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186 Cards in this Set

  • Front
  • Back
Name the three big factors when dealing with fluid and electrolytes?
water, sodium, colloid.
Total body water, which is actually sodium free water, makes up about 60% in adults. How many liters in a 70 kg person?
40 to 42 L.
Name the two compartments that total body water is divided into?
ICF, ECF.
ICF--intracellular fluid-makes up about anywhere between blank to blank liters?
25-28 L
ECF--extracellular fluid makes up about blank to blank liters?
14-15 L.
Blank fluid makes up anywhere between 25-28 L?
ICF.
Blank fluid makes up anywhere between 14-15 L?
ECF.
Red blood cells and your plasma volume are under the extracellular component and makes up about blank liters of red blood cells and blank liters of plasma, which makes a total of blank liters of whole blood volume?
2 L, 3 L, 5 L.
Blank: RBC = 2 L. Plasma = 3 L.?
Extracellular.
Blood volume = blank liter for 70 kg person?
5.
Extracellular: RBC blank Liter. Plasma blank liter?
2L. 3L.
Total body water is affected by what three things?
age, gender, body habitus.
How does total body water effect age?
Newborn 80%. Elderly 50%.
How does total body water effect, gender?
men> women.
How does total body water effect Body habitus?
Lean> obese.
Total body water is greater for men than for women. Men equals blank percent. Women equal blank percent?
Men 60%. Women 50%.
Total body water is blank in lean folks than for obese people?
Greater.
Obese people--because adipose tissue is hydrophobic. Do they have more or less total body water?
less.
When you get a patient who is NPO and morbidly obese they are usually really blank?
hypovolemic.
Blank adults have less body water?
obese.
Blank is a difference in body water, newborns total body water makes up blank % of their body weight. They are like little bags of water. So you can understand why fluid deficit are so extreme. And this is why we say we do not want babies not having anything for 12 hours?
Age. 80%.
Elderly patients-- their total body water is less than others and makes up about blank percent of their total body weight. The elderly are relatively blank and this will affect how they react to anesthesia?
50%. Dry.
Blank includes the fluid inside all cells of the body. It is the aqueous medium for cellular metabolism?
ICF.
Blank is the fluid outside the cells in the fluid that is moving within your cardiovascular system. The fluid that's moving within your organs and interstitial spaces. The fluid that is bringing Blank to cells and bring in Blank away from the cells?
ECF. Nutrients. Waste.
ICF includes the fluid inside all blank of the body. It is a blank medium for blank metabolism?
Cells. Aqueous. Cellular.
ECF includes fluid blank the cells. Fluid that is moving within your blank system. Fluid that's moving within your blank?
Outside. Cardiovascular. Organs.
Blank fluid brings nutrients to the cells and brings wastes away from the cell?
ECF.
ECF is in the blank spaces?
interstitial.
Blank fluid is in the interstitial spaces?
ECF.
ICF and ECF fluids also contain blank and blank. You have different quantities on each side--in the cell and outside the cell?
electrolytes and non-electrolytes.
The blank is an important component because that's what gives you your colloid osmotic pressure?
Plasma.
The plasma is an important component because that's what gives you your blank blank blank?
colloid osmotic pressure.
You need colloid osmotic pressure to minimize the loss of the blank. Because the blank is so important, its interchanging the interstitial fluid and that's bringing metabolic substances and oxygen?
Plasma. Plasma.
Blank is part of your plasma and it is an important component with pharmacology?
albumin.
Albumin is part of your plasma and is an important component with pharmacology. Because of how Blank Blank some of our drug are?
protein bound.
Albumin levels in patients are so important--not only to having fluid stay in the vascular compartment, but we needed for its effect on our blank?
pharmacology.
Why is albumin important?
having fluid stay in our vascular compartment and its effects on pharmacology.
How many cc is the daily intake of fluids in adults?
2000 or 2300 cc.
Water Gain: Sensible--oral fluids blank to blank cc. Solid fluids blank to blank cc?
800 1500 cc. 500 and 700 cc.
Oral fluids and solid fluids are blank water gain?
Sensible.
Water of oxidation is a blank water gain?
Insensible.
Water Gain: insensible-- water of oxidation blank to blank cc?
150 to 250 cc.
Water Gain: water of oxidation. 150 to 250 cc (gained through oxidation of hydrogen in blank. The oxidation from your blank sources gives you a certain amount of water. Cellular metabolism)?
