Duke PA Surgery Fluids and electrolytes
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| total body water accounts for __% or more of body weight | show 🗑
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| show | skeletal muscle
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| show | 2/3
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| extracellular water composes __ of total body water | show 🗑
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| show | 75
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| show | 25
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| in the intracellular compartment __ is the dominant cation | show 🗑
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| in the interstitial and intravascular compartments __ is the dominant cation | show 🗑
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| show | chloride and bicarb ions
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| show | plasma cations, mostly sodium
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| show | Donnan effect
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| show | olsmolarity
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| show | tonicity
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| show | renin
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| show | Angiotensin-converting enzyme (ACE)
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| show | aldosterone
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| show | increase sodium reabsorption and potassium excretion
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| angiotensin increases | show 🗑
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| normally and adult ingests __L of water per day | show 🗑
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| show | 300
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| show | oliguria, loss of skin turgor, orthostatic hypotension, low urine sodium concentration, BUN/creatinine ratio that exceeds 15:1.
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| show | hypotension, tachycardia, and tachypnea
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| show | 6-15
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| show | 150
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| show | hyperosmolarity
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| any net gain in sodium will increase the | show 🗑
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| show | excessive salt intake, excessive water loss, reduced salt excretion, reduced water intake
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| show | ADH release
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| in surgical patients, hypernatremia may result from the administration of __ which lead to free water depletion | show 🗑
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| show | malaise, lethargy, vomiting, general seizures, and coma
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| show | cerebral dehydration
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| show | restoring volume with isotonic saline solution
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| show | free water in the form of D5W
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| show | 135
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| show | excessive water intake, impaired renal water excretion, and loss of renal diluting capacity
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| symptoms of hyponatremia are | show 🗑
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| show | extracellular fluid hypo-osmolality
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| in hyponatremia cerebral swelling causes | show 🗑
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| patients in this group often have edema | show 🗑
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| causes include renal failure, CHF, COPD, severe liver disease | show 🗑
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| the most common cause of normovolemic hyponatremia is | show 🗑
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| show | central nervous system pathology such as stroke or injury, and in pulmonary conditions including tuberculosis and cancer
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| pateints with hypovolemic hyponatremia have | show 🗑
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| in hypervolemic hyponatremic patients the treatment includes | show 🗑
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| patients with SIADH usually respond to | show 🗑
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| show | salt and water replacement
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| in asymptomatic patients, hyponatremia should be treated | show 🗑
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| with symptomatic hyponatremia, current recommendations are to increase the serum sodium concentration no faster than __mEq/L/hr | show 🗑
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| in patients with stupor, coma, or other severe neurologic symptoms from hyponatremia __ is used | show 🗑
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| most of the bodies potassium is found in | show 🗑
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| the normal plasma potassium concentration is __ mEq/L | show 🗑
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| show | 1-1.5
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| show | 5.5
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| show | renal or adrenal insufficiency, metabolic acidosis, or iatrogenic causes
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| the most common cause of metabolic alkalosis in surgical patients is | show 🗑
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| the peritoneal surfaces represent __% fo body surface area | show 🗑
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| show | 10
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| show | rhabdomyolysis due to muscle ischemia or crush injury
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| show | glucagon, aldosterone, cortisol, and antidiuretic hormone
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| hyperkalemia occurs with __ due to transcellular exchange of K+ and H+ | show 🗑
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| show | intravascular hemolysis, rhabdomyolysis, seizures, and sever GI bleed
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| iatrogenic causes of hyperkalemia | show 🗑
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| the earliest EKG abnormality of hyperkalemia is | show 🗑
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| as plasma potassium increases | show 🗑
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| show | loss of P waves and widening of QRS
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| show | complete heart block, v-tach, then asystole
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| extracardiac symptoms of hyperkalemia | show 🗑
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| to reverse cardiac toxicity in hyperkalemia __ should be administered | show 🗑
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| show | 1-5 minutes and lasts 30 minutes
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| show | insulin or sodium bicarbonate
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| show | kayexalate (50-100 g as enema) or 40g orally with sorbitol
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| the most effective method of removing potassium is | show 🗑
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| show | kayexalate
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| show | 3.5
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| hypokalemia is a common problem in surgical patients and is usually caused by | show 🗑
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| show | metabolic alkalosis
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| metabolic acidosis decreases | show 🗑
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| show | t-wave flattening/inversion, diminished QRS voltage, and U waves
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| show | hypokalemia
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| potassium should be given __ unless the hypokalemia is severe (<2.5 mEq/L) | show 🗑
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| the serum ionized calcium concentration is maintained within a narrow range of ___ mg/dL | show 🗑
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| a reduction in serum calcium stimulates a release of | show 🗑
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| show | calcium reabsorption from bone
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| show | calcium reabsorption from the distal convoluted tubule
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| show | formation of the active metabolite of vitamin D that increases gut absorption of elemental calcium
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| show | 5.3
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| show | cancer
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| show | Paget's disease, pheochromocytoma, hyperthyroidism, and use of thiazide diuretics
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| cardiovascular manifestations of hypercalcemia include | show 🗑
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| show | anorexia, constipation, pancreatitis, and hyperacidity
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| the most common renal defect associated with hypercalcemia is | show 🗑
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| show | surgery
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| initial supportive therapy for hypercalcemia includes | show 🗑
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| show | calcitonin
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| show | biphosphonates
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| show | 4.4
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| hypocalcemia is seen in | show 🗑
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| neuromuscular findings in hypocalcemia include | show 🗑
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| show | heart block, arrhythmias, bradycardia, and refractory hypotension
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| EKG findings with hypocalcemia | show 🗑
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| show | IV calcium therapy
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| show | citric, pyruvic, sulfuric, phosphoric, acetoacetic
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| show | bicarbonate and hemoglobin
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| show | carbonic anhydrase
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| kidneys can compensate for the buffer lost during CO2 excretion by the lungs with | show 🗑
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| show | 22
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| in spontaneously breathing patients the increase in hydrogen ion concentration should stimulate __ thereby decreasing PCO2 | show 🗑
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| show | anion gap
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| the anion gap is calculated as the difference between the concentrations of | show 🗑
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| a normal anion gap is __mEq/L | show 🗑
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| show | Dr. Maples
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| show | Diabetic Ketoacidosis, Renal failure, methanol, alcohol, paraldehyde, lactic acidosis, ethylene glycol, salicylates
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| in trauma patients metabolic acidosis must be assumed to be due to | show 🗑
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| show | buffer base
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| common causes of non-anion gap metabolic acidosis | show 🗑
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| 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 | show 🗑
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| explained by the inability of the kidney to excrete excess bicarbonate or to retain hydrogen ion | show 🗑
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| metabolic alkalosis is usually accompanied by | show 🗑
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| show | elevated
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| respiratory acidosis is due to | show 🗑
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| treatment of respiratory acidosis may require | show 🗑
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| respiratory alkalosis is present when the pH is high and the PCO2 is | show 🗑
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| caused by alveolar hyperventilation | show 🗑
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| show | hypoxia, central nervous system lesion, pain, hepatic encephalopathy, and mechanical ventilation
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| show | minimal
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| show | a decrease in hydrogen ion excretion
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| show | asymptomatic
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| hyperventilation is particularly dangerous in patients with subarachnoid hemorrhage because it ecacerbates | show 🗑
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