Absite Review Fluids And Electrolytes

Front 1

how much of the total body water is intracellular?

Back 1

Two thirds, 2/3

Front 2

in which cell is most of the bodies intracellular water?

Back 2

Muscle

Front 3

what is the most common cause of volume overload?

Back 3

Iatrogenic

Front 4

what is responsible for the plasma interstitial osmotic pressure gradient?

Back 4

Proteins, mainly albumin

Front 5

what is responsible for the intracellular – extracellular pressure gradient?

Back 5

Sodium

Front 6

how many mEq of sodium and chloride does a liter of 0.9% normal saline contain?

Back 6

154 mEq of each

Front 7

what are all the electrolytes in lactated ringers? And mEq of each?

Back 7

sodium 130, chloride 109, lactate 28, potassium 4, calcium 3

Front 8

how is plasma osmolarity calculated?

Back 8

(2Na) x (Glucose/18) x (BUN/2.8)

Front 9

how is free water deficits calculated?

Back 9

0.6 x kg x [(Na/140) -1]

Front 10

what drop in measured sodium does each 100 mg/dL rise in glucose cause?

Back 10

3 mEq/L drop in measured sodium for every 100 mg/dL rise in glucose

Front 11

what is the effect of acidosis on serum calcium?

Back 11

Acidosis promotes calcium disassociation from albumin. Acidosis therefore causes increased free/ionized calcium

Front 12

how much fluid is lost to evaporation and open abnormal cases?

Back 12

Up to 1 L per hour

Front 13

how much fluid is lost to insensible fluid losses? (sweat, respiration, etc.)

Back 13

up to 10 mL per kilogram per day

Front 14

what is the benefit to switching to dextrose containing IV fluids after G.I. surgery?

Back 14

Dextrose will stimulate insulin release, enhance amino acid uptake and protein synthesis which will prevent catabolism

Front 15

how many grams of dextrose does a liter of D5W contain?

Back 15

50 g

Front 16

how much fluid is secreted by the stomach per day?

Back 16

1 to 2 L per day

Front 17

how much food is secreted by each of pancreas, duodenum, and biliary system?

Back 17

Each produce up to 1 L per day

Front 18

what are daily and potassium requirements?

Back 18

1 mEq per kilogram per day

Front 19

which body fluid has the highest concentration of potassium?

Back 19

Saliva

Front 20

what effect does increase flow have on pancreatic/biliary secretion?

Back 20

increase flow results in higher levels of bicarbonate in the secretion

Front 21

what is the best test to diagnose the cause of azotemia?

Back 21

fractional excretion of sodium FeNa

Front 22

how is the fractional excretion of sodium calculated?

Back 22

Urine sodium/creatinine divided by plasma sodium/creatinine

Front 23

what is the FeNa in prerenal azotemia?

Back 23

less than 1%

Front 24

why is myoglobin toxic to renal cells?

Back 24

Myoglobin gets converted to Ferrihemate in acidic environments, which in turn is toxic to renal cells

Front 25

which electrolyte decreases in tumor lysis syndrome?

Back 25

Calcium

Front 26

what is the treatment for tumor lysis syndrome?

Back 26

IV fluids to dilute, allopurinol to decrease further uric acid production, and diuretics to decrease potassium and phosphorus

Front 27

where does the synthesis of vitamin D in the body begin?

Back 27

The skin, from UV sunlight to form 7-dehydro cholesterol. Subsequently gets 25 – OH in liver, followed by 1 – OH in kidneys

Front 28

what is the initial treatment of hyperkalemia?

Back 28

Calcium gluconate to stabilize the heart

Front 29

what is the characteristic EKG finding of hyperkalemia?

Back 29

Peaked T-wave

Front 30

what are the EKG findings of hypokalemia?

Back 30

T-wave depression, U-wave, ST depression, and QT prolongation

Front 31

hypokalemia that is refractory to replacement can be due to deficiency in which other electrolyte?

Back 31

Magnesium

Front 32

what is the initial treatment for hyponatremia?

Back 32

Water restriction

Front 33

what is the effect of aggressive hyponatremia correction?

Back 33

Central pontine myelinosis

Front 34

how is sodium deficit calculated?

Back 34

0.6 x kg x (140-Na)

Front 35

what is the most common malignant cause of hypercalcemia?

Back 35

breast cancer

Front 36

which diuretics should be avoided in hypercalcemia?

Back 36

Thiazides, since they promote calcium reabsorption

Front 37

how does magnesium affect calcium levels?

Back 37

Magnesium is required for PTH function. Hypomagnesemia therefore results in hypocalcemia

Front 38

what is the EKG finding in hypocalcemia?

Back 38

QT prolongation

Front 39

what is the effect of hypoalbuminemia on calcium levels?

Back 39

Each 1 g drop in serum albumin decreases the measured calcium by 0.8

Front 40

what is the Henderson Hesselbach equation?

Back 40

pH=pK + log [HCO3/CO2]

Front 41

patient status post parathyroidectomy, POD7 develops perioral tingling and numbness, and notices twitching of face... Diagnosis? Tx?

Back 41

hypocalcemia from bone hunger, treatment is calcium

Front 42

what is the most common cause of significant hypo-phosphatemia?

