Fluid & Electrolytes/abgs Clin Med Ii

Front 1

What percent of our TBW is water?

Back 1

45-65%

Intracellular component 66%
Extracellular component 33%

Front 2

What is the primary ECF cation?

Back 2

Sodium

Along with, anions Cl & HCO3

Front 3

Where is K & phosphate found?

Back 3

ICF

Front 4

What determines the net transfer of water between ICF & ECF?

Back 4

Sodium

Front 5

What is osmolality?

Back 5

Measure of concentration of solutes dissolved (ie. higher the osmolality, the higher the concentration of solutes or lower concentration of water

Front 6

What is normal plasma osmolality?

Back 6

280-295

Serum osm= (2 x Na) + urea + glucose

Front 7

What are some causes of hypertonic ECF?

Back 7

Excessive H2O loss: Diarrhea, vomiting, sweating

Insufficient H2O intake: Extreme exercise, desert travel, no able to take PO

Front 8

What are some causes of hypotonic ECF?

Back 8

Volume overload: Renal failure, cirrhosis, SIADH

Front 9

What is tonicity?

Back 9

Measure of osmotic pressure of two solutions separated by a semi-permeable membrane. Influenced by only solutes that cannot cross the membrane. Sodium is important!

Front 10

What is the difference between crystalloid & colloid IVF?

Back 10

Crystalloid fluids are composed of simple electrolytes

Colloid fluids contain larger synthetic, insoluble particles like hetastarch, pentastarch, dextran

Natural colloids are blood & plasma!

Front 11

What is colloid osmotic pressure?

Back 11

Pressure exerted by proteins int he blood to pull water into the vascular space. This theoretically reduces the tendency for fluid to leak into the interstitial space

Front 12

How much fluid does a person lose via urination everyday? (Insensible loss)

Back 12

1200-1500 ml

Sweat: 200-400 ml
Resp: 500 ml
Feces: 100-200 ml

Front 13

How do you calculated maintenance fluid rate?

Back 13

4:2:1 rule

4 cc/kg first 10 kg
2 cc/kg next 10 kg
1cc/kg

Front 14

If you have a hypotensive pt what kind of fluid do you want to give them?

Back 14

NS or LR

They are isotonic (ALWAYS USE ISOTONIC FLUIDS TO RESUSCITATE)

Front 15

What is the MC electrolyte abnormality?

Back 15

Hyponatremia (Na<135)

Front 16

What is colloid osmotic pressure?

Back 16

Pressure exerted by proteins int he blood to pull water into the vascular space. This theoretically reduces the tendency for fluid to leak into the interstitial space

Front 17

How much fluid does a person lose via urination everyday? (Insensible loss)

Back 17

1200-1500 ml

Sweat: 200-400 ml
Resp: 500 ml
Feces: 100-200 ml

Front 18

How do you calculated maintenance fluid rate?

Back 18

4:2:1 rule

4 cc/kg first 10 kg
2 cc/kg next 10 kg
1cc/kg

Front 19

If you have a hypotensive pt what kind of fluid do you want to give them?

Back 19

NS or LR

They are isotonic (ALWAYS USE ISOTONIC FLUIDS TO RESUSCITATE)

Front 20

What is the MC electrolyte abnormality?

Back 20

Hyponatremia (Na<135)

Front 21

How do you tx hypovolemic hyponatremia?

Back 21

NS

Front 22

How do you tx euvolemic hyponatremia?

Back 22

SIADH: Free water restriction, tx underlying cause

Tolvaptan

Front 23

Hypervolemic hyponatremia

Back 23

Restrict free water, lasix in CHF, colloid infusions in cirrhotics

Front 24

How do you treat hypernatremia?

Back 24

Goal is to drop Na 10 mmol/L/day

Hypervolemic: Calculate water def, five slowly

Euvolemic: Central DI-DDAVP

Hypervolemi: D5W + loop

Front 25

What is the best way to give potassium?

Back 25

PO! Best absorbed in gut

Front 26

How much K do you give when pt is between 3.0-3.5?

Back 26

Every 0.1 below 3.5 will require 10 mEq to correct

Front 27

How to you tx hyperkalemia with NO EKG changes?

Back 27

Lasix 20-40 mg IV

Kayexalate 20-45 mg PO

Front 28

How do you treat hyperkalemia with EKG changes?

Back 28

Calcium gluconate (stabilizes cardiac cell membrane)
Insulin 10 U reg & glucose
Bicarb 1-2 amps
Albuterol 10-15 mg neb

Hemodialysis if nothing else works

Front 29

How do you treat hypocalcemia? How about hypercalcemia?

Back 29

Hypo: Acute & symptomatic-IV calcium gluconate
Chronic: PO CaCO3 & vit D

Hyper: Acute-saline & loops
Malignancies: Bisphosphonate

Front 30

How do you tx hypermagnesemia?

Back 30

Calcium gluconate
Dualysis
Loop diuretics if normal renal function

Front 31

What is normal pH?

Back 31

7.35-7.45

Front 32

Normal pCO2?

Back 32

35-45

Front 33

Normal pO2?

Back 33

60-80

Front 34

Normal HCO3?

Back 34

22-26

Front 35

7.49/38/80/30/98%

Back 35

Metabolic alkalosis

Front 36

7.32/42/118/16/100%

Back 36

Metabolic acidosis

Front 37

7.28/98/62/24/96%

Back 37

Resp acidosis

Front 38

7.51/18/60/26/90%

Back 38

Resp alkalosis

Front 39

7.36/74/69/38/92%

Back 39

Need to determine what went wrong first...look at hx! May have retained CO2 & renal system has compensated via bicarb reabsorption

Front 40

7.20/45/82/18/100%

Back 40

Metabolic acidosis

Front 41

7.18/65/513/16/100%

Back 41

Mixed metabolic & resp acidosis

Front 42

7.35/38/69/24/95%

Back 42

Normal

Front 43

7.49/42/491/37/97%

Back 43

Metabolic alkalosis

Front 44

7.52/30/91/35/95%

Back 44

Mixed metabolic/resp alkalosis

Front 45

7.22/24/90/13/95%

Back 45

Uncompensated metabolic acidosis (slight compensation)

Front 46

7.18/42/121/12/95%

Back 46

Metabolic acidosis

Front 47

7.52/40/78/35/96%

Back 47

Metabolic alkalosis

Front 48

7.25/60/68/27/95%

Back 48

Resp acidosis

Front 49

7.20/37/84/19/94%

Back 49

Metabolic acidosis

Front 50

7.55/20/70/26/94%

Back 50

Resp alkalosis

Front 51

7.36/55/78/32/96%

Back 51

Compensated met or resp alkalosis (look at hx)

Front 52

7.48/37/84/34/96%

Back 52

Met alkalosis

Front 53

7.36/38/84/26/96%

Back 53

Normal

Front 54

7.18/68/62/8/90%

Back 54

Mixed resp & met acidosis