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total body water accounts for __% or more of body weight
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water is contained primarily in
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DU PA Surg Flui/elec
Duke PA Surgery Fluids and electrolytes
| Question | Answer |
|---|---|
| total body water accounts for __% or more of body weight | 60 |
| water is contained primarily in | skeletal muscle |
| intrecellular water composes __ of total body water | 2/3 |
| extracellular water composes __ of total body water | 1/3 |
| interstitial water accounts for __% of extracellular water | 75 |
| intravascular water or plasma water, constitutes __% of extracellular water volume or 4-7% of body weight | 25 |
| in the intracellular compartment __ is the dominant cation | potassium |
| in the interstitial and intravascular compartments __ is the dominant cation | sodium |
| electrical neutrality is maintained by a balanced amount of | chloride and bicarb ions |
| to maintain electrical neutrality, the negative charge on plasma albumin requires an increase in | plasma cations, mostly sodium |
| the redistribution of ions across the semipermeable membrane is called the | Donnan effect |
| refers to the number of particles dissolved in a solution | olsmolarity |
| is calculated by considering only the concentration of impermeable solutes in solution | tonicity |
| ___ is an enzyme released by the juxtaglomerular cells of the afferent arteriole in response to a decrease in arterial blood pressure, hypovolemia, hyponatremia, and increased beta-adrenergic activity | renin |
| Renin converts angiotensinogen to angiotensin I which is then converted to angiotensin II in the pulmonary circulation by | Angiotensin-converting enzyme (ACE) |
| Angiotensin releases ___ from the renal cortex | aldosterone |
| Aldosterone acts on the distal tubules and collecting ducts to | increase sodium reabsorption and potassium excretion |
| angiotensin increases | cardiac output and peripheral resistance |
| normally and adult ingests __L of water per day | 2-3 |
| ___ mL/day is the minimal volume required to allow solute excretion | 300 |
| chronic volume depletion is manifested by | oliguria, loss of skin turgor, orthostatic hypotension, low urine sodium concentration, BUN/creatinine ratio that exceeds 15:1. |
| Acute volume losses are manifested by | hypotension, tachycardia, and tachypnea |
| normal dietary salt intake is __g/day | 6-15 |
| hypernatremia is defined as a serum sodium concentration that exceeds __ mEq/L | 150 |
| hypernatremia is always accompanied by | hyperosmolarity |
| any net gain in sodium will increase the | extracellular fluid and trigger transmembrane water shifts leading to cellular dehydration |
| hypernatremia may be due to | excessive salt intake, excessive water loss, reduced salt excretion, reduced water intake |
| ordinarily the hyperosmolar state of hypernatremia will drive thirst and | ADH release |
| in surgical patients, hypernatremia may result from the administration of __ which lead to free water depletion | loop diuretics |
| neurologic symptoms of hypernatremia | malaise, lethargy, vomiting, general seizures, and coma |
| rapid sodium increases will lead to | cerebral dehydration |
| therapy for hypernatremia is directed first at | restoring volume with isotonic saline solution |
| once intravascular volume is restored in hypernatremia, it is further corrected by administration of | free water in the form of D5W |
| hyponatremia is defined as a serum sodium concentration that is less than __mEq/L | 135 |
| hyponatremia may be caused by | excessive water intake, impaired renal water excretion, and loss of renal diluting capacity |
| symptoms of hyponatremia are | mostly neurologic and are due to cellular swelling |
| cellular swelling in hyponatremia is induced by | extracellular fluid hypo-osmolality |
| in hyponatremia cerebral swelling causes | lethargy, confusion, vomiting, seizures, and coma |
| patients in this group often have edema | hypervolemic hyponatremia |
| causes include renal failure, CHF, COPD, severe liver disease | hypervolemic hyponatremia |
| the most common cause of normovolemic hyponatremia is | the syndrome of inappropriate secretion of ADH (SIADH) |