Food. Food.
Water Loss (output)-- name the sensible water loss?
urine and intestinal.
Urine is sensible water loss. How many cc?
800 to 1500 (most of our loss).
Intestinal is sensible water loss. How many cc?
0 to 250 cc.
Intestinal 0 to 250 cc is blank water loss?
Sensible.
Lungs, skin, evaporation through sweat, and respiratory are all blank water loss?
Insensible.
Respiratory-insensible water loss is blank cc?
700.
Skin--insensible water loss is blank cc?
300.
Sodium is the principal blank of the blank?
Cation of ECF.
Chloride is the principal blank of the blank?
Anion of ECF.
Potassium is the principal blank of the blank?
Cation of ICF.
Proteins are the principal blank of the blank?
Anion of ICF.
In the ECF albumin is the more important oncotic component 4.0g/dl (mostly all located in the blank)?
plasma.
How much sodium is in the ECF and ICF?
ECF= 140 mEq/L. ICF= 10 mEq/L.
How much potassium is in the ICF and ECF?
ICF= 141 mEq/L. ECF= 3.5-5.5 mEq/L.
How much chloride is in the ECF?
103 mEq/L.
How much Bicarb HCO3 is in the ECF?
28 mEq/L.
What is the principle Anion in the ICF?
proteins.
What is the principal cation in the ICF?
potassium.
What is the principle Anion in the ECF?
chloride.
What is the principal cation in the ECF?
sodium.
Blank is very important because it acts as the Anion in the ECF holding the sodium in place in the plasma, so that you get the osmolarity of 280 Osmoles/L?
Albumin
The blank blank blank helps you keep your plasma, water in the intravascular compartment. Keep pressure in the capillaries rather than any interstitial fluid so that you don't have all that leaking?
colloid osmotic pressure.
Your colloid osmotic pressure helps keep your plasma, water in the intravascular compartment. Keep pressure in the Blank rather than in the Blank fluid so that you don't have all that leaking?
Capillaries. Interstitial.
Regulation of electrolytes and fluids are accomplished by the blank-blank system and the blank system?
renin-angiotensin. Aldosterone.
The blank nervous system comes into play with the regulation of electrolytes and fluids?
sympathetic.
Name the hormone released from the pituitary gland that helps us retain fluids?
ADH.
Named 4 non-electrolytes?
Glucose. Urea. Creatinine. Billirubin.
Glucose, urea, creatinine, and billiubin are all blank?
non-electrolytes.
In the ICF: potassium and magnesium on the principal blank?
cations.
In the ICF: phosphate and proteins are the principal blank?
anions.
In the ECF: sodium is the principal blank?
cation.
In the ECF: chloride and bicarb are the principal blank?
anions.
Name the principal cations in the ICF?
potassium and magnesium.
Name the principal anions in the ICF?
phosphate and proteins.
Name the principal anions in ECF?
chloride and bicarb.
Name the principal cation in the ECF?
sodium.
Potassium and magnesium of the principal cations in the blank?
ICF.
Phosphate and proteins of the principal anions in the blank?
ICF.
Sodium is the principal cation in the blank?
ECF.
Chloride and bicarb the principal anions in the blank?
ECF.
The most common problem in anesthesia are blank problems. Patients often become blank?
Volume. Hypovolemic.
Preop and perioperative deficits are mostly ECF. If the osmolarity is unchanged, then you won't have any fluid shift from the ICF to the ECF. So we tend to be blank, because we have low fluids in the ECF compartment?
dry.
Preop and perioperative deficits are mostly blank?
ECF.
Fluid loss can be due to having fluid sequestered because of soft tissue injury. You can have intra-abdominal fluid sequestering intra-abdominal he or retroperitoneally. Inflammation, trauma, infection = all sequestering fluid. A lot of general surgery patients have Blank loss, because they've lost so much from the G.I. tract with vomiting or NG suction, diarrhea or fistula drainage, 3rd spacing. All of these result in volume depletion in the vessels?
ECF.
Name 5 signs of fluid volume and depletion (hypovolemia)?
Hemoconcentration of the electrolytes. Increased BUN. Dec skin trigger. Dry mucous membrane. Increased thirst.
Hemoconcentration of electrolytes, increased BUN, decreased skin trigger, dry mucous membranes and increased thirst are all signs of what?
fluid volume depletion (hypovolemia).
