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126 Cards in this Set

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copared with muscle, fat contains more/less fluid as a percent of body weight?
less
2 ECF compartments?
intravascular

interstitial
the extracellular space is divides into the _________ space and the _____________ spacees by the ___________________.
intravascular
insterstitial
capillary membrane
The ICF contains approx. _________ of the total body fluid.
2/3
The ECF is separated from the ICF by the _______________.
cellular membrane
what compartment is characterized by high concentrations of K, Phos and Mg?
ICF
what compartment is characterized by high concentrations of Na and Cl?
ECF
The ____________ maintains the high concentrations of K found in the ICF.
THE ATPase driven Na-K pump
THE ATPase driven Na-K pump exchanges ____________ for __________.
3 Na ions for 2 K ions
The ECF contains approx. _________ of the total body water?
1/3
The IVF is also known as the _________.
plasma
The IVF contains approx. __________ of the total body fluid and hhas the same composition and concentraion of electrolytes as the _________.
1/4

ISF
Component which distinguishes the IVF from the ISF?
plasma protiens, specifically albumin
capillary membrane permeability to plasma protiens?
very low
What is responsible for the movement of fluid (water and electrolytes) among compartments fo the body?
the properities of the membranes that separeate the compartments


relative concentration of osmotically active substances within each compartment
which compartment is accesible to the clinician and the chief focus of fluid therapy?
the IVF
What are the 4 forces that determine the motion of fluids across the capillary membrane?
(between the IVF and the ISF)
the Starling forces

1. capillary pressure
2. ISF pressure
3. ISF collodial osmotic pressure
4. plasma osmotic pressure
What force is maintains the circulating fluid volume within the intravascular space?
plasme osmotic pressure
the plasma osmotic pressure is determined primarily by the?
plasma protien concentration
Plasma protien concentrations can be manipulated by?
the types of IV fluid the anesthetist admisters
total body fluid (% of body weight)

full term newborn?
70-80
total body fluid (% of body weight)

1 year?
64
total body fluid (% of body weight)
puberty to 39 years?
M-60
F-52
total body fluid (% of body weight)

40-60 years?
M-55
F-47
total body fluid (% of body weight)

>60 years?
M=53
F-46
main cation of the ECF?

main anion of the ECF?
Na+

Cl-
main cation of the ICF?

main antion of the ICF?
K+

PO4---
What preoperative conditions can lead to electrolyte imbalances? [5]
burns
vomiting
diarrhea
fever
gastric suctioning
What is a iatrogenic phenomenon secondary to bowel preparation and preoperative fasting?
hypovolemia
What is evaporative loss?
Loss from exposed viscera.
main cation of the ECF?

main anion of the ECF?
Na+

Cl-
main cation of the ICF?

main antion of the ICF?
K+

PO4---
What preoperative conditions can lead to electrolyte imbalances? [5]
burns
vomiting
diarrhea
fever
gastric suctioning
What is a iatrogenic phenomenon secondary to bowel preparation and preoperative fasting?
hypovolemia
What is evaporative loss?
Loss from exposed viscera.
Replacement of fluid lost from the instravascular space is best carried out by administratino of ____________?
BALANCED SALT SOLUTIONS, which have an electrolyte composition similar to that of the ECF.
Absorption of electrote free irrigation solutions during TURP or endometrial ablation can lead to?
a potentiall life threatening hyperosmolar state.
The vasodilatory effects of both regional and general anesthesia can result in _______________.
a relative hypovolemia which may leaqd to hypotention on induction.
General anesthesia increases the release of _______?
ADH hormone which causes increased retention of water which can lead to hyponatremia.
mechanical ventilation can increase __________?
evaporative loss of water and decrease the release of ATRIAL NATURETIC PEPTIDE which results in conservation of Na+.
3rd spaced fluids are typically mobilized on the ___________ postop day.
3rd
Osmolarity is the expression of _________________?
the number of osmoles of solute in a liter of solution.
osmolaity is the expression of __________?
the number of osmoles of solute in a kilogram of solvent.
Tonicity is ________________?
describes how a solution affects cell volume.
normal body fluid osmlality?
285 mOsm
What is volume depletion or hypovolemia?
the loss of ECF
What is dehydration
a concentration disorder in which insufficient water is present relative to Na+ levels.
Hypovolemia can result from _____________?
an absolute loss of fluid from the body or a relative loss of bodily fluid in which water is redistributed within the body leading to a reduced circulation volume.
Causes of absolute fluid loss?
loss from the GI tract
polyuria
diaphoresis
decreased intake of fluids