| SIADH is seen in patients with | central nervous system pathology such as stroke or injury, and in pulmonary conditions including tuberculosis and cancer |
| pateints with hypovolemic hyponatremia have | renal or extrarenal losses of sodium that exceed water losses |
| in hypervolemic hyponatremic patients the treatment includes | volume restriction and loop diuretics |
| patients with SIADH usually respond to | fluid restriction |
| in hypovolemic hyponatremic patients treatment includes | salt and water replacement |
| in asymptomatic patients, hyponatremia should be treated | slowly |
| with symptomatic hyponatremia, current recommendations are to increase the serum sodium concentration no faster than __mEq/L/hr | 0.5 |
| in patients with stupor, coma, or other severe neurologic symptoms from hyponatremia __ is used | hypertonic (3% NaCl) solution |
| most of the bodies potassium is found in | skeletal muscle |
| the normal plasma potassium concentration is __ mEq/L | 3.5-5 |
| the usually dietary intake of potassium is __ mEq/kg | 1-1.5 |
| hyperkalemia is defined as a serum potassium concentration greater than __ mEq/L | 5.5 |
| hyperkalemia can result from | renal or adrenal insufficiency, metabolic acidosis, or iatrogenic causes |
| the most common cause of metabolic alkalosis in surgical patients is | nasogastric losses or vomiting |
| the peritoneal surfaces represent __% fo body surface area | 50 |
| during laparotomy, the expected evaporative fluid loss from exposed peritoneum is __ mL/kg/hr | 10 |
| hyperphosphatemia may result from | rhabdomyolysis due to muscle ischemia or crush injury |
| the stress response to surgery results in the release of | glucagon, aldosterone, cortisol, and antidiuretic hormone |
| hyperkalemia occurs with __ due to transcellular exchange of K+ and H+ | metabolic acidosis |
| extrarenal causes of hyperkalemia | intravascular hemolysis, rhabdomyolysis, seizures, and sever GI bleed |
| iatrogenic causes of hyperkalemia | NSAIDs, ACEIs |
| the earliest EKG abnormality of hyperkalemia is | peaking of T waves |
| as plasma potassium increases | PR intervals become prolonged, and the RR interval increases |
| further increases in K+ concentration are associated with | loss of P waves and widening of QRS |
| the final effect of hyperkalemia on the heart is | complete heart block, v-tach, then asystole |
| extracardiac symptoms of hyperkalemia | paresthesias, flaccid paralysis, ileus |
| to reverse cardiac toxicity in hyperkalemia __ should be administered | calcium gluconate |
| in hyperkalemia the response to calcium salt therapy occurs in | 1-5 minutes and lasts 30 minutes |
| in hyperkalemia concurrent treatment with __ moves K+ into cells | insulin or sodium bicarbonate |
| potassium can be removed by treatment with the cation-exchange resin | kayexalate (50-100 g as enema) or 40g orally with sorbitol |
| the most effective method of removing potassium is | dialysis |
| when using ___ to treat hyperkalemia, the onset of action is slow, and the effects last 4-6 hours | kayexalate |
| hypkalemia is defined as a serum potassium concentration that is less than __mEq/L | 3.5 |
| hypokalemia is a common problem in surgical patients and is usually caused by | GI losses from vomiting, diarrhea, or fistula, and the use of diuretics |
| ___ often coexists with hypokalemia | metabolic alkalosis |
| metabolic acidosis decreases | renal potassium conservation |
| EKG may show ___ in hypokalemia | t-wave flattening/inversion, diminished QRS voltage, and U waves |
| in patients taking digoxin __ can provoke life threatening arrhythmias | hypokalemia |
| potassium should be given __ unless the hypokalemia is severe (<2.5 mEq/L) | orally |
| the serum ionized calcium concentration is maintained within a narrow range of ___ mg/dL | 4.4-5.3 |
| a reduction in serum calcium stimulates a release of | parathyroid hormone |
| parathyroid hormone increases | calcium reabsorption from bone |
| PTH enhances | calcium reabsorption from the distal convoluted tubule |
| PTH stimulates | formation of the active metabolite of vitamin D that increases gut absorption of elemental calcium |
| hypercalcemia is defined as ionized calcium concentration that exceeds __ mg/dL | 5.3 |
| although hypercalcemia is most frequently associated with hyperparathyroidism in surgical patients, it is also commonly associated with | cancer |
