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SB82 Fluids Lytes

Loosely taken from Fiser's ABSITE review chapter 9 on Fluids and Electrolytes

QuestionAnswer
How much of a normal male’s body weight is water? two thirds
How much of a normal male’s body WATER weight is intracellular? two thirds
How much of a normal male’s extracellular water is interstitial? two thirds
What molecule determines the plasma/interstitial compartment osmotic pressure? Proteins
What molecule determines the intracellular/extracellular osmotic pressure? Sodium
What is the first sign of volume overload? Weight gain (usually iatrogenic)
How many milliequivalents of sodium is in normal saline? 154
How many milliequivalents of sodium is in lactated Ringer’s? 140
How many milliequivalents of chloride is in lactated Ringer’s? 109
What is normal value for plasma osmolarity? 280-295
What is the equation for plasma osmolarity? (2 x Na) + (glucose/18) + BUN/2.8)
What is the best indicator for adequate volume replacement? Urine output
How much body fluid is normally lost in an open abdominal operation (barring blood loss)? 0.5 – 1.0 L per hour
How many milliliters of insensible fluid loss occurs per kilogram on an average person in one day? Ten
What percentage of insensible fluid loss occurs through the skin? 75%
How much fluid is secreted by the stomach each day? 1-2L
How much potassium is required per day? 0.5 – 1.0 mEq/kg/day
How much sodium is required per day? 1.0 – 2.0 mEq/kg/day
What fluid has the highest concentration of potassium in the body? Saliva
What are the side effects of hypernatremia? Restlessness, irritability, ataxia, seizures
What is the equation for total free water deficit? 0.6 x weight (kg) x [(Na/140) – 1]
What is the water replacement equation in hypernatremia? (desired change in Na+ over one day x TBW)/(desired Na+ after giving the water requirement)
How many mEq of sodium are usually changed in hypernatremia in one day? 16 mEq/day
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
What are the side effects of hypOnatremia? Headaches, delirium, seizures, nausea, vomiting
What is the equation for sodium deficit? Na deficit = 0.6 x weight (kg) x (140 – Na)
What is the sequence of treatments for hyponatremia? Water restriction -> diuresis -> NaCl
How fast can you correct hyponatremia? No more than 1 mEq/h
What may develop if you correct hyponatremia too fast? Central pontine myelinolysis
What condition can cause pseudonyponatremia? Hyperglycemia
For each 100 increment of glucose above normal, add ________ points to the sodium value Two
What central neurologic condition may cause hyponatremia? SIADH
What is the most common malignant cause of hypercalcemia? Breast cancer
What is Chvostek’s sign? Tapping over the lateral cheek causes twitching
What is Trousseau’s sign? Carpopedal spasm
What condition causes Chvostek’s and Trousseau’s sign? HypOcalcemia
How do you calculate the protein adjustment for calcium? For every 1g decrease in albumin, add 0.8 to the calcium level
What is the treatment for hypermagnesemia? Calcium
What are the causes of anion-gap metabolic acidosis? ”MUDPILES” -> Methanol, Uremia, Diabetic ketoacidosis, Paraldehydes, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates
Normal gap acidosis is usually due to what condition? Loss of sodium and bicarb (ileostomies, small bowel fistulas)
Metabolic alkalosis is usually due to what condition? Dehydration (contraction alkalosis)
Nasogastric suction can cause what acid-base abnormality? Hypochloremic, hypokalemic metabolic alkalosis with paradoxical aciduria
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
What is the best test for azotemia? FeNa
What urine osmolarity is seen in prerenal azotemia? > 500 mOsm
What BUN/Creatinine ratio is seen in prerenal azotemia? > 20
What is the best method of prevention of renal damage from contrast dyes? Volume expansion
Myoglobin causes direct tubular damage in an acidic environment by its conversion to what substance? Ferrihemate
In tumor lysis syndrome, what electrolyte abnormalities do you see? Increased phosphate and uric acid, decreased calcium
What is the treatment for tumor lysis syndrome? Hydration, allopurinol, diuretics, alkalinization of urine
Created by: StudyBug82
 

 



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