Acute fluid loss can happen intraoperatively through evaporative fluid loss through the respiratory tract or an open abdomen, bloody floor, sponges, canisters, if you get behind in has an acute intraoperative fluid loss, you'll see what five things happen hemodynamically?
#1)Tachycardia. 2)Hypotension-- systemic hypotension. 3)Central line--Low venous filling pressure. 4)Diminished heart sounds. 5)Oliguria.
Tachycardia, hypotension--systemic hypotension, low venous filling pressure with a central line, diminished heart sounds, and oliguria are all seen with what?
acute fluid loss.
The electrolyte blank helps us with osmolarity, osmolality, ECF, action potential?
sodium.
The electrolyte blank helps us with membrane potential and action potential?
potassium.
The electrolyte blank helps us with excitation contraction in the muscle, secretion, neurotransmission, mitosis, enzyme activation, very important inside the cell doing second messenger work, cardiac pacemaker activity, anything with structures that require movement, cardiac action potential, membrane structure, and bone structure?
calcium.
Name three electrolytes that are important for action potentials to occur?
sodium, potassium, calcium.
The electrolyte blank helps us with enzyme cofactor (sodium potassium pump) regulation of slow calcium channels, regulation parathyroid gland secretion, controls potassium movement into the cells, membrane excitability, and bone structure?
magnesium.
Name two electrolytes responsible for bone structure?
calcium and magnesium.
Which electrolyte controls potassium movement into the cells?
magnesium.
Name the most abundant cation in the ECF?
sodium.
What is sodium's most important role?
exerting osmotic pressure.
Blank is regulated in the renal system by ADH and aldosterone?
sodium.
What is the normal value of the level of sodium in the ECF?
135 to 145 mEq/L..
ADH effects the reabsorption of blank through the kidney and therefore changing that concentration of sodium in the blood volume, and the system of ECF?
water.
Aldosterone is going to reabsorb blank and dump blank?
sodium, potassium.
Too much water absorption no matter what the cause will result in blank?
hyponatremia.
Blank--can cause weakness, confusion, nausea and vomiting. If progressing: loss of reflexes postural hypotension, lethargy, severe can result in cerebral edema. If blank is diluted under 115 mEq/L. = seizures?
hyponatremia. Sodium.
Hyponatremia: sodium<135 mEq/L.: moist mucous membranes. Potential for pulmonary edema. Polyurea. Low specific gravity (no sodium to excrete). Lethargy. Convultions. Coma. What is the cause of the moist mucous membranes and pulmonary edema?
water intoxication. Shift in sodium.
When treating hyponatremia what you want to be most cautious of?
rapid correction
Treatment for hyponatremia. Give IV replacement with 3% or 5% sodium solution but have to be very cautious can develop blank blank?
pulmonary edema.
Treatment for hyponatremia. Free water fluid blank (safer). Preferred fluid is blank with gradual correction. Blank helps with reconcentrating the urine?
restriction. .9% NS. Lasix.
Rapid correction of hyponatremia can lead to what?
demyelinated lesion of the pons.
Treatment for hyponatremia. Water intoxication can occur in OB cases with blank blank?
Pitocin drips.
Signs and symptoms of blank = dry mucous membranes, increased temperature, increased thirst, tachycardia, increased blood viscosity, oliguria, increased specific gravity, muscle weakness, tremors, hallucinations, respiratory arrest?
hypernatremia.
The following are all causes of blank. Over ingestion, excessive IV infusions, water deficit, dysphagia, NPO status (longtime), neurologic alterations, excessive G.I. losses, diaphoresis, mechanical ventilation, polyurea, burns, adrenal insufficiencies?
hypernatremia
What Is the Treatment for Hypernatremia?
Diuretic. Can administer D5W. but not too rapid = cerebral edema, shifting fluid.
Blank-- 80% of this electrolyte is excreted via the renal system daily, because the body does not conserve this electrolyte?
potassium.
Blank--causes of this electrolyte imbalance are: alcoholism, alkalosis, insulin shock, G.I. loss, renal loss, hyper aldosterone, malnutrition/starvation, crush injury, Cushing's disease?
hypokalemia.
Blank--signs and symptoms of this electrolyte imbalance: fatigue, lethargy, muscle weakness, abdominal distention, paralytic ileus, hypotension, ventricular arrhythmias, ST depression, muscle paralysis?
hypokalemia.
