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Organize the following in order of HIGHEST total body water to LOWEST: woman, baby, man, body builder, fat woman
- Muscle and babies have a lot of water, fat doesnt:
- 1. Baby
- 2. Body builder
- 3. Woman
- 4. Fat woman
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Roughly, what percentage of body weight is water?
66% (2/3)
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First sign of volume overload?
Weight gain
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Composition of normal saline (in mEq of Na and Cl)
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Composition of LR (name all 5 electrolytes and their mEq in 1 L)
- Similar to body fluid composition (except for Ca)
- Na 130 mEq
- K 4 mEq
- Ca 3 mEq
- Cl 109 mEq
- lactate/HCO3 28 mEq
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What happens to the lactate in LR once it is infused?
Turns into lactate.
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Formula for plasