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186 Cards in this Set

  • Front
  • Back
Calcium is mobilized from thebone by 2 hormones ___ and___ to maintain homeostasis of plasma concentrations of calcium.
Parathyroid hormone and vitamin D
The action of ___is to antagonize parathormone and inhibit bone resorption by lowering both serum clacium and phosphate.
calcitonin
____ and ___ factor are intimately associated with at least one major route of B12 absorption from the distal ileum.
Calcium and intrinsic factor
The mediation of a protein (using Vitamin K) called ____ in hypercalcemic, hemodialyzed patients may cause bone calcium resorption, reslting in even more severe hypercalcemia.
osteocalcin
Calcium gluconate can potentially contribute greater than 80% of the total ___ load from TPN and the accumulation of this element in bone may be the etiology of metabolic bone pain.
aluminum
____ is the only pediatric amino acid formula that contains significant amounts of cysteine (~ 15 mg/dL).
Trophamine
____ appears to be the primary determinant of calcium/phosphate solubility.
pH
____increases serum calcium concentration by promoting osteoclastic acitivity and calcium resorption from bone by increasing proximal renal tubular calsium resorption, and by enhancing GI tract absorption of calcium through fromation of 1,25 dihydroxycholecaciferol and calcium-binding protein.
Parahomone or parathyroid hormone
Most patients with hypocalcemia have a (low or high) intracellular magensium content.
Low
___%of oral calcium is abosrbed from the small intestine (duodenum and proximal jejunum).
30%
The RDA for pregnant (>13 weeks) and lactating women is based on ___% bioavailability.
50%
Once calcium gains entry into the systemic circulation it becomes __% to ___% protein-bound by albumin.
40-50%
____(hyper or hypocalcemia) presents as shortened QT interval with an ST segment shift.
Hypercalcemia
Ionized calcium represents ~ ___% to ___% of plasma calcium while the remainder is primarily bound to albumin.
50-60%
~15% of critically ill surgical patients develop ____, which may represent a new form of hyperparathyroidism.
Hypercalcemia
The product of serum calcium and serum phosphate is used as a clinical guide in the assessment of soft tissue calcium/phosphate deposits (when the product exceeds __ to ___ mg/dL) and defective mineralization of bone (when the product is below 30-40 mg/dL)
60-70 mg/dL
The circadian acrophase (the highest part of the day) of total calcium, as well as actual (ionized) calcium, is approximately ___PM, while circadian nadirs are at about 6:00AM and 2:00AM
12:00 noon
Serum from both normal subjects and critically ill patients contained an ether-extractable factor which ____(lowered or raised) ionized calcium concentrations and increased albumin-calcium binding.
Lowered
Lipid infusions have ____(lowered or raised) mean serum ionized calcium values in critically ill patients.
Lowered
The best clinical evaluation of ionized calcium is achieved by taking measurement from ____ _____ _____ ____ (fluid).
anaerobically collected whole blood
~ ___% of filtered calcium is resorbed from the kidney.
99%
Increased ____ (about 20% greater than continuous) occurred with the use of cyclic TPN (75% cyclic TPN patients were found in negative calcium balance).
hypercalciuria
Hypercalciuria induced by high concentrations of amino acid infusion during TPN may contribute to the development of ___ ____ ____.
Metabolic bone disease
Since the cardiac function is intimately related to the calcium cation, IV calcium solutions should be administered at a rate no greater than ___to ___mEq/min.
0.75-3 mEq/min
Dietary phosphorous has been observed to have a ___effect.
Hypocalciuretic
TPN-induced hypercalciuria can be attenuated in the short term by IV ____
phosphate
Metabolic bone disease is characterized by __,___,___, and ___.
hypercalcemia, hypercalciuria, osteomalacia, and bone pain
____calcium intake has been associated with hypertension.
Hypercalcemia
____'s phenomenon is elicited by applying a blood pressure cuff to an upper extremity and inflating the cuff above the systolic bp for 3 min.
Trousseau's phenomenon
___'s sign identifies tetany as a unique lateral contraction of the facial muscles and the muscles of the eyelids elicited by percussion of the facial nerve anterior to the ear.
Chovstek
Cardiac standstill can occur at plasma calcium concentrations of greater than ___ mg/dL
18
Elevated chloride to phosphated ratios beyond 33 have been associated with the ___ of primary hyperparathyroidism
Hypercalcemia
____ (acidemia or alkalemia) causes calciuria
Acidemia
Although more chemically reactive, replacement of calcium gluconate by calcium chloride may help to reduce the aluminum content by ~ ___% in the final parenteral solution.
34
Cardiac standstill can occur at plasma calcium concentrations of greater than ___ mg/dL
18
Adding ____ (alkalinizers or acidifiers) to total pareneral nutrition solutions has been associated with less urinary calcium excretion.
alkalinizers.
Elevated chloride to phosphated ratios beyond 33 have been associated with the ___ of primary hyperparathyroidism
Hypercalcemia
____ (acidemia or alkalemia) causes calciuria
Acidemia
Although more chemically reactive, replacement of calcium gluconate by calcium chloride may help to reduce the aluminum content by ~ ___% in the final parenteral solution.
34
Adding ____ (alkalinizers or acidifiers) to total pareneral nutrition solutions has been associated with less urinary calcium excretion.
alkalinizers.
Cardiac standstill can occur at plasma calcium concentrations of greater than ___ mg/dL
18
Elevated chloride to phosphated ratios beyond 33 have been associated with the ___ of primary hyperparathyroidism
Hypercalcemia
____ (acidemia or alkalemia) causes calciuria
Acidemia
Although more chemically reactive, replacement of calcium gluconate by calcium chloride may help to reduce the aluminum content by ~ ___% in the final parenteral solution.
34
Adding ____ (alkalinizers or acidifiers) to total pareneral nutrition solutions has been associated with less urinary calcium excretion.
alkalinizers.
In the setting of dialysis and __ (Hyper or hypocalcemia), vitamin K which mediates osteocalcin and promotes resorption should be avoided.
Hypercalcemia
Patients at risk for hypervitaminosis A (Vitamin A is osteolytic), such as acute and chronic renal failure patients, may promote ___ (hyper or hypocalcemia).
Hypercalcemia
~__% of the total magnesium int he body is present in soft tissue and ___% is in the bone
50, 50
At least ___mEq of magensium per gram of nitrogen is/are needed for anabolism.
2
Parenterally administered magnesium is a reliable and effective treatment to prevent and control convulsions associtated with ___ and ___
preeclamsia and eclampsia
Adequate ___(macronutrient) intake is necessary for optimum total body magnesium retention.
protein
High intakes of ___ appear to increase the need for magnesium.
glucose
Magnesuym should be administered cautiously to patients with ___ impairment.
renal
Digitalis intoxication may be cause by magnesium ___.
deficiency
About 30-50% of magnesium occurs in the ____ parenchyma
jejuno-ileal
Adequate ___(macronutrient) intake is necessary for optimum total body magnesium retention.
protein
High intakes of ___ appear to increase the need for magnesium.
glucose
Magnesuym should be administered cautiously to patients with ___ impairment.
renal
Digitalis intoxication may be cause by magnesium ___.
deficiency
Magnesium s bound ~30% to plasma ____.
albumin
Many authoritis consider that ___ ___ magnesium content most accurately reflects magnesium status.
skeletal muscle
Magensium supplementation has been shown to decrease ___excretion.
potassium
___homone enhances tubular reabsorption of magensium
Parathyroid
____ loading may cause increased urinary magnesium loss.
Protein
Increased urinary magnesium (also calcium and phosphorous) has been observed in pateints receiving ___ versus continuous TPN solution administration.
cyclic
The maximum IV magnesium dosing should not exceed ___ mEq/min.