WEIGHT LOSS
causes of relative fluid loss?
burns
3rd spacing

NO WEIGHT LOSS
Most cases of hypovolemia are caused by _________?F
loss of ECF
Fluid replacement appropriate for hypovolemia?
isotonic crystalloid
Hypervolemia is _______?
an excess of fluid volume in an isotonic concentration
Hypervolemia seen in?
-CHF
-renal failure
-cirrhosis of the liver

iatrogenic causes:
-steriod administration
-excessive isotonic fluid administration
excessive Na+ consumption
Hypervolemia treatment?
Na+ restriction
diuretics
hemodyalisis/ultrafiltration
What is responsible for the osmotic activity of the ECF?
Na+ and Cl-
What does alterations in Na+ ECF concentration lead to?
movement of fluid across the cell membrane.
The BBB has ___________ permeability to ionic solutes.
limited
What is the most important osmotically active substance influencihng the water content of the brain tissues?
Na+
evaluation of Na+ inbalance should take into consideration both __________ as well as _________.
the volume of water (the solvent)

the volume of Na+ (the solute)
causes of isotonic hyponatremia?
hyperlipidemia
hyperprotienemia
isotonic nonelectrolyte susbstances (mannitol, glucose)
causes of hypertonic hyponatremia?

serum osm >285
hyperglycemia
infusion of hypertonic nonelectrolyte substances
causes of hypotonic hyponatremia?

serum osm <280
diuretics
salt losing nephropathy
ketonuria
3rd spacing
adrenal insufficiency
vomiting
diarrhea
causes of isovolemic hypotonic hyponatremia?
SIADH
renal failure
hypothyroidism
drugs
water intoxicatiaon
causes of hypervolemic hypotonic hyponatremia?
nephrotic syndrome
cirrhosis
CHF
neurologic clinical manifestations of hyponatremia?
seizures
coma
agitation
confusion
HA
cerebral edema
GI clinical manifestations of hyponatremia?
anorexia
N/V
muscular clinical manifestations of hyponatremia?
Cramps
weakness
Water intoxication and SIADH lead to hyponatremia from?
an excess of water, not a lack of Na+.
Hyponatremia results in a state in which the ICF environment is __________ relative to the ECF.

This leads to?
hyperosmolar

an influs of water into the ICF.

Cerebral edema
___________ are at increased risk of brain damage resulting form hyponatremia.

why?
menstruant women

estrogen/progesterone inhibit the efficiency of the Na/K pump.

female sex hormones may facilitate movement of water into the brain throught the mediation of ADH.
In chronically hyponatrimic patients, rapid correction of serum Na can lead to?
myelinosis aka central pontine myelinosis
what is central pontine myelinosis?
disorder of the upper neurons, spastic quadriparesis, pseudobulbar palsy, mental disorders and potentially death
risk factors for myelinosis?
>48 hr hyponatremnic state
orthotopic liver transplant
alcoholism
Treatment of hyponatremia?
1-2 mEq/L/hr if symptomatic

3% saline at 1-2 ml/kg/hr

if stable, then not more than 10-15 mmol/l in 25 hrs
Hypernatremia causes?
restricted water intake (iatrogenic)
treatment for hypernatremia?
replace free water deficit

always treat hypovolemia first with isotonic crystalloids, than swith to hypotonic solutions

1-2 mEq/hr decrease
Where is 98% of the body's supply of K?
ICF
What is largely responsible for the resting membrane potential of the cell?
the ration of intracellular to extracellular K.
clinical neurologic manifestations of hypernatremia?
thirst
weakness
seizure
coma
intercranial bleeding
disorientatoin
hallucinations
irritability
clinical CV manifestations of hypernatremia?
hypovolemia
clinical renal manifestations of hypernatremia?
polyuria or oliguria
renal isufficiency
what promotes movement of K into the intracellular space?
beta adrenergic stimulation
insulin
alkalosis
The symptoms associated with disorders of K homoestasis are largely a reflection of disorders of _____________.

this is seen most clearly in?
resting membrane potential

dysrhythmias associated with abnormal K levels
hypokalemia causative factors?

redistribution?
alkalosis
insulin administration
beta agonists
hypokalemia causative factors?

increased renal excretion?
multiple drug use, PCN, especially K losing diuretics, aminoglycosides, corticosteriods
hyperaldosteronism
renal tubular acidosis
Mg deficiency
hypokalemia causative factors?

