AP Lecture 1

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AP Lecture 1
2013-01-04 18:19:48
aa emory anesthesia practice

Questions and key points of Lecture 1. (Fluids, Electrolytes, Acid/Base)
Show Answers:

  1. What percent of the body is water?
  2. What fraction of water is intracellular?
  3. What fraction of water is extracellular?
  4. NPO defecit calculation:
    4-2-1 rule. or add 40 to weight in kg above >20 kg.
  5. Minimal fluid loss due to evaporation:
  6. Moderate fluid loss due to evaporation:
    • 4-6ml/kg/hr
    • Example: chole
  7. Severe fluid loss due to evaporation:
    • 6-8ml/kg/hr
    • Example: Bowel ressection, open surgery
  8. Define third Spacing:
    • Refers to an internal redistribution of fluids,
    • caused by leaking of intravascular fluid from inflamed tissue
  9. How much blood is absorbed by a small lap?
    10 ml
  10. How much blood is absorbed by a large lap?
    100 ml
  11. Define Crystalloid:
    Solution of inorganic and small organic molecules dissolved in water. Main solute is saline or glucose.
  12. Crystalloid advantges (4):
    • safe
    • nontoxic
    • reaction free
    • inexpensive
  13. Crystalloid disadvantges:
    • short half life (30-60 min)
    • edema occurs with large volumes
    • fluid replacement in a 3:1 ratio
  14. D5W: A) components
    B) pH
    • A) Dextrose 5g/L
    • B) 5.0
    • C) 253
  15. 0.9 Sodium Chloride:
    A) components
    B) pH
    • A)Na (154), Cl (154,
    • B)4.2
    • C)308
  16. LR:
    A) components
    B) pH
    • A)Na (130), Cl (109), K (4.0), Ca (3.0), Lactate (28)
    • B)6.5
    • C)273
  17. Plasma-Lyte:
    A) components
    B) pH
    • A)Na (140), Cl (98), K (5.0), Mg (3.0), acetate (27)
    • B)7.4
    • C)294
  18. reguarding osmolarity compared to the normal human blood, LR is
  19. reguarding osmolarity compared to the normal human blood, NS is
  20. Who should not receive LR?
    renal patients (k), blood transfusion (ca)
  21. What condition can a saline solution cause?
    hyperchloremic metabolic acidosis
  22. What condition can LR cause?
    Metabolic alkalosis
  23. Why is normal saline used in neuro cases?
    NS pulls h2o from brain tissue
  24. Define Colliod:
    homogenous noncrystalline substance consisting of large molecules dissolved in a solvent. 
  25. Colloid Advantages:
    • Longer half life
    • more efficient for replacing severe fluid defecit
    • Ratio of replacement 1:1
  26. half life of hetastarch
    6-12 hrs up to 17days
  27. Common colloids
    • albumin
    • dextran
    • hetastarch
    • hespan (ns)
    • Hextend (LR)
  28. Natural Colloids:
    A) side effects
    B) molecular weight
    A) hyocalcemia allergic reaction, impared lung function, hypotension
  29. synthetic colloids:
    • dextran
    • hetastarch
  30. Dextran D40 mol weight
  31. Dextran:
    A)half life
    B) side effects
    • A) 6-12 hours
    • B) coagulopathy, renal dysfunction, anaphalaxis, osmotic diuresis
  32. Hetastarch:
    A) half life
    B) side effects
    • A) 6-12 hrs up to 17 days
    • B) coagulopathy, anaphylactiod rxns
  33. Colloid Distribution in body
    100% extracellular --> 100% intravascular
  34. Normal Na level:
    135-145 mEq/L
  35. Normal K level:
    3.5-5.0 mEq/L
  36. Normal Ca level:
    8.5-10 mEq/L
  37. Normal MG level:
    1.5-2.5 mEq/L
  38. Normal Cl- levels:
    100-106 mEq/L
  39. Normal HCO3- levels:
    22-26 mEq/L
  40. Key regulator of water balance in the body
  41. Hyponatremia occurs when plasma sodium level is?
    < 135 mEq/L
  42. Hyponatremia causes: (true loss)
    True loss of Na- excess sweating, vomiting, diarrhea, burns, diuretics
  43. Dilutional Hyponatremia:
    Excess TBW due to excess ADH release (stress, SNS, SIADH), TURP syndrome
  44. Most common type of hyponatremia
  45. Hyponatremia has what effect on MAC?
  46. Symptoms of hyponatremia:
    Neuro symptoms (N&V, visual, confusion, agitation, coma, seizure, muscles cramps, weakness, myoclonus)
  47. Na level <123 mEq/L leads to what?
    Cerebral Edema
  48. Na <100 mEq/L leads to what?
    cardiac symptoms
  49. HYPERVOLEMIC hyponatremia can cause what?
    pulmonary edema, hypertension, heart failure
  50. How to treat Hyponatremia:
    • replace Na def slowly,
    • Diuretics for fluid overload (TURP)
  51. What can occur if Na is not corrected SLOWLY?
    Central Pontine Myelinolysis
  52. define Central Pontine Myelinolysis