12
An ___ (decrease or increase) in conduction time (with lengthened PR and QRS intervals), hypotension, premature ventricular contractions and cardiac arrect may all present with elevated plasma magnesium concetrations.
Increase
The central nervous system manifestations of hypermagnesemia include decreased neurotransmittter release and CNS _____.
depression
Magensium ____(salt) has little associated diarrhea because it is a more soluble salt.
gluconate
The average daily parenteral nutrition requirement for magensium is __ to ____ mEq/day.
10-45
Magnesium intoxication is manifested by a sharp drop in __ ___ and respiratory paralysis
blood pressure
A(n) ____ (deficit or excess) of magnesium can cause cardiac effects (prolonged PR and QRS intervals, elevated T waves, AV block or PVCs).
excess
Hypermagnesemia may be treated with 1-2 grams of ___ ___.
calcium gluconate
____(Lack of or Prolonged) exercise may depress serum magnesium
Prolonged
One grams of magensium sulfate will provide ___ mEq magnesium.
8.1
Deep tendon reflexes disappear at magnesium concentrations of __ mEq/L.
4
Magnesium produces peripheral ____(vasodilation, vasoconstriction).
vasodilation
Magnesium is used in the treatment of __ withdrawal.
alcohol
Magensium is effective as a ___ (bronchoconstrictior or bronchodilator).
bronchodilator
___ (electrolyte) can antagonize magnesium toxicity.
Calcium
IV magnesium is generally used for tosemia of pregnancy ___ (prior to, during or after) delivery).
2 hours prior to delivery
Magnesium ____(decreases or increases) acetylcholine and blocks neuromuscular transmission to prevent or control convulsions.
decreases
Phosphorus, as ____(intracellular anion), is important as an extracellular bufferm component of phospholipids, constituent of nucelic acids in chromosomes and ribosomes and mediator of energy transport (in concert with the nucleotides ATP and GTP).
phosphate
Phosphate is found in erythrocytes as 2,30____ and the maintenance of oxygen release from hemoglobin.
diphosphoglycerate
Two phosphate salts, ___ and ___, are used in parenteral therapy.
monobasic and dibasic
Phosphate's role in adenosine triphosphate and its action as 2,3-diphosphoglycerate (2,3-DPG) and the release of oxygen from hemoglobin therapy promoting a beneficial swing to the ___ in the oxygen:hemoglobin dissociation curve.
right
___ and phosphate solubility presents a major problem to the pharmacist in compounding parenteral nutrition solutions.
Calcium
___ plays a major role in solubility phenomena.
pH
There is a reciprocal relationship between serum _____ and phosphate.
calcium
Approximately 70% of all phosphate is absorbed, primarily fromthe ___ and amy increase to 90% in dietary phosphate restricted states.
jejunum
Serum ___ ___ enzymes may increase dramatically when patients are transitionalized from parenteral nutrition or a period of bowel rest to enteral nutrition.
alkaline phosphatases
The ___ phosphate parenteral salt is more soluble.
monosodium
The buffer effects of phosphate are more pronounces in the ____ than in ____fluids.
intracellular, extracellular
A decreased serum phosphate encourages more calcium to be resorbed into the blood from bone, while an increased phosphate plasma concentration stimulates the effect of _____, which facillitates deposition of calcium into the bone.
calcitonin
Children and neonatals have ___ (higher or lower) serum phosphate concentrations than adults.
higher
Serum phosphorous may ____(decrease or increase) during states of dehydration, after meals and transiently after exercise.
increase
Hypophosphatemia symptoms __ (may or may not) appear, even when serum phosphorous concentrations fall below 1 mg/dL
may not
Since serum phosphate concentrations may vary as much as __-___mg/dL/day and increase after meals, the serum phosphate should be obtained at the same time in the morning before breakfast.