GI loss?
diarrhea
gastric suctioning
villous adenoma
fistulas
hypokalemia causative factors?

inadequate intake?
anorexia
alcoholism
debilitation
hypokalemia clinical manifestations?
CV?
ST-segment depression
widened QRS
flattened T waves
ventricular ectopy
hypokalemia clinical manifestations?

neuromuscular?
weakness
decresased reflexes
confusion
hypokalemia clinical manifestations?

renal?
polyuria
concentrationg effect
hypokalemia clinical manifestations?

metabolic?
glucose intolerance
potentiation of hypercalcemia and hypomagnesemia
PO K replacement should be in the form of a _________.

Why?
chloride

because a hypocholoride state makes it difficult for the kidney to conserve K.
K replacement should be mixed in a _________?

why?
dextrose free solution

to prevent stimulation of insulin leading to increased redistribution of K to the ICF
which K imbalance is more common?
hypokalemia more common
causes of K movement ICF TO ECF?
lysis of cells
acidemia
beta blockers
Calcium is a ________ cation.

where is it?
divalent

99% in bone
most important role of Ca for the anesthetist?
role as second messenger that couples cell membranes receptors to cellular responses......

muscle contractions
release of hormones/NT's

also coagulation, muscle function
3 ECF Ca fractions
50% ionized (active)
40% protien bound
10% anion bound
which K imbalance is more common?
hypokalemia more common
causes of K movement ICF TO ECF?
lysis of cells
acidemia
beta blockers
Calcium is a ________ cation.

where is it?
divalent

99% in bone
most important role of Ca for the anesthetist?
role as second messenger that couples cell membranes receptors to cellular responses......

muscle contractions
release of hormones/NT's

also coagulation, muscle function
3 ECF Ca fractions
50% ionized (active)
40% protien bound
10% anion bound
acidemia effect on Ca?
acidemia decreases the protien bound fraction and increases the ionized fraction (more available)
total serum Ca levels are dependent on ________ levels.
Albumin
Hyperkalemia clinical manifestations.

CV
tall peaked t waves
widened QRS
cardiac arrest
ventricular dysrhythmias
Hyperkalemia clinical manifestations.

neuromuscular
confusion
muscle weakness
hyperkalemia causative factors?

redistribution?
acidosis
hypertonicity
hemolysis
tissue necrosis
rhabdomyolysis
hyperkalemia causative factors.

decreased renal excretion?
renal insufficiency and failure
K sparing diuretics
hypoaldosterosism
drugs-NSAIDS, Beta=blockers, ace inhibitors
hyperkalemia causative factors.

excessive intake
IV/PO supplentation
excessove use of salt substitutes
rapid transfusion of banked blood
hypocalcemia causative factors.
hypoparathyroidism (or psuedo)
malabsorption
acute pancreatitis
malignancy
alkalosis
hyperphosphatemia
CRI
hypomagnesemia
hypocalcemia clinical manifestation?

CV
dysrthymia
prolonged QT
T wave inversion
hypotension
decreased myocardial contractility
hypocalcemia clinical manifestation?

neuromuscular
cramps
muscle weakness
chvostek's sign
trousseau's sign
seizures
numbness
tingling
hypocalcemia clinical manifestation?

pulmonary manifestations
laryngospasm
bronchospasm
hypoventilation
hypercalcemia causative factors
hyperparathyroidism
malignancy
thiazide diretics
thyrotoxicosis
renal failure
excessive CA supplements
hypercalcemia clinical manifestations.

CV
hypertension
heart block
shortened QT
dysrhytmia
hypercalcemia clinical manifestations.

neuromuscular
muscle weakness
decreased deep tendon reflexes
sedation
hypercalcemia clinical manifestations.

renal
hypercalcuria
polyuria
hypercalcemia clinical manifestations.

GI
anorexia
pancreatitis
treatment of hypercalcemia?
loopo diretics
NS
biphosphonates
mithramycin
calcitonin
glucocorticoids phosphate salts
hypotonic solutions [2]
D5W
1/2 NS
isotonic solutions [3]
NS
D51/4NS
LR
hypertonic solutions? [4]
D51/2NS
D5LR
3% NS
D5NS
average blood volume?
premmie 95ml.kg
full term 85ml/kg
infant 80 ml/kg
men 75ml/kg
women 67ml/kg
universal donor?
universal recipeint?
O
AB