Loosely taken from Fiser's ABSITE review chapter 9 on Fluids and Electrolytes
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| How much of a normal male’s body weight is water? | two thirds
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| How much of a normal male’s body WATER weight is intracellular? | two thirds
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| How much of a normal male’s extracellular water is interstitial? | two thirds
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| What molecule determines the plasma/interstitial compartment osmotic pressure? | Proteins
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| What molecule determines the intracellular/extracellular osmotic pressure? | Sodium
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| What is the first sign of volume overload? | Weight gain (usually iatrogenic)
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| How many milliequivalents of sodium is in normal saline? | 154
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| How many milliequivalents of sodium is in lactated Ringer’s? | 140
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| How many milliequivalents of chloride is in lactated Ringer’s? | 109
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| What is normal value for plasma osmolarity? | 280-295
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| What is the equation for plasma osmolarity? | (2 x Na) + (glucose/18) + BUN/2.8)
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| What is the best indicator for adequate volume replacement? | Urine output
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| How much body fluid is normally lost in an open abdominal operation (barring blood loss)? | 0.5 – 1.0 L per hour
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| How many milliliters of insensible fluid loss occurs per kilogram on an average person in one day? | Ten
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| What percentage of insensible fluid loss occurs through the skin? | 75%
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| How much fluid is secreted by the stomach each day? | 1-2L
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| How much potassium is required per day? | 0.5 – 1.0 mEq/kg/day
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| How much sodium is required per day? | 1.0 – 2.0 mEq/kg/day
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| What fluid has the highest concentration of potassium in the body? | Saliva
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| What are the side effects of hypernatremia? | Restlessness, irritability, ataxia, seizures
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| What is the equation for total free water deficit? | 0.6 x weight (kg) x [(Na/140) – 1]
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| What is the water replacement equation in hypernatremia? | (desired change in Na+ over one day x TBW)/(desired Na+ after giving the water requirement)
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| How many mEq of sodium are usually changed in hypernatremia in one day? | 16 mEq/day
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| How much water would you give to a 70-kg man with a sodium of 165, which you want to correct to 149? | [16 x (70x0.6)] / 149 = (16 x 42) / 149 = 4.5 L
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| What are the side effects of hypOnatremia? | Headaches, delirium, seizures, nausea, vomiting
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| What is the equation for sodium deficit? | Na deficit = 0.6 x weight (kg) x (140 – Na)
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| What is the sequence of treatments for hyponatremia? | Water restriction -> diuresis -> NaCl
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| How fast can you correct hyponatremia? | No more than 1 mEq/h
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| What may develop if you correct hyponatremia too fast? | Central pontine myelinolysis
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| What condition can cause pseudonyponatremia? | Hyperglycemia
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| For each 100 increment of glucose above normal, add ________ points to the sodium value | Two
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| What central neurologic condition may cause hyponatremia? | SIADH
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| What is the most common malignant cause of hypercalcemia? | Breast cancer
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| What is Chvostek’s sign? | Tapping over the lateral cheek causes twitching
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| What is Trousseau’s sign? | Carpopedal spasm
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| What condition causes Chvostek’s and Trousseau’s sign? | HypOcalcemia
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| How do you calculate the protein adjustment for calcium? | For every 1g decrease in albumin, add 0.8 to the calcium level
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| What is the treatment for hypermagnesemia? | Calcium
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| What are the causes of anion-gap metabolic acidosis? | ”MUDPILES” -> Methanol, Uremia, Diabetic ketoacidosis, Paraldehydes, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates
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| Normal gap acidosis is usually due to what condition? | Loss of sodium and bicarb (ileostomies, small bowel fistulas)
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| Metabolic alkalosis is usually due to what condition? | Dehydration (contraction alkalosis)
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| Nasogastric suction can cause what acid-base abnormality? | Hypochloremic, hypokalemic metabolic alkalosis with paradoxical aciduria
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| How does paradoxical aciduria occur, with gastric fluid losses? | Sodium is reabsorbed in an attempt to reabsorb water. This causes potassium excretion through the Na+/K+ ATP pump. Na+/H+ exchanger is activated to reabsorb water, then the K+/H+ exchanger is activated to reabsorb potassium, resulting in net H+ loss
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| What is the best test for azotemia? | FeNa
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| What urine osmolarity is seen in prerenal azotemia? | > 500 mOsm
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| What BUN/Creatinine ratio is seen in prerenal azotemia? | > 20
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| What is the best method of prevention of renal damage from contrast dyes? | Volume expansion
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| Myoglobin causes direct tubular damage in an acidic environment by its conversion to what substance? | Ferrihemate
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| In tumor lysis syndrome, what electrolyte abnormalities do you see? | Increased phosphate and uric acid, decreased calcium
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| What is the treatment for tumor lysis syndrome? | Hydration, allopurinol, diuretics, alkalinization of urine
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