1-2
Phosphate homeostasis is regulated in the bone, gut and kidney by ___ hormone (which increase phosphate excretion and increases intestinal absorption of phosphate), growth hormone, and vitamin D (both of which increase phosphate renal reabsorption and intestinal absorption).
parathyroid
About __% of the approximately 700-800 g of phosphate in the human body is in the bone.
85%
____(Decreased or Increased) urinary losses of calcium, phosphorous, and magnesium occur in patients receiving cyclic versus continuous TPN.
Increased
Hemodialysis (HD), in patients with mild elevations of phosphorous receiving HD three times a week, removes only __mM of phosphate per run while peritoneal dialysis (PD) removes ___mM/day of phosphate.
8, 10
Exceeding a serum calcium phosphate solubility product of __to __ mg2/dL2 usually in the face of hypercalcemia, may produce calcium phosphate deposition in soft tissue.
60-70
___(Hyper or Hypo) phosphatemia has been associated with significat reduction of neutrophil phagocytosis, intracellular killing, consumption of ixygen and generation of superoxide during phagocytosis.
Hypo
___(Hyper or Hypo)phosphatemia may decrease high energy substrate availability at the cellular level leading to respiratoy muscle function.
Hypo
IV glucose, antacids, diuretics and steroids are the most common agents associated with profound___ (hyper or hypo) phosphatemia.
hypo
Acute ___(hyper or hypo) phosphatemia can result in death.
hypo
The degree of fatty liver infiltration, since elevations of SGOT enzymes have correlated significantly with ___ (low or high) serum phosphate concentrations, may increase with ____(hyper or hypo) phosphatemia.
low, hypo
One millimole of phosphorous is equal to ___mg.
31
Lipid emulsions contain approximately __mM phosphate per 500 mL.
7.5
Hyperphosphatemia per se does not have any adverse clinical effects except for ___ ___.
ectopic calcifications
There are approximately ___to ___ mg/day of phosphrous in the stool while urinary excretion amounds to 700-800 mg/day.
100-200 mg/day
Chronic hypophosphatemia may induce ___ in children, and ___ in adults.
rickets, osteomalacia
A dosage of ___ mM/kg over 6 hours has been suggested for recent uncomplicated hypophosphatemia, while __mM/kg over 6 hours are recommended for prolonged, multiple-etiology hypophosphatemia.
0.08, 0.16
Beta blockers can block the ___ (hyperphosphaturia or hypophosphaturia) of acute respiratory alkalosis in humans.
hypophosphaturia
Chronic IV phosphate administration generates and maintains renal metabolic alkalosis in salt-replete humans and induces ____.
hyperparathyroidism
Sodium ___(phosphate ester) has been shown to be of value in the treatmetn of neonatal hypophosphatemia.
glycerophosphate
Anions that are metabolic precursors to bicarbonate are ___, ____, ____ and ____.
acetate, citrate, gluconate and lactate
The normal ratio between bicarbonate and carbonic acid at pH 7.4 is __:___.
20:1
A renally compromised patient having a pH of 7.38, base excess of -7.6, chloride of 111 and bicarbonate of 17, is ____.
acidemic
Carbon dioxide is considered to represent ___ (acid or base) status.
acid
Citrate (eg Shohl's, Polycitra, Bicitra) is frequently contaminated with high concentrations of ___ (trace element).
aluminum
Bicarbonate is the principal _____(extracellular or intracellular) buffer in the body.
extracellular
Calcilate the amount of bicarbonate (BW = 70Kg and bicarbonate = 24-28 mEq/L) needed in a patient with a serum pH of 7.47, base excess of +8.2, potassium of 2.1 mEq/L and a serum bicarbonate of 40 mEq/L.
None since the patient is clearly alkalemic; fatal hypokalemia may follow additional alkalinization
Calculate the amount of bicarbonate (BW = 70 Kg and bicarbonate = 24-28 mEq/L) needed in a patient with a serum pH of 7.2, base excess of 6.5 mEq/L and a serum bicarbonate of 18 mEq/L.