| other causes of enhanced bone reabsorption | Paget's disease, pheochromocytoma, hyperthyroidism, and use of thiazide diuretics |
| cardiovascular manifestations of hypercalcemia include | arrhythmias and a shortened QT interval |
| GI effects of hypercalcemia | anorexia, constipation, pancreatitis, and hyperacidity |
| the most common renal defect associated with hypercalcemia is | polyuria |
| if hyperparathyroidism is the cause of hypercalcemia the best treatment is | surgery |
| initial supportive therapy for hypercalcemia includes | saline diuresis and furosamide |
| __ reduces bone reabsorption and has an immediate effect | calcitonin |
| ___ are highly effective inhibitors of osteoclast activity but have a delayed onset of 2-3 days | biphosphonates |
| hypocalcemia is defined as an ionized calcium concentration of less than __ mg/dL | 4.4 |
| hypocalcemia is seen in | parathyroid or thyroid surgery, sever pancreatitis, magnesium deficiency, and after massive blood transfusion |
| neuromuscular findings in hypocalcemia include | paresthesias, muscular spasms, seizures, tetany, and weakness |
| cardiovascular symptoms of hypocalcemia include | heart block, arrhythmias, bradycardia, and refractory hypotension |
| EKG findings with hypocalcemia | prolongation of the QT interval and T-wave inversion |
| in patients with symptomatic or severe hypocalcemia ___ is indicated | IV calcium therapy |
| fixed acids | citric, pyruvic, sulfuric, phosphoric, acetoacetic |
| ___ are the main buffers in the body | bicarbonate and hemoglobin |
| in body fluids CO2 combines with water to form | carbonic anhydrase |
| kidneys can compensate for the buffer lost during CO2 excretion by the lungs with | bicarbonate reabsorption and ammonia production |
| metabolic acidosis is present when pH is less than 7.35 and plasma bicarbonate is less than __ mEq/L | 22 |
| in spontaneously breathing patients the increase in hydrogen ion concentration should stimulate __ thereby decreasing PCO2 | compensatory increase in ventilatory rate |
| the presence or absence of an ___ helps to categorized metabolic acidoses | anion gap |
| the anion gap is calculated as the difference between the concentrations of | the major extracellular cation sodium and the major anions chloride plus bicarbonate |
| a normal anion gap is __mEq/L | 8-12 |
| the causes of anion gap acidosis can be remembered by the mnemonic | Dr. Maples |
| Dr. Maples stands for | Diabetic Ketoacidosis, Renal failure, methanol, alcohol, paraldehyde, lactic acidosis, ethylene glycol, salicylates |
| in trauma patients metabolic acidosis must be assumed to be due to | blood loss (hypoperfusion and tissue hypoxia) |
| non-anion gap metabolic acidosis is characterized by loss of | buffer base |
| common causes of non-anion gap metabolic acidosis | GI tract loss, renal tubular acidosis, Addison's disease, total parenteral nutrition, and use of carbonic anhydrase inhibitors |
| therapy with ___ is reserved for those in severe metabolic acidosis (<7.2), and in those with life threatening ventricular arrhythmias, hemodynamic instability, inadequate compensatory response | sodium bicarbonate |
| explained by the inability of the kidney to excrete excess bicarbonate or to retain hydrogen ion | metabolic alkalosis |
| metabolic alkalosis is usually accompanied by | respiratory compensation |
| respiratory acidosis is present when the pH is low and the PCO2 is | elevated |
| respiratory acidosis is due to | ineffective alveolar ventilation |
| treatment of respiratory acidosis may require | intubation and mechanical ventilation |
| respiratory alkalosis is present when the pH is high and the PCO2 is | low |
| caused by alveolar hyperventilation | respiratory alkalosis |
| in the surgical pateint respiratory alkalosis may be caused by | hypoxia, central nervous system lesion, pain, hepatic encephalopathy, and mechanical ventilation |
| in acute respiratory alkalosis renal compensation is | minimal |
| in chronic respiratory alkalosis renal compensation is by | a decrease in hydrogen ion excretion |
| most patients with respiratory alkalosis are | asymptomatic |
| hyperventilation is particularly dangerous in patients with subarachnoid hemorrhage because it ecacerbates | vasospasm |
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bwyche
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