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105 Cards in this Set
- Front
- Back
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percent of body weight that's fluid
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60%
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% of body fluid that's intracellular
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66%
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% of body fluid that's extracellular
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33%
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what is what part of body weight
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TIE
Total fluid is 60 Intracellular is 40 Extracellular is 20 |
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percent of body weight that's blood
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7%
lucky 7 blood |
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24 hour fluid requirements for
- water - K - Cl - Na |
water: 30-35 mL/kg
K: 1 mEq/kg CL: 1.5 mEq/kg Na: 1-2 mEq/kg |
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amounts of daily water loss by
- urine - sweat - respiration - feces |
urine: 1200-1500 mL
sweat: 200-400 Respiratory: 500-700 Feces: 100-200 |
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levelsoof normal daily electrolyte loss
- sodium - potassium - chloride |
Na: 100 mEq
K: 100 Cl: 150 |
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levels of sodium and chloride in sweat
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40 mEq each
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major electrolyte in colonic feculent fluid
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K 65 mEq/L
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physiologic response to hypovolemia?
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- renin
- sodium/H2O retention - aldosterone - water retention via ADH - vasoconstriction via angiotensin II and sympathetics - low urine output - tachycardia (early) - hypotension (late) |
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when does third spacing happen postop
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third day
3rd space on 3rd day |
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proper reaction to third-spacing
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- switch to hypotonic fluid
- decrease IV rate basically, IV hydration with isotonic fluids |
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classic signs of third spacing
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tachycardia
decreased urine output |
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surgical causes of metabolic acidosis
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loss of bicarb;
- diarrhea - ileus - fistula - high-ouput ileostomy - carbonic anhydrase inhibitors |
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surgical caues of hypochloremic alkalosis
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NGT suction
loss of gastric HCl through vomiting/NGT |
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Surgical causes of increase in acids:
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- lactic acidosis (ischemia)
- ketoacidosis - renal failure - necrotic tissue |
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surgical causes of metabolic alkalosis
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- vomiting
- NG suction - diuretics - alkali ingestion - mineralocortidoid excess |
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surgical causes of respiratory acidosis
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- hypoventilation (e.g., CNS depression)
- drugs (morphine) - PTX - pleural effusion - parenchymal lung disease - acute airway obstruction |
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surgical causes of respiratory alkalosis
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- hyperventilation (anxiety, pain, fever, wrong ventilator settings)
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classic acid base finding with significant vomiting or NGT suctioning
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hypokalemic hypochloremic metabolic alkalosis
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why hypokalemia with NGT suctioning?
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loss in gastric fluid -
loss of HCl - alkalosis - drives K into cells - K+ loss into urine exchange for Na |
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treatment for hypokalemic hypochloremic metabolic alkalosis
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IVG
Cl/K replacement |
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what is paradoxic alkalotic aciduria
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seen in severe hypokalemiccc, hypovolemic, hypochloremic metapolic alkalsois, with paradoxic metabolic alkalosis of serum and acidic urine
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how does paradoxic alkalotic aciduria occur?
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H+ lost in urine in exchange for Na+ in an attempt to restore volume
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with paradoxic alkalotic aciduria, why is H+ preferentially lost?
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H+ is exchanged preferentially into the urine instead of K+ because of the low concentration of K+
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what can be followed to assess fluid status
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urine output
base deficit lactic acid vital signs weight changes skin turgor JVD mucosal membranes rales CVP PCWP CXR |
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with hypovolemia, what changes occur in vital signs
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- tachycardia
- tachypnea - initial rise in diastolic blood pressure because of clamping down (peripheral vasoconstriction) with subsequent decrease in both systolic and diastolic blood pressures |
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what are insensible fluid losses?
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feces: 100-200 mL
Breathing: 500-700 mL (increases with fever and tachypnea) Skin: 300mL |
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how much bile secreted per day?
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1L!!
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how much gastic acid secreted per day
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2L!!
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how much pancreatic fluid / day
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600 mL
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how much SI secretion per day?
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3L!!
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how much saliva secretion each day?
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1.5L
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trick for remembering how much of each fluid is secreted
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BGS and 123 litres (alphabetical)
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what's in NS
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154 mEq each of Cl and Na
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what's in Ringer's (LR)
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mEq:
Na 130 Cl 109 lactate 28 K 4 Ca 3 |
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what's in D5W
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5% dextrose (50g) in H2O
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why can't ringers be used as a maintenance fluid
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the lactate is converted into bicarbonate, and patients would become alkalotic
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how to replace gastric juices
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D5 1/2NS plus 20 KCl
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how to replace biliary, pancreatic and colonic fluids?