0.5 L/Kg * BW * (desired bicarbonate - mEq/L of bicarbonate) = dose

0.5*70Kg*(26-18) = 280 mEq
Approximately ___ of calculated bicarbonate deficits should be initially administered.
1/2 (then recheck blood gases)
Lactate to bicarbonate metabolic conversion requires ___ to ____ hours.
1-2 hours
Extracellular fluid bicarbonate concentration is ___-____ mEq/L and dissolved carbon dioxide represents ___-____ mEq/L.
23-28 mEq/L; 1-2 mEq/L
Intracellular bicarbonate is typically around ___ mEq/L.
10 mEq/L
Acetate and gluconate are also converted to bicarbonate in vivo on an equimolare basis, with their metabolism apparently occuring ___ (extra or intra)hepatically.
extrahepatically
In the presence of carbonic anhydrase, the combination of carbon dioxide and water produces carbonic acd that dissociates into ____(which is resorbed) and the ____ ion (which is actively secreted).
Bicarbonate and hydrogen
An ____(deficit or excess) of bicarbonate decreases oxygen release from hemoglobin to tissues.
excess
Approximately ___ units of whole blood or ___ units of fresh frozen plasma can produce clinically significant alkalemia.
8, 10
When acidosis or alkalosis is present, which electrolyte should be carefully monitored due to changes in distribution pattern?
potassium
TPN acetate content may exacerbate acid/base balance in patients with pulmonary dysfunction (true or false).
True, acetate can alkalinize and precipitate respiratory carbon dioxide compensation
Patients with chronic respiratory diseases who retain carbon dioxide will have ___ (decreased or increased) bicarbonate (frequently designated as serum CO2).
Increased
Chloride is the principal ion of the ____ (extracellular or intracellular) fluid.
extracellular
The major indication for chloride is in metabolic alkalemia where urine chloride concentration is ___ (greater or less) that 10 mEq/L accompanied by extracellular fluid volume depletion and potassium loss is characteristic.
less
With the exception of ammonium chloride, which is acidic, the chloride salts generally produes ____(acidic or basic or neutral) aqueous solutions since they are derived from strong acids (HCl acid) and bases (NaOH, KOH).
neutral
Metabolically, chloride ions will, in turn, ____ (decrease or increase) serum hydronium ions.
increase
Acetate ions have been suggested to ____(compete for or promote) renal tubular reabsorption of chloride.
compete for
Intracellular chloride also plays a unique role in the RBC by being exchangeable for ____(hydronium ion or bicarbonates) in the plasma.
bicarbonates
Sincer schloride is excreted with ____(potassium or sodium), many of the cation features regarding excretion also apply to chloride.
sodium
The kidney, sweat and particularly, ___ fluids represent the major routes of chloride loss in the body/
gastrointestinal
Like sodium, chloride is completely filtered by the glomerulus; over (25, 50, 99)% is then reabsorbed along the proximal tubule, loop of henle, distal tubule and collecting duct.
99
The majority of chloride reabsorption occurs via a(n) ____(active or passive) transport process in the ascending limb of the loop of Henle.
active
Urine chloride concentration should increase from ___ to ___ mEq/L as normal acid-base balance returns.
60-70%
___ teaspoonfuls of sodium chloride per liter will provide normal saline.
2
What is the chloride eficit in a 70 Kg patient having a chloride level of 85 mEq/dL (nl = 100 mEq/dL)?
Chloride deficit (mEq) = 0.21/Kg * (normal chloride - measured chloride)= 210 mEq chloride.
In metabolic alkalemia, urinary chloride is __ (greater or less) than 10 mEq/L.
less
Sodium chloride in TPN are usually added in similar concentrations, however, sever, uncompensated metabolic _____ (acidemia or alkalemia) would require the use of a salt other than chloride.
acidemia
___ alkalemia is often characterized by a hypernatremia in the setting of a high pH and positive base excess
contraction
What calcium salt should be avoided, although it has relatively less aluminum contamination, in TPN solution
chloride
Potassium is the principal ____ (extracellular or intracellular) cation in the body.
intracellular
A typical 70 Kg male has a total of approximately 3500 mEq of potassium of which ___% is intracellular.