Blank = The most common cause of this electrolyte imbalance is renal failure?
hyperkalemia.
What is a treatment for hypokalemia?
replace K. avoid hyperventilation.
Signs and symptoms of blank include twitching, hyperreflexia, muscle weakness, paresthesias, peaked T-wave, intestinal colic, vomiting, hypocalcemia, muscle paralysis, bradycardia, digoxin toxicity, U wave?
hyperkalemia.
What is the treatment for hyperkalemia (5)?
1) restrict K. 2) sodium bicarbonate. 3) I. V. calcium gluconate. 4) K-exalate. 5) Insulin/glucose combo.
Name the most abundant cation in the body?
calcium.
Blank--Role In: cellular permeabilities, 50% in nonionized form, reciprocates with phosphorus?
calcium.
Hypocalcemia is a calcium level under what numerical value?
<9mg/dl.
If a patient undergoing spinal anesthesia complains of not being able to see. You would probably want to check to know if they have what?
hyponatremia.
Blank has the following causes--inadequate intake, excessive GI loss, vitamin D. deficiency, hypoparathyroidism, excessive citrated blood transfusion, hypoproteinuria, hypoalbuminemia, renal disease, chronic cimetidine use?
Hypocalcemia
Signs and symptoms of blank include a prolonged QT, arrhythmias (v fib) muscle spasm, confusion, tetany (can cause laryngospasm), laryngeal stridor, hypotension, hypo magnesium, hypokalemia, hyperphosphatemia?
Hypocalcemia
What re the EKG changes due to hypokalemia?
ST depression, ventricular arrhythmias.
What are the 4 EKG changes due to hyperkalemia?
Peaked T-wave, bradycardia, u wave. Widened QRS.
What are the EKG changes due to hypocalcemia?
prolonged QT, arrhythmias (v fib).
What are the EKG changes d/t hyercalcemia?
Dec QT interval, prolonged PR interval, AV block.
Chvostek & Trosseau test results are signings and symptoms of blank?
hypocalcemia.
The treatment of blank is calcium chloride 3-5 mls 10% solution. Calcium gluconate 10 to 20 ML 10% solution. Oral calcium and vitamin D. Avoid alkalosis.?
hypocalcemia.
What is the treatment for hypocalcemia?
calcium chloride 3-5 ml 10% solution. Calcium gluconate 10-20 ml 10% solution. Oral calcium and vitamin D. Avoid alkalosis.
The following are causes of blank--adrenal insufficiency, pheochromocytoma, parathyroid tumors, excessive vitamin D intake, Paget's disease, neoplastic metastasis to bone, prolonged immobilization, alkalosis, excessive intake (tums)?
hypercalcemia.
Signs and symptoms of blank include anorexia, lethargy, confusion, bone pain, renal failure, pathologic fracture?
hypercalcemia.
.5 or .9 normal saline, loop diuretic, mithromyosin, steroids and dialysis are all treatments for blank?
hypercalcemia.
Blank is a catalyst for enzymatic reactions in the cell, membrane excitability, most this electrolyte is intracellular, 50% bound to plasma proteins?
magnesium.
The following are causes of blank-- hypoalbuminemia, inadequate intake, renal loss, G.I. losses, intracellular shifts, medications, acute pancreatitis, chronic alcoholism, hyperthyroidism, Cysplatin?
hypomagnesium.
What are the EKG changes with hypo magnesium?
ventricular arrhythmias, tachycardia, prolonged PR interval, wide QRS, ST depression.
What is the treatment for hypo magnesium?
oral magnesium salts, magnesium oxide, magnesium sulfate, if seizing 1-2 g slowly over 15 or 20 minutes.
What is the abnormal value for hypercalcemia?
>11 mg/dl.
What is the abnormal value for hypo magnesium?
<1.6 mEq/L.
What is the abnormal value for hyper magnesium?
> 2.0 mEq/L.
Renal failure is the most common cause of what electrolyte imbalances?
hyper magnesium, and hyperkalemia
The following are causes of blank --- renal failure, magnesium sulfate toxicity, magnesium salt abuse, hypothermia, Addison's disease, ketoacidosis, hypothyroidism, hypothermia?
hyper magnesium.
What are the EKG changes of hypermagnesium?
Prolonged QT interval. Bradycardia. AV block.
