14115800
Description
Flashcards by Jennifer Huber, updated more than 1 year ago
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Created by Jennifer Huber
almost 6 years ago
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| Question | Answer |
| Fraction of total body weight that is water | 2/3 - in men more in infants less in women |
| 2/3 of water weight is located where? | intracellular - mostly muscle |
| 1/3 of water weight is located where? | extracellular 2/3 in interstitial 1/3 in plasma |
| MCC of volume overload | iatrogenic |
| 0.9% Normal Saline is composed of: | Na 154 Cl 154 |
| 3% Normal Saline components | Na 513 Cl 513 |
| Lactated Ringers Composition | Na 130, K 4, Ca 2.7, Cl 109, Lactate 28 Lactate is converted to HCO3 in body |
| Equation for plasma osmolarity & normal range | (2 x Na) + (Glucose/18) + (BUN/2.8) Normal: 280-295 |
| Maintenance Fluids | 4cc/kg/hr for 1st 10kg 2cc/kg/hr for 2nd 10kg 1cc/kg/hr for each kg after |
| Which fluid to chose during OR time and first 24hours after | Lactated Ringers |
| Which Fluid to switch to after 24hours of initial fluid post-op? | D5 1/2NS + 20mEq KCl (dextrose stim insulin release, prevents protein catabolism) |
| Fluid Losses in open abdominal operations | 0.5-1L/hr |
| Best indicator for adequate fluid replacement | Urine Output |
| Rate for adequate U/O | 0.5cc/kg/hr |
| insensible fluid losses | 10cc/kg/ady 75% through skin 25% respiratory |
| Fluid of choice to resuscitate Sweat Loss (Marathon Runner) | Normal Saline |
| Fluid of Choice for Patients with Gastric Fluid Loss (gastric outlet obstruction) | Normal Saline |
| Fluid of Choice for pancreas, biliary, or small bowel fluid loss | Lactated Ringers |
| Fluid of choice for massive diarrhea | Lactated Ringers |
| Ratio for GI fluid loss replacement | 1:1 |
| Fluid Secretion of Stomach | 1-2L/day |
| Fluid Secretion of Biliary System | 500-1,000mL/day |
| Fluid Secretion of Pancreas | 500-1,000mL/day |
| Fluid Secretion of Duodenum | 500-1,000mL/day |
| Electrolyte losses in sweat | hypotonic Na conc 35-65 |
| Electrolyte losses in saliva | potassium, highest concentration in body |
| electrolyte losses from stomach | H+, Cl- |
| Electrolyte losses from pancreas | HCO3- |
| Electrolyte losses from Bile | HCO3- |
| Electrolyte losses from small intestine | HCO3-, K+ |
| Electrolyte losses from Large Intestine | K+ |
| Normal Body K+ requirement | 0.5-1mEq/kg/day |
| Normal Body Na Requirement | 1-2mEq/kg/day |
| HyperK treatment | calcium gluconate Sodium Bicarb, 10U insulin 1amp 50% dextrose, kayexalate, lasix, albuterol dialysis if refractory |
| cause of pseudo-hyperK | hemolysis of blood |
| First Line treatment for hypoNa | Water Restrict |
| What can cause pseudohypoNa? | hyperglycemia and hyperlipidemia |
| What is Diabetes Insipidus | decrease ADH, increased urine output, decrease urine specific gravity, increase serum Na and Osm occurs with EtOH and head injury |
| Treatment for Diabetes Insipidus | Chronic: free water Acute: DDAVP |
| What is SIADH? | Increased ADH decreased U/O, conc urine, HypoNa, hypo-osm |
| Treatment of Acute SIADH | Conivaptan, Tolvaptan |
| Treatment of Chronic SIADH | Fluid Restrict and Diuresis |
| Symptoms of Hypercalcemia | usually is calcium >13 nausea, vomiting, lethargy, HoTN, upset stomach, constipation |
| MC malignant cause of hypercalcemia | Breast Cancer |
| MCC and MC benign cause of hypercalcemia | Hyperparathyroidism |
| MCC of hypercalcemic crisis | undiagnosed hyperparathyroidism with stressor (ex. surgery) |
