chapter 9 fluid and electrolytes.txt

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chapter 9 fluid and electrolytes.txt
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2010-01-11 11:08:39
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fluids electrolytes ABSITE
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ABSITE ch 9 fluids and electrolytes
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  1. % of body weight that is water
    66%
  2. % of water weight that is intracellular
    66%
  3. % of water weight that is extracellular
    33%
  4. factor determining plasma/interstitial compartment osmotic pressures
    proteins
  5. factor determining intracellular/extracellular osmotic pressure
    sodium
  6. first sign of volume overload
    weight gain
  7. makeup of normal saline
    Na 154, Cl 154
  8. Makeup of lactated ringers
    Na 130, K4,Ca 2.7, Cl 109,bicarb 28
  9. Plasma osmolarity
    (2 X Na) + (glucose/18) + (BUN/2.8)
  10. fluid loss during open abdominal operations
    0.5-1.0L/hr
  11. daily insensible fluid losses
    10cc/kg/day. 75% skin, 25% respiratory
  12. daily secretion of stomach
    1-2 L/day
  13. daily secretion of biliary system
    500-1000 mL/day
  14. daily secretion of pancreas
    500-1000 mL/day
  15. daily secretion of duodenum
    500-1000 mL/day
  16. normal K requirement
    0.5-1.0 mEq/kg/day
  17. normal Na requirement
    1-2 mEq/kg/day
  18. electrolyte tonicity of sweat
    hypotonic
  19. predominant electrolyte in saliva
    K
  20. Predominant electrolytes in stomach (2)
    H, Cl
  21. Predominant electrolyte of pancreas
    Bicarb
  22. Predominant electrolyte of bile
    Bicarb
  23. Predominant electrolytes of small intestine (2)
    K, HCO3
  24. Predominant electrolytes of colon
    K
  25. Fluid to replace gastric losses
    D5 ? NS + 20K
  26. Fluid to replace biliary/small intestinal losses
    LR
  27. Fluid to replace large intestine (diarrhea) losses
    LR + K
  28. Mechanism of bicarbonate lowering K
    K enters cell in exchange for H, causing alkalosis
  29. Mechanism of insulin/dextrose lowering K
    K driven into cells along with glucose
  30. Sodium deficit
    = 0.6 X (weight in kg) X (140-Na)
  31. treatment for hyponatremia
    water restriction, then diuresis, then NaCl
  32. complication of correcting hyponatremia too fast
    central pontine myelinosis
  33. correction of hyperglycemia in determining pseudohyponatremia
    add 2 points to Na for each 100 of glucose over normal
  34. most common malignant cause of hypercalcemia
    breast cancer
  35. treatment of hypercalcemia
    NS (200-300 mL/hr), lasix
  36. Symptoms of hypocalcemia (5)
    Hyperreflexia, Chvostek�s sin, perioral tingling, Trousseasu�s sign, prolonged QT
  37. Symptoms of hypercalcemia (1)
    Lethargy
  38. Treatment of hypermagnesemia
    Calcium
  39. Anion gap
    Na � (HCO3 + Cl)
  40. Causes of anion gap acidosis (8)
    Methanol, uremia, DKA, paraldehydes, isoniazid, lactic acidosis, ethylene glycol, salicylates
  41. Cause of most normal gap acidosis
    Loss of Na/HCO3 (ileostomies, small bowel fistulas)
  42. Causes of metabolic alkalosis
    Contraction alkalosis, NG suction,
  43. Metabolic derangement of NG suction
    Hypochloremic, hypokalemic, metabolic acidosis with paradoxical aciduria
  44. Physiology of paradoxical aciduria during NG suction
    Na/H exchanger activated in an effort to resorb water in kidney
  45. Physiology of hypokalemia during NG suction
    Loss of water causing kidney to resorb Na in exchange for K, thus losing K
  46. Hendersen-Hasselbach equation
    pH = pK + log [HCO3]/[CO2]
  47. FeNa equation
    = (urine Na/Cr)/ (plasma Na/Cr)
  48. FeNa, urine Na, and BUN/Cr in prerenal failure
    <1%, <20, and >20
  49. reason myoglobin is toxic
    is converts to ferrihemate in acidic environment, which is toxic to renal cells
  50. release of purines and pyrimidines leading to hyperphosphatemia and inc. uric acid
    tumor lysis syndrome
  51. treatment of tumor lysis syndrome (4)
    hydration, allopurinol, diuretics, urine alkalinization
  52. location where vitamin D becomes 25-hydroxylated
    liver
  53. location where vitamin D becomes 1-hydroxylated
    kidney
  54. effect of vitamin D on calcium
    inc calcium binding protein, causing increased intestinal Ca absorption
  55. transporter of iron
    transferring
  56. storage form of iron
    ferritin

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