98
Since total bocy stores remain within a narrow range, daily loss balances daily intake with about ___% eliminated renally and the remainder eliminated via the sweat and feces.
90
The kidneys can adjust quickly to increased intake and ___ (can or cannot) prevent depletion in the absence of any potassium ingestion.
cannot
Increased potassium renal loss can occur in the presenc of high concentration of non-reabsorbable anions (eg penicillins) that ___ (decrease or increase) the intraluminal negativity of the distal tubule and promote potassium excretion.
increase
Adrenal insufficiency produces potassium ___ (excretion or retention) and sodium ____ (retention or wasting).
retention, wasting
Insulin promotes an ____ (extracellulare or intracellular) potassium shift.
intracellular
Exercise results in potassium cellular ___ (efflux or influx) and venous blood concentrations ____ (decrtease or increase) immediately.
efflux, increase
Only about ___% of total body potassium is present in the extracellular fluid
10
A ___ pH unti shift in the plasma results in 0.4-0.6 mEq/L potassium shift.
0.1
Approximately ___% to ___% of potassium is bound to plasma proteins.
10-20%
During nutritional replacement, potassium is depositied in newly synthesized cells up to ___ mEq/g to ___ mEq/g pf administered nitrogen may be required.
5-6
Ina 70 Kg male, a decrease of ____mEq/L in serum potassium from 5 mEq/L represents a deficit of 100-200 mEq
1
Urinary potassium of less than ___ mEq/L is indicative of a deficit.
40
Metabolic acidemia leads to ____ serum potassium.
increased
ACE inhibitor therpay may ____(decrease or increase) serum potassium.
increase
_____ (anticoadulant) has been associated with hyperkalemia.
Heparin.
Sodium is the principal ____(extracellular or intracellular) cation in the body.
extracellular
Normal extracellular flduid sodium concentration is about 140 mEq/L, while the intracellular fluids contain about ___ mEq/L.
10
Mineralocorticoid hormones act on the ___ (distal or proximal) tubule to enhance sodium reabsorption and potassium excretion.
distal
The kidney, sweat and ___fluids represent the mahor routs of sodium excretion in the body.
gastrointestinal
At a normal GFR of 100 mL/min and a normal serum sodium concentration of 140 mEq/L, ___ mEq/min of sodium are filtered.
14
Patient PJ (70 Kg) is dehydrated and has cental nervous system manifestations of hyponatremia, and a serum sodium of 120 mEq/L. Sodium replacement is ___ mEq.
208
[125- measure serum sodium (mEq/L) * 0.6 L/kg * wt (kg)]
The amount of normal saline in PH would be ___ L.

Patient PJ (70 Kg) is dehydrated and has cental nervous system manifestations of hyponatremia, and a serum sodium of 120 mEq/L. Sodium replacement is 208 mEq.
1.35
Hypertonic saline solutions (commercially available) are ___ to ___ % sodium chloride.
3-5%
Acute hyponatremia is classified as any drop in serum sodium that exceeds the rate of ___mEq/L/hr.
0.5
Continuous nasogastric suction combined with H2-antagonists can result in large sodium losses due to the suppression of ___ ion resulting in rising of gastric sodium content.
hydrogen
A diabetes insipidius patient should receive ___ (decreased or increased) sodium in TPN.
decreased
Demedocycline therapy will cause serum sodium to ___ (decrease or increase)
increase.
Vasopressin therapy will ____(decrease or increase) serum sodium.
decrease
Patients receiving chronic ___ therapy (mani depression medication) should receive meticulou serum sodium monitoring.
lithium
The fractional excretion of sodium greater than 1 indicates.
nephrosis
Serum osmolality is primarily a function of serum ____.
sodium