# AP Lecture 1

 .remove_background_ad { border: 1px solid #555555; padding: .75em; margin: .75em; background-color: #e7e7e7; } .rmbg_image { max-height: 80px; } What percent of the body is water? 60% What fraction of water is intracellular? 2/3 What fraction of water is extracellular? 1/3 NPO defecit calculation: 4-2-1 rule. or add 40 to weight in kg above >20 kg. Minimal fluid loss due to evaporation: 2-4ml/kg/hr Moderate fluid loss due to evaporation: 4-6ml/kg/hrExample: chole Severe fluid loss due to evaporation: 6-8ml/kg/hrExample: Bowel ressection, open surgery Define third Spacing: Refers to an internal redistribution of fluids,caused by leaking of intravascular fluid from inflamed tissue How much blood is absorbed by a small lap? 10 ml How much blood is absorbed by a large lap? 100 ml Define Crystalloid: Solution of inorganic and small organic molecules dissolved in water. Main solute is saline or glucose. Crystalloid advantges (4): safenontoxicreaction freeinexpensive Crystalloid disadvantges: short half life (30-60 min)edema occurs with large volumesfluid replacement in a 3:1 ratio D5W: A) components B) pH C)mOsm/L A) Dextrose 5g/LB) 5.0C) 253 0.9 Sodium Chloride: A) components B) pH C)mOsm/L A)Na (154), Cl (154, B)4.2C)308 LR: A) components B) pH C)mOsm/L A)Na (130), Cl (109), K (4.0), Ca (3.0), Lactate (28)B)6.5C)273 Plasma-Lyte: A) components B) pH C)mOsm/L A)Na (140), Cl (98), K (5.0), Mg (3.0), acetate (27)B)7.4C)294 reguarding osmolarity compared to the normal human blood, LR is HYPOosmotic reguarding osmolarity compared to the normal human blood, NS is HYPERosmotic Who should not receive LR? renal patients (k), blood transfusion (ca) What condition can a saline solution cause? hyperchloremic metabolic acidosis What condition can LR cause? Metabolic alkalosis Why is normal saline used in neuro cases? NS pulls h2o from brain tissue Define Colliod: homogenous noncrystalline substance consisting of large molecules dissolved in a solvent.  Colloid Advantages: Longer half lifemore efficient for replacing severe fluid defecitRatio of replacement 1:1 half life of hetastarch 6-12 hrs up to 17days Common colloids albumindextranhetastarchhespan (ns)Hextend (LR) Natural Colloids: A) side effects B) molecular weight A) hyocalcemia allergic reaction, impared lung function, hypotension synthetic colloids: dextranhetastarch Dextran D40 mol weight 40,000 Dextran: A)half life B) side effects A) 6-12 hoursB) coagulopathy, renal dysfunction, anaphalaxis, osmotic diuresis Hetastarch: A) half life B) side effects A) 6-12 hrs up to 17 daysB) coagulopathy, anaphylactiod rxns Colloid Distribution in body 100% extracellular --> 100% intravascular Normal Na level: 135-145 mEq/L Normal K level: 3.5-5.0 mEq/L Normal Ca level: 8.5-10 mEq/L Normal MG level: 1.5-2.5 mEq/L Normal Cl- levels: 100-106 mEq/L Normal HCO3- levels: 22-26 mEq/L Key regulator of water balance in the body Na+ Hyponatremia occurs when plasma sodium level is? < 135 mEq/L Hyponatremia causes: (true loss) True loss of Na- excess sweating, vomiting, diarrhea, burns, diuretics Dilutional Hyponatremia: Excess TBW due to excess ADH release (stress, SNS, SIADH), TURP syndrome Most common type of hyponatremia DILUTIONAL Hyponatremia has what effect on MAC? DECREASE Symptoms of hyponatremia: Neuro symptoms (N&V, visual, confusion, agitation, coma, seizure, muscles cramps, weakness, myoclonus) Na level <123 mEq/L leads to what? Cerebral Edema Na <100 mEq/L leads to what? cardiac symptoms HYPERVOLEMIC hyponatremia can cause what? pulmonary edema, hypertension, heart failure How to treat Hyponatremia: replace Na def slowly,Diuretics for fluid overload (TURP) What can occur if Na is not corrected SLOWLY? Central Pontine Myelinolysis define Central Pontine Myelinolysis demyelination of of nerves in brain due to fluctuation in osmotic forces. causes paralysis and death HYPERnatremia: definition and cause Na > 145 mEq/LWater loss dues