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126 Cards in this Set
- Front
- Back
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copared with muscle, fat contains more/less fluid as a percent of body weight?
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less
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2 ECF compartments?
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intravascular
interstitial |
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the extracellular space is divides into the _________ space and the _____________ spacees by the ___________________.
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intravascular
insterstitial capillary membrane |
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The ICF contains approx. _________ of the total body fluid.
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2/3
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The ECF is separated from the ICF by the _______________.
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cellular membrane
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what compartment is characterized by high concentrations of K, Phos and Mg?
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ICF
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what compartment is characterized by high concentrations of Na and Cl?
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ECF
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The ____________ maintains the high concentrations of K found in the ICF.
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THE ATPase driven Na-K pump
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THE ATPase driven Na-K pump exchanges ____________ for __________.
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3 Na ions for 2 K ions
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The ECF contains approx. _________ of the total body water?
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1/3
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The IVF is also known as the _________.
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plasma
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The IVF contains approx. __________ of the total body fluid and hhas the same composition and concentraion of electrolytes as the _________.
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1/4
ISF |
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Component which distinguishes the IVF from the ISF?
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plasma protiens, specifically albumin
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capillary membrane permeability to plasma protiens?
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very low
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What is responsible for the movement of fluid (water and electrolytes) among compartments fo the body?
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the properities of the membranes that separeate the compartments
relative concentration of osmotically active substances within each compartment |
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which compartment is accesible to the clinician and the chief focus of fluid therapy?
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the IVF
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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 |
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What force is maintains the circulating fluid volume within the intravascular space?
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plasme osmotic pressure
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the plasma osmotic pressure is determined primarily by the?
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plasma protien concentration
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Plasma protien concentrations can be manipulated by?
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the types of IV fluid the anesthetist admisters
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total body fluid (% of body weight)
full term newborn? |
70-80
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total body fluid (% of body weight)
1 year? |
64
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total body fluid (% of body weight)
puberty to 39 years? |
M-60
F-52 |
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total body fluid (% of body weight)
40-60 years? |
M-55
F-47 |
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total body fluid (% of body weight)
>60 years? |
M=53
F-46 |
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main cation of the ECF?
main anion of the ECF? |
Na+
Cl- |
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main cation of the ICF?
main antion of the ICF? |
K+
PO4--- |
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What preoperative conditions can lead to electrolyte imbalances? [5]
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burns
vomiting diarrhea fever gastric suctioning |
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What is a iatrogenic phenomenon secondary to bowel preparation and preoperative fasting?
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hypovolemia
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What is evaporative loss?
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Loss from exposed viscera.
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main cation of the ECF?
main anion of the ECF? |
Na+
Cl- |
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main cation of the ICF?
main antion of the ICF? |
K+
PO4--- |
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What preoperative conditions can lead to electrolyte imbalances? [5]
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burns
vomiting diarrhea fever gastric suctioning |
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What is a iatrogenic phenomenon secondary to bowel preparation and preoperative fasting?
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hypovolemia
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What is evaporative loss?
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Loss from exposed viscera.
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Replacement of fluid lost from the instravascular space is best carried out by administratino of ____________?
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BALANCED SALT SOLUTIONS, which have an electrolyte composition similar to that of the ECF.
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Absorption of electrote free irrigation solutions during TURP or endometrial ablation can lead to?
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a potentiall life threatening hyperosmolar state.
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The vasodilatory effects of both regional and general anesthesia can result in _______________.
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a relative hypovolemia which may leaqd to hypotention on induction.
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General anesthesia increases the release of _______?
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ADH hormone which causes increased retention of water which can lead to hyponatremia.
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mechanical ventilation can increase __________?
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evaporative loss of water and decrease the release of ATRIAL NATURETIC PEPTIDE which results in conservation of Na+.
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3rd spaced fluids are typically mobilized on the ___________ postop day.
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3rd
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Osmolarity is the expression of _________________?
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the number of osmoles of solute in a liter of solution.
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osmolaity is the expression of __________?
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the number of osmoles of solute in a kilogram of solvent.
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Tonicity is ________________?
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describes how a solution affects cell volume.
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normal body fluid osmlality?
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285 mOsm
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What is volume depletion or hypovolemia?