Back 42

Re-feeding syndrome

Front 43

what is the most common cause of significant hypocalcemia?

Back 43

Previous thyroid surgery

Front 44

what is the most common cause of significant hypo-magnesemia?

Back 44

Massive diuresis

Front 45

what is the most common cause of significant hypokalemia?

Back 45

Over diuresis

Front 46

patient with severe pancreatitis and hyperlipidemia has a sodium of 125... Diagnosis? Tx?

Back 46

Pseudo-hyponatremia as a result of hyperlipidemia associated with pancreatitis elevated lipids draw fluid into the intravascular compartment no specific treatment -treat underlying disorder

Front 47

what is the composition of lactated ringers?

Back 47

Sodium 130, chloride 109, K four, calcium 2.7, HCO3 28

Front 48

a ventilated patient has the following ABG: pH 7.5, CO2 55, HCO3 35 this condition is most likely caused by A. poor minute ventilation, B. aggressive NG tube suctioning, C. renal failure, D. severe sepsis

Back 48

the ABG suggests a metabolic alkalosis therefore B. NG tube

Front 49

ventilated patient with ABG of: pH 7.5, CO2 24, HCO3 18 this condition is most likely caused by low or high minute ventilation, NG tube, or renal failure

Back 49

ABG suggests a respiratory alkalosis and a high minute ventilation is the most likely cause

Front 50

ABG of pH 7.25, CO2 70, HCO3 35 this condition is most likely caused by

Back 50

ABG respiratory acidosis, most likely caused by poor minute ventilation

Front 51

ABG values of pH 7.26, CO2 28 HCO3 18, this condition is most likely caused by..

Back 51

ABG is most consistent with metabolic acidosis of the options renal failure is most likely to give you a metabolic acidosis

Front 52

what is the initial treatment of choice for hyperkalemia with arrhythmias after succinylcholine?

Back 52

Calcium gluconate to stabilize cardiac muscle cell membranes

Front 53

what electrolyte abnormalities are seen in re-feeding syndrome? And how is it prevented?

Back 53

low K, Mg, and PO4, it is prevented by starting nutrition at a low rate initially (10 – 15 kcal per kilogram per day)

Front 54

which electrolyte abnormality can cause prolonged ventilation?

Back 54

hyperphosphatemia can result in prolonged ventilation due to relative ATP insufficiency

Front 55

what is the initial fluid of choice for dehydration due to small bowel fistula?

Back 55

Lactated ringers

Front 56

what is the initial fluid of choice for dehydration due to sweat loss?

Back 56

Normal saline

Front 57

what is the initial fluid of choice for dehydration due to large bowel fistula?

Back 57

lactated ringers

Front 58

what is the initial fluid of choice for dehydration due to gastric losses from pyloric stenosis?

Back 58

normal saline

Front 59

DKA results in what electrolyte abnormality?

Back 59

Hyperkalemia

Front 60

what is the best indicator of adequate volume replacement?

Back 60

Urine output

Front 61

what is the rule to calculate maintenance IVF?

Back 61

421
4 mL per kilogram per hour for the first 10 kg, 2 mL per kilogram per hour for the second 10 kg, 1 mL per kilogram per hour for each kilogram after that (first 20 kg equals 60 mL +1 mL for every kilogram after that)

Front 62

what fluid do you never bolus?

Back 62

Normal saline with potassium added can cause cardiac arrest

Front 63

what is the most common cause of hypernatremia? treatment?

Back 63

Poor fluid intake 95%, D5 water , correct slowly to avoid brain swelling (less than 0.7 mEq per liter per hour)

Front 64

at what rate can you correct hyponatremia?

Back 64

Slowly to avoid central pontine myelinolysis ( less than 0.5 mEq per liter per hour)

Front 65

what is the most common cause of hyperkalemia? Tx?

Back 65

Renal disease 80%, Tx: 1. calcium gluconate 1 amp
2. 10 units of insulin and one ampule of 50% dextrose
3. 1 amp sodium bicarbonate
4. Kayexalate,
lasix, albuterol, and dialysis if refractory

Front 66

what is the most common cause of hypokalemia?Tx?

Back 66

diuretics, Tx: potassium chloride every 10 mEq increase serum potassium by 0.1 mEq per liter

Front 67

what is the most common malignant cause of hypercalcemia?

Back 67

Small cell lung cancer

Front 68

what is the most common cause of hypercalcemia crisis?

Back 68

Previous primary hyperparathyroidism undergoing another procedure

Front 69

what levels of calcium are dangerous? And what is the treatment for hypercalcemia crisis?

Back 69

calcium greater than 13 mg/dL or ionized greater than six causes symptoms, calcium greater than 15 mg/dL or an ionized greater than seven has a risk for cardiac arrest
Tx: 1. Rapid volume infusion NS no LR 2. Lasix, no thiazides 3. Dialysis if refractory 4. If malignancy bisphosphonates (alendronate) 5. if hyperparathyroidism -parathyroidectomy

Front 70

what is Trousseau's sign?

Back 70

carpopedal spasm after occluding arm blood flow seen with hypocalcemia, calcium less than eight ionized less than four