to diabetes insipidus (ADH low), GI, diuresis, sweat, thirst impairment in hypothalmus Hypernatremia has what effect on MAC? INCREASE HYPERnatremia treatment: diuretics and hypotonic crystalloids to restore normal osmolality/volume. CORRECT SLOWLY MOST abundant ECF cation: Na MOST abundant ICF cation: K Three things that lower K in plasma hyperventilationB2 agonistsHCO3- long term maintenance of K: aldosterone from kidneys 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. Define Hypokalemia: K< 3.5 mEq/L Hypokalemia causes: starvationexcess renal loss- diuretics, met alk, hpyomagnesemiaGI loss- vomiting, diarrheaECF to ICF shift due to B2 agonist, insulin, hyperventilation, alkalosis Hypokalemia symptoms: arrythmia, muscle weakness, ST depression, t wave depression, U wave presence Hypokalemia treatment: give K slowly Hyperkalemia define: >5.3 mEq/L Hyperkalemia causes: altered internal K - acidosis, low insulin, cell necrosis, MHDrugs- Succ, Ace-I, digitalis, B blockersaltered external K- renal disease, decreased excretion Pseudohyperkalemia cause: Lysis of cells at sample site, for example if IV if diffucult, or tech problems. Symptoms of Hyperkalemia: PEAK T WAVES, muscle weakness, wide QRS, v-fib Hyperkalemia treatment: insulin, Ca, glucose, hyperventilate Why is calcium given when treating Hyperkalemia? To protect and stabilize heart Calcium balance is controlled by: (2) PTH- increasesCalcitonin- decreases What percentage of calcium is bound to protein? 40% What percentage of calcium is ionized and phys. active? 50% What percentage of calcium is is nonionized, chelated with anions? what are these anions? 10% phosphate, citrate, sulfate Define Hypocalcemia: Ca <8.5 mEq/dL, ionized <1.1-1.4 mmol/L Hypocalcemia Causes: LOW PTHineefective PTHLow albuminiatragenic in OR due to admin of blood products Hypocalcemia symptoms: mental change, tetany, laryngospasm, hypotension, heart block Hypocalcemia tx: give Ca slowly What two forms of Ca are used to treat hypocalcemia? CaClCaglucinate Hypercalcemia causes: hyperparathyroidism, excess vit d, renal failure, bone fracture hypercalcemia symptoms: bone pain, urination, thirst hypercalcemia treatment: diuretics EKG effects of calcium disturbance (little man on R) Hyper- increase in T wave (peaked T)Hypo- prolonged ST Magnesium has what effect on ACH? inhibits Magnesium is a Ca ______. antagonist Magnesium is a cofactor for uptake of what electrolyte? K Magnesium has what effect on vessels? dilate What electrolyte is useful as a membrane stablizer when treating arrythmias? Mg Hypomagnesemia define: Mg <1.5 mEq/L Hypomagnesemia occurs in what pt's? athletes, critical care, high metabolic states (pregnancy), diarrhea/diuretics, CHRONIC ALCOHOLICS Hypomagnesemia signs: CNS irritability Hypomagnesemia tx: magnesium sulfate (1-2 mEq/kg) over 8 hoursIV during arrythmia Hypermagnesemia define: Mg >2.5 mEq/L Hypermagnesemia: Rare but can occur with renal pt's Hypermagnesemia s/s: sedation, hypoventilation, bradycardia, hypotension, muscle weakness Hypermagnesemia tx: diuretics, fluid loading, dialysis What percentage of Mg is excreted by the kidneys? 100% When should Blood gases be taken? baselineif sig changes occurhourly to monitor pt in certain cases Define RES ACIDOSIS: pH <7.35PaCO2 >45mmHg RES ACIDOSIS cause: Hypoventilation. Low pH = _____ CO2 HIGH Define RES ALKALOSIS: pH >7.45PaCO2 < 35mmHg High pH = ____ CO2 LOW define MET ACIDOSIS: pH <7.35HCO3 <22mEq/LBE > -2 mEq/L MET ACIDOSIS Tx: treat underlying cause MET ACIDOSIS = _____ bicarb/pH LOW MET ALKALOSIS = _____ bicarb/pH HIGH Define MET ALKALOSIS: pH >7.45HCO3 >26mEq/L .remove_background_ad { border: 1px solid #555555; padding: .75em; margin: .75em; background-color: #e7e7e7; } .rmbg_image { max-height: 80px; } AuthorAnonymous ID191392 Card SetAP Lecture 1 DescriptionQuestions and key points of Lecture 1. (Fluids, Electrolytes, Acid/Base) Updated2013-01-04T23:19:48Z Show Answers