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the loss of ECF
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What is dehydration
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a concentration disorder in which insufficient water is present relative to Na+ levels.
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Hypovolemia can result from _____________?
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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.
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Causes of absolute fluid loss?
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loss from the GI tract
polyuria diaphoresis decreased intake of fluids WEIGHT LOSS |
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causes of relative fluid loss?
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burns
3rd spacing NO WEIGHT LOSS |
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Most cases of hypovolemia are caused by _________?F
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loss of ECF
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Fluid replacement appropriate for hypovolemia?
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isotonic crystalloid
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Hypervolemia is _______?
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an excess of fluid volume in an isotonic concentration
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Hypervolemia seen in?
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-CHF
-renal failure -cirrhosis of the liver iatrogenic causes: -steriod administration -excessive isotonic fluid administration excessive Na+ consumption |
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Hypervolemia treatment?
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Na+ restriction
diuretics hemodyalisis/ultrafiltration |
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What is responsible for the osmotic activity of the ECF?
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Na+ and Cl-
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What does alterations in Na+ ECF concentration lead to?
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movement of fluid across the cell membrane.
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The BBB has ___________ permeability to ionic solutes.
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limited
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What is the most important osmotically active substance influencihng the water content of the brain tissues?
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Na+
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evaluation of Na+ inbalance should take into consideration both __________ as well as _________.
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the volume of water (the solvent)
the volume of Na+ (the solute) |
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causes of isotonic hyponatremia?
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hyperlipidemia
hyperprotienemia isotonic nonelectrolyte susbstances (mannitol, glucose) |
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causes of hypertonic hyponatremia?
serum osm >285 |
hyperglycemia
infusion of hypertonic nonelectrolyte substances |
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causes of hypotonic hyponatremia?
serum osm <280 |
diuretics
salt losing nephropathy ketonuria 3rd spacing adrenal insufficiency vomiting diarrhea |
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causes of isovolemic hypotonic hyponatremia?
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SIADH
renal failure hypothyroidism drugs water intoxicatiaon |
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causes of hypervolemic hypotonic hyponatremia?
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nephrotic syndrome
cirrhosis CHF |
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neurologic clinical manifestations of hyponatremia?
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seizures
coma agitation confusion HA cerebral edema |
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GI clinical manifestations of hyponatremia?
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anorexia
N/V |
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muscular clinical manifestations of hyponatremia?
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Cramps
weakness |
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Water intoxication and SIADH lead to hyponatremia from?
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an excess of water, not a lack of Na+.
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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 |
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___________ 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. |
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In chronically hyponatrimic patients, rapid correction of serum Na can lead to?
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myelinosis aka central pontine myelinosis
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what is central pontine myelinosis?
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disorder of the upper neurons, spastic quadriparesis, pseudobulbar palsy, mental disorders and potentially death
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risk factors for myelinosis?
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>48 hr hyponatremnic state
orthotopic liver transplant alcoholism |
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Treatment of hyponatremia?
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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 |
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Hypernatremia causes?
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restricted water intake (iatrogenic)
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treatment for hypernatremia?
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replace free water deficit
always treat hypovolemia first with isotonic crystalloids, than swith to hypotonic solutions 1-2 mEq/hr decrease |
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Where is 98% of the body's supply of K?
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ICF
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What is largely responsible for the resting membrane potential of the cell?
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the ration of intracellular to extracellular K.
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clinical neurologic manifestations of hypernatremia?
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thirst
weakness seizure coma intercranial bleeding disorientatoin hallucinations irritability |
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clinical CV manifestations of hypernatremia?
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hypovolemia
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clinical renal manifestations of hypernatremia?
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polyuria or oliguria
renal isufficiency |
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what promotes movement of K into the intracellular space?
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beta adrenergic stimulation
insulin alkalosis |
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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 |
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hypokalemia causative factors?
redistribution? |
alkalosis
insulin administration beta agonists |
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hypokalemia causative factors?
increased renal excretion? |
multiple drug use, PCN, especially K losing diuretics, aminoglycosides, corticosteriods
hyperaldosteronism renal tubular acidosis Mg deficiency |
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hypokalemia causative factors?
