bone structure, nerves, woulnd healing, muscle contraction etc

how is calcium regulated by PTH

acts via G protein couped receptor: stimulate osteoclast inreases serum calcium

do PTH and calcitonin both have the same effect

PTH and calcitonin have opposite actions

does serum calcium increase or decrease serum calcium

calcitonin reduces serum calcium

what is the chemical name of vit D

25 hydroxylation - 1,25 DHCC

how does liver disease cause reduced vit D

liver makes vit D precurser

what are some causes of hypocalcaemia

hypoparathyroidism, Vit D deficiency, fat embolism, hyperphosphataemia, rhabdomyolysis, pancreatitis, transfusion leading to rapid infusion of albumin

**what are 2 signs of hypocalcaemia

chvostek sign trousseau sign

what are some signs and symptoms of hypocalcaemia

muscle cramp, seizures, bronchospasms, long QT syndrome, heart failure, cataracts, altered mental status, personality disturbance

what is commonly in exam qusetins

chvostek sign trousseau sign

what is chvosek sign

tap facial nerve and facial spasm will occur on same side

what is trousseaus sign

what are some causes of hypercalcaemia

maligancy, sarcoidosis, thiazides, renal failure

how does renal failure cause high calcium

increase PTH

how do thiazides cause increased calcium

increases ca reabsorbsion in proximal tubule

forusamide is used for what

loop diuretic - increases calcium secreted - hypercalcaemia

signs and symptoms of hypercalcaemia

muscle shock, fatigue, short QT, pancreatitis, polyuria (DI, ARF, CKD),

management of hypercalcaemia

hydration lower serum calcium - furousamide give bisphosphonate

what is normal plasma potassium levels

3.5-5mmol/L

what is potassium used for

cellular membrane potential, acid-base homeostasis, vascular tone, hormone secretion, glucose and insulin metabolism

how does the body regulate potassium

depends on age 90-95% excreted, transcellular potassium shift

how is potassium maintained in homeostasis

what is cellular potassium shift

insulin drives potassium into the cells

what is treatment for high potassium

high potassium in blood treatment is insulin and beta agonism (salbutamol)

where is the majority of potassisum reabsorbed

65-70% at proximal tubule by passive trasport 10-25% in thick ascending limb of Henle - NKCC2 chanel fine adjustment in collecting tubule

how do new diuretcs act - furosamide

inhibits NKCC2 cjhnel so calcium cannot get into tubule cell

what 3 things cause K to enter cells

concentration gradient - K+ driven to blood electrical gradient K+ permeability (how many K+ channels are open)

what are the 4 factors which regulate potassium

aldosterone, plasma K, distal flow rate, distal Na delivery

easiest way to get low potassium

alot of urine

what is the max potassium flow rate

20mmol/hr NEVER reach this 40mmol in 6-8hrs is normal

what is cardioplegia

stopping the heart intentially - e.g. heart transplant - give a lot of potassium

causes of high potassium

heparin, increased intake, ACE inhibitors, spironalactone, cyclosporin, trimethoprim

management of hyperkalaemia

1st calcium gluconate - to protect heart insulin and glucose albuterol furosemide sodium bicarbonate

ECG findings of hyperkalaemia

tall T wave small/absent p wave ST depression prolonged QRS

56 years old Mr John is referred by his GP to the clinic after he has found potassium of 6.3 on his routine bloods. He was recently started on Ramipril 5mg by his GP for HTN. Likely cause What are the management steps?

ramipril stop ramipril treat calcium gluconate and

what is the first line radiological investigation

Ultrasound safe, cheap and can tell acute, chronic or obstruction

what is the normal size of the kidney

fist - 10-12cm

Urology - Water and Electrolytes Flashcards

(72 cards)