| Treatment for hypercalcemia | NS at 200-300cc/hr and Lasix if malignant cause: calcitonin, alendronic acid (bisphosphonates), dialysis |
| Fluids NOT to give to a hypercalcemic patient | No Lactated Ringers of Thiazide Diuretics |
| Symptoms of Hypocalcemia | Ca <8 or ionized Ca <4 perioral numbness/tingling hyperreflexia, Chvostek's sign (facial nerve) Trousseau's Sign (carpopedal spasm), prolonged QT |
| Protein Adjustment for Calcium | for every 1g decrease in protein, add 0.8 to Calcium |
| MCC for hypocalcemia | previous thyroidectomy injuring a parathyroid gland |
| Symptoms of hypermagnesemia | LETHARGIC lethargy, EKG changes (prolonged PR/QT), Tendon reflexes diminished, HoTN, Arrhythmias (bradycardia), Respiratory arrest, GI issues (N/V), impair breathing (2/2 muscle weakness), Cardiac Arrest |
| Treatment of Hypermagnesemia | Calcium gluconate |
| Hypomagnesemia Signs | Torsades de pointes hyperreflexia Nausea Irritability, Confusion, Seizures |
| Causes of Hypomagnesemia | massive diuresis, chronic TPN without replacement of Magnesium, ETOH abuse |
| Treatment of Hyperphosphatemia | Sevelamer (Renagel) Low Phosphate Diet (avoid dairy) Dialysis |
| What is hypophosphatemia associated with? | Refeeding Syndrome PO4 shift from extracellular to intracellular |
| Treatment for Hypophosphatemia | Potassium phosphate |
| How to measure Anion Gap? | Na - (HCO3 +Cl) |
| High Anion Gap Acidosis Causes | MUDPILES methanol, uremia, DKA, par-aldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates |
| Causes of Normal AG Metabolic Acidosis | Loss of Na/HCO3 (ileostomies, small bowel fistulas, lactulose) rapid infusion of fluids w/o HCO3 primary hypoparathyroid mafenide acetate |
| Treatment of Metabolic Acidosis | treat underlying cause, keep pH >7.2 w/ bicarbonate |
| How Nasogastric Suction affects electrolytes | hypochloremic, hypokalemic, metabolic alkalosis |
| Respiratory Acidosis pH, CO2, HCO3 | pH low CO2 high HCO3 high |
| Respiratory Alkalosis pH, CO2, HCO3 | pH high CO2 low HCO3 low |
| Metabolic Acidosis pH, CO2, HCO3 | pH low CO2 low HCO3 low |
| Metabolic Alkalosis pH, CO2, HCO3 | pH high CO2 high HCO3 high |
| Length of time for respiratory compensation for acidosis/alkalosis | CO2 regulation takes minutes |
| Length of time for renal compensation for acidosis/alkalosis | HCO3 regulation hours to days |
| Best test for azotemia | FeNa |
| How to Calculate FeNa | (Urine Na/Cr) / (plasmaNa/Cr) |
| Prerenal | FeNa <1% UNa <20 BUN/Cr >20 UrineOsm >500mOsm |
| How much damage does the kidney require before BUN and Cr increase? | 70% renal mass |
| How Myoglobin affects the Kidneys | it converts to ferrihemate in acidic environment which is toxic Tx: hydration, alkalizine the urine |
| Effects if Tumor Lysis Syndrome | release of purines and pyrimidines leads to increase PO4, K and uric acid. Leads to decrease Ca Can increase BUN & Cr from renal damage |
| Risk Factors for developing tumor lysis syndrome | leukemias and lymphomas |
| Treatment for Tumor Lysis Syndrome | hydration (best) rasburicase (converts uric acid in allantoin) allopurinol (decrease uric acid production) diuretics alkalinization of urine |
| Vitamin D, areas it becomes active form | Skin - UV light converts 7-dehydrocholesterol to cholecalciferol goes to LIVER for 25-OH then kidney for 1-OH |
| What does active form of Vitamin D do? | increases calcium binding protein leading to increased intestinal Ca absorption |
| What is Transferrin? | transporter of iron |
| What is Ferritin | Storage form of iron |
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