GI loss? |
diarrhea
gastric suctioning villous adenoma fistulas |
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hypokalemia causative factors?
inadequate intake? |
anorexia
alcoholism debilitation |
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hypokalemia clinical manifestations?
CV? |
ST-segment depression
widened QRS flattened T waves ventricular ectopy |
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hypokalemia clinical manifestations?
neuromuscular? |
weakness
decresased reflexes confusion |
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hypokalemia clinical manifestations?
renal? |
polyuria
concentrationg effect |
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hypokalemia clinical manifestations?
metabolic? |
glucose intolerance
potentiation of hypercalcemia and hypomagnesemia |
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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. |
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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 |
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which K imbalance is more common?
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hypokalemia more common
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causes of K movement ICF TO ECF?
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lysis of cells
acidemia beta blockers |
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Calcium is a ________ cation.
where is it? |
divalent
99% in bone |
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most important role of Ca for the anesthetist?
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role as second messenger that couples cell membranes receptors to cellular responses......
muscle contractions release of hormones/NT's also coagulation, muscle function |
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3 ECF Ca fractions
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50% ionized (active)
40% protien bound 10% anion bound |
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which K imbalance is more common?
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hypokalemia more common
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causes of K movement ICF TO ECF?
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lysis of cells
acidemia beta blockers |
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Calcium is a ________ cation.
where is it? |
divalent
99% in bone |
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most important role of Ca for the anesthetist?
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role as second messenger that couples cell membranes receptors to cellular responses......
muscle contractions release of hormones/NT's also coagulation, muscle function |
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3 ECF Ca fractions
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50% ionized (active)
40% protien bound 10% anion bound |
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acidemia effect on Ca?
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acidemia decreases the protien bound fraction and increases the ionized fraction (more available)
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total serum Ca levels are dependent on ________ levels.
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Albumin
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Hyperkalemia clinical manifestations.
CV |
tall peaked t waves
widened QRS cardiac arrest ventricular dysrhythmias |
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Hyperkalemia clinical manifestations.
neuromuscular |
confusion
muscle weakness |
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hyperkalemia causative factors?
redistribution? |
acidosis
hypertonicity hemolysis tissue necrosis rhabdomyolysis |
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hyperkalemia causative factors.
decreased renal excretion? |
renal insufficiency and failure
K sparing diuretics hypoaldosterosism drugs-NSAIDS, Beta=blockers, ace inhibitors |
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hyperkalemia causative factors.
excessive intake |
IV/PO supplentation
excessove use of salt substitutes rapid transfusion of banked blood |
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hypocalcemia causative factors.
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hypoparathyroidism (or psuedo)
malabsorption acute pancreatitis malignancy alkalosis hyperphosphatemia CRI hypomagnesemia |
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hypocalcemia clinical manifestation?
CV |
dysrthymia
prolonged QT T wave inversion hypotension decreased myocardial contractility |
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hypocalcemia clinical manifestation?
neuromuscular |
cramps
muscle weakness chvostek's sign trousseau's sign seizures numbness tingling |
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hypocalcemia clinical manifestation?
pulmonary manifestations |
laryngospasm
bronchospasm hypoventilation |
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hypercalcemia causative factors
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hyperparathyroidism
malignancy thiazide diretics thyrotoxicosis renal failure excessive CA supplements |
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hypercalcemia clinical manifestations.
CV |
hypertension
heart block shortened QT dysrhytmia |
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hypercalcemia clinical manifestations.
neuromuscular |
muscle weakness
decreased deep tendon reflexes sedation |
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hypercalcemia clinical manifestations.
renal |
hypercalcuria
polyuria |
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hypercalcemia clinical manifestations.
GI |
anorexia
pancreatitis |
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treatment of hypercalcemia?
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loopo diretics
NS biphosphonates mithramycin calcitonin glucocorticoids phosphate salts |
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hypotonic solutions [2]
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D5W
1/2 NS |
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isotonic solutions [3]
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NS
D51/4NS LR |
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hypertonic solutions? [4]
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D51/2NS
D5LR 3% NS D5NS |
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average blood volume?
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premmie 95ml.kg
full term 85ml/kg infant 80 ml/kg men 75ml/kg women 67ml/kg |
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universal donor?
universal recipeint? |
O
AB |