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LR +/- sodium bicarb
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what fluid is replaced by straight Ringers
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small bowl (ileostomy)
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what are maintenance IV fluids for a 24 hour period
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100 mL for first 10 kg
50 mL for next 10 kg 20 mL for every kg over 20 |
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what are maintenance fluids for hourly rate:
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4mL/kg for first 10
2 for next 10 1 for every kg over 20 |
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common adult maintenance fluid
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D5 1/2NS with 20 mEq KCl/L
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common pediatric maintenance fluid
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D5 1/4 with 20 mEq KCl/L (half the D5, same of the rest)
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why add dextrose to maintenance fluid
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to prevent muscle breakdown
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minimal urine output for an adult on maintenance IV
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30mL/hr
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minimal urine output for an adult trauma patient
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50mL/hr
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how many mL's in 1 oz
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30
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common isotonic fluids
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NS
LR |
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why not combine bolus fluids with dextrose
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hyperglycemia
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possible consequence of hyperglycemia in patient with hypovolemia
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osmotic diuresis
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what kinds of fluids to expand the intravascular space
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isotonic
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most common trauma resuscitation fluid
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ringers
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effect of hyperkalemia on reflexes
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decreased
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are paresthesias caused by hyper or hypokalemia
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hyper
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urgent treatment for hyperkalemia
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- IV calcium
- IV sodium bicarb (alkalosis drives K+ into cells) - glucose and insulin - albuterol - kayexalate - furosemide - dialysis |
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non acute treatment for hyperkalemia
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furosemid and kayexalate
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acronym for acute tx of hyperkalemia
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CB DIAL K
calcium bicarb dialysis insulin/dextrose albuterol lasix kayexalate |
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effect of insulin on K
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dirves it into cells
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weakness
tetany nausea vomiting ileus paraesthesia |
hypokalemia
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flattened T waves, U waves
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hypokalemia
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rapid tx for hypokalemia
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intravenous KCl
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maximum KCl delivered in IV? central line?
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10
20 mEq/hr |
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chronic tx for hypokalemia
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PO KCl
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most common electrolyte-mediated ileus in surgical patient
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kypokalemia
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what electrolyte condition exacerbates digitalis toxicity
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hypokalemia
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what electrolyte deficiency can cause hypokalemia
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low magnesium
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what electrolyte do you have to replace first before replacing K
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magnesium
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seizures
confusion stupor pulmonary or peripheral edema tremors respiratory paralysis |
hypernatremia
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usual tx for hypernatremia
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D5W, 1/4 NS or 1/2 NS
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risk of lowering sodium too fast
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seizures
(NOT central pontine myolysis, which results from too fast correction of hyponatremia) |
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how fast to lower sodium level in hypernatremia
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less than 12mEq/L per day (same for hyponatremia)
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what can cause Euvolemic hyponatremia
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SIADH
CNS abnormalities drugs |
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seizures
coma nausea vomiting ileus lethargy confusion weakness |
hyponatremia
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how to treat SIADH
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furosemide and NS acutely
fluid restriction |
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how to treat hypervolemic hyponatremia
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dilutional
fluid restriction diuretics |
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risk of overcorrection of hyponatremia
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central pontine myelinolysis
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confusion
spastic quadriplegia horizontal gaze paralysis |
central pontine myelinolysis
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MC cause of mild postop hyponatremia
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fluid overload
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causes of hypercalcemia
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CHIMPANZEES
Calcium supplmentation IV Hyperparathyroidism/hyperthyroidism Immobilitiy/iatrogenic (thiazides) Mets/Milk alkali syndrome Paget's disease Addison's disease/Acromegaly Neoplasm Zollinger-Ellision (part of MEN I) Excessive vit D Excessive vit A Sarcoid |
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stones
bones abdominal groans psychiatric overtones polydipsia polyuria constipation |
hypercalcemia
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short QT
prolonged PR |
hypercalcemia
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acute tx for hypercalcemic crisis
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expand volume with NS
diurese with furosemide (not thiazides) |
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how to diurese for hypercalcemis
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loops not thiazides
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calculation for actual calcium
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(4 minus measured albumin) x 0.8
plus measured calcium |
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perioral paraesthesia (early)
increased DTRs (late confusion abdominal cramps laryngospasm stridor seizures tetany paranoia depression hyperkalemia |
hypocalcemia
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acute tx for hypokalemia
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calcium gluconate IV
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possible complication of infused calcium via IV
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tissue necrosis if it infiltrations
no never administer peripherally unless absolutely necessary |
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causes of hypophosphatemia
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GI losses
inadequate supplementation medications sepsis alcohol abuse renal loss |
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complication of severe hypophosphatemia
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respiratory failure
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weakness
cardiomyopathy neurologic dysfunction (ataxia) rhabdomyolysis hemolysis poor pressor response |
hypophosphatemia
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calcification (ectopic)
heart block |
hyperphosphatemia
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tx for hyperphosphatemia
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aluminum hydroxide (binds phosphate)
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consequence of untreated hyperkalemia
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vtachy/fib to death
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which electrolyte is an inotrope
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calcium
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effect of potassium on heart
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dysrhythmias
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effect of magnesium on heart
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dysrhythmias
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effect of calcium on heart
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dysrhythmias, inotropy
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if patient on digitalis, which electroly to watch
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potassium
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most common electrolyte-caused ileus
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hypokalemia
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what's the rational for the albumin furosemide sandwich
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albumin will pull interstitial fluid into intravascular space
furosemide helps excrete the fluid as urine |
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elderly patient goes into CHF on postop day 3 after laparotomy. what's happened
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mobilizaiton of third space fluid into intravascular space
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what electrolyte is associated with succinycholine
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hyperkalemia
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