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