    demyelination of of nerves in brain due to fluctuation in osmotic forces. causes paralysis and death
  53. HYPERnatremia: definition and cause
    • Na > 145 mEq/L
    • Water loss dues to diabetes insipidus (ADH low), GI, diuresis, sweat, thirst impairment in hypothalmus
  54. Hypernatremia has what effect on MAC?
  55. HYPERnatremia treatment:
    diuretics and hypotonic crystalloids to restore normal osmolality/volume. CORRECT SLOWLY
  56. MOST abundant ECF cation:
  57. MOST abundant ICF cation:
  58. Three things that lower K in plasma
    • hyperventilation
    • B2 agonists
    • HCO3-
  59. long term maintenance of K:
    aldosterone from kidneys
  60. low pH has what effect on K? explain why
    Increases.  Excess H with a low pH is partially compensated by exchanging the extracellular H with the intracellular K.
  61. Define Hypokalemia:
    K< 3.5 mEq/L
  62. Hypokalemia causes:
    • starvation
    • excess renal loss- diuretics, met alk, hpyomagnesemia
    • GI loss- vomiting, diarrhea
    • ECF to ICF shift due to B2 agonist, insulin, hyperventilation, alkalosis
  63. Hypokalemia symptoms:
    arrythmia, muscle weakness, ST depression, t wave depression, U wave presence
  64. Hypokalemia treatment:
    give K slowly
  65. Hyperkalemia define:
    >5.3 mEq/L
  66. Hyperkalemia causes:
    • altered internal K - acidosis, low insulin, cell necrosis, MH
    • Drugs- Succ, Ace-I, digitalis, B blockers
    • altered external K- renal disease, decreased excretion
  67. Pseudohyperkalemia cause:
    Lysis of cells at sample site, for example if IV if diffucult, or tech problems.
  68. Symptoms of Hyperkalemia:
    PEAK T WAVES, muscle weakness, wide QRS, v-fib
  69. Hyperkalemia treatment:
    insulin, Ca, glucose, hyperventilate
  70. Why is calcium given when treating Hyperkalemia?
    To protect and stabilize heart
  71. Calcium balance is controlled by: (2)
    • PTH- increases
    • Calcitonin- decreases
  72. What percentage of calcium is bound to protein?
  73. What percentage of calcium is ionized and phys. active?
  74. What percentage of calcium is is nonionized, chelated with anions? what are these anions?
    • 10%
    • phosphate, citrate, sulfate
  75. Define Hypocalcemia:
    Ca <8.5 mEq/dL, ionized <1.1-1.4 mmol/L
  76. Hypocalcemia Causes:
    • LOW PTH
    • ineefective PTH
    • Low albumin
    • iatragenic in OR due to admin of blood products
  77. Hypocalcemia symptoms:
    mental change, tetany, laryngospasm, hypotension, heart block
  78. Hypocalcemia tx:
    give Ca slowly
  79. What two forms of Ca are used to treat hypocalcemia?
    • CaCl
    • Caglucinate
  80. Hypercalcemia causes:
    hyperparathyroidism, excess vit d, renal failure, bone fracture
  81. hypercalcemia symptoms:
    bone pain, urination, thirst
  82. hypercalcemia treatment:
  83. EKG effects of calcium disturbance (little man on R)
    • Hyper- increase in T wave (peaked T)
    • Hypo- prolonged ST
  84. Magnesium has what effect on ACH?
  85. Magnesium is a Ca ______.
  86. Magnesium is a cofactor for uptake of what electrolyte?
  87. Magnesium has what effect on vessels?
  88. What electrolyte is useful as a membrane stablizer when treating arrythmias?
  89. Hypomagnesemia define:
    Mg <1.5 mEq/L
  90. Hypomagnesemia occurs in what pt's?
    athletes, critical care, high metabolic states (pregnancy), diarrhea/diuretics, CHRONIC ALCOHOLICS
  91. Hypomagnesemia signs:
    CNS irritability
  92. Hypomagnesemia tx:
    • magnesium sulfate (1-2 mEq/kg) over 8 hours
    • IV during arrythmia
  93. Hypermagnesemia define:
    Mg >2.5 mEq/L
  94. Hypermagnesemia:
    Rare but can occur with renal pt's
  95. Hypermagnesemia s/s:
    sedation, hypoventilation, bradycardia, hypotension, muscle weakness
  96. Hypermagnesemia tx:
    diuretics, fluid loading, dialysis
  97. What percentage of Mg is excreted by the kidneys?
  98. When should Blood gases be taken?
    • baseline
    • if sig changes occur
    • hourly to monitor pt in certain cases
  99. Define RES ACIDOSIS:
    • pH <7.35
    • PaCO2 >45mmHg
  100. RES ACIDOSIS cause:
  101. Low pH = _____ CO2
  102. Define RES ALKALOSIS:
    • pH >7.45
    • PaCO2 < 35mmHg
  103. High pH = ____ CO2
  104. define MET ACIDOSIS:
    • pH <7.35
    • HCO3 <22mEq/L
    • BE > -2 mEq/L
    treat underlying cause
  106. MET ACIDOSIS = _____ bicarb/pH
  107. MET ALKALOSIS = _____ bicarb/pH
  108. Define MET ALKALOSIS:
    • pH >7.45
    • HCO3 >26mEq/L