Muscle weakness, lethargy, drowsiness, Flushing's hypotension, hyperreflexia, are all signs and symptoms of what?
hyper magnesium.
Treatment of blank includes calcium gluconate, calcium chloride, correct acidosis, hemodialysis?
hypermagnesium.
Intraoperative blank are used for maintenance, insensible losses, trauma, deficit from surgery, blood loss?
fluids.
Name 3 IV solutions that we use as maintenance fluids?
D5W, D5LR, D5 1/2NS.
Name 3 IV solutions that we use as replacement fluids?
LR, D5 1/2NS, NS.
Blank percent of bodyweight is considered a mild deficit?
4%.
Blank percent of body weight is considered a moderate deficit?
6-8%.
Blank percent of body weight is considered severe fluid deficit?
10%.
4% loss of bodyweight is considered a blank deficit?
mild.
6- 8% loss of bodyweight is considered a blank deficit?
moderate.
10% loss of body weight is considered a blank deficit?
severe.
The following are signs of a blank fluid loss deficit-- signs of orthostatic hypotension, cool, dry skin, subnormal temperatur?
moderate.
The following are signs and symptoms of blank--irritability, disorientation, muscle spasm, hyperreflexia, seizures, hypokalemia, hypocalcemia, paresthesia (feet)?
hypomagnesium.
Blank solution: used postop, fluid out of interstitial back into vessel to excrete any overload?
D5 1/2 NS.
How do you calculate fluid replacement for NPO status?
4-2-1 rule. First 10kg ---4 cc/kg/hr. 11th - 20th kg---2 cc/kg/hr. 21st-nth kg---1cc/kg/hr. multiply total by total number of hours NPO.
What is the average blood volume of a premature neonate?
95 ml/kg.
What is the average blood volume of a full-term neonate?
85 ml/kg.
What is the average blood volume of an infant?
80 ml/kg.
What is the average blood volume of an adult male?
75 ml/kg.
What is the average blood volume of an adult female?
65 ml/kg.
What is the replacement for blood?
1 ml : 1 ml replacement.
What is the replacement for crystalloids?
3 ml/ 1 ml of blood loss.
Blank-- solutions with electrolytes dissolved in water or solutions with electrolytes and dextrose dissolved in water?
crystalloids.
Blank needs glucose during surgery-or patients receiving insulin, patients on insulin pump, or patients on drugs which interfere with the glucose process?
infants.
Disadvantage of using blank containing fluids will limit fluid resuscitation because of potential osmotic diuresis?
glucose.
With upper abdominal surgery--even without major hemorrhage--Blank percent decline in functional ECF.--without major blood loss?
15%.
Hypovolemia transfers cascade can occur within blank minutes--body shifts fluid from interstitial to plasma volume?
10 minutes.
Name 3 types of colloids?
albumin, hespan. Dextran.
Name three disadvantages of crystalloids?
short-lived hemodynamically, if used in massive resuscitation or produce peripheral edema, less tolerant patients (CHF) = pulmonary edema.
Name some disadvantages of using colloids?
expensive, coagulopathy, can impair cross match.
Blank disadvantages: need 3:1 replacement, effects are short-lived, can fluctuate protein level, decrease oncotic pressure?
crystalloids.
Reactions to blank are mild and include fever, chills and hives?
albumin.
Blank is 30 times more expensive than crystalloids?
albumin.
Blank--transports drugs, metals, contributes 80% of colloid osmotic pressure, intravascular half-life 16 hours, infection risk is reduced but not eliminated?
albumin.
Blank--osmolarity 310m Osm/L. Molecular weight varies because molecules are different sizes. Half-life depends on particle size. No histamine release. 50% of normal patient will excrete it within two days?
Hespan.
Blank--low molecular weight-tends to cause problems-5% incidence of anaphylaxis, life-threatening reactions, real failure secondary to molecules accumulate renal tubules, decrease platelet adhesiveness, coats RBC, false elevations in blood glucose, increased serum bilirubin, interferes with cross match?
Dextran.
There is a blank bag limit on using Hespan because of volume overload, coagulopathy, prolongs PT, activated thromboplastin time, decrease platelets?
2.
The following list is rationales for giving blank-- if high rate of crystalloids will be needed to sustain hemodynamic stability. Risk of unstable volume status (myocardial ischemia), ICP, pulmonary capillary pressure is high (heart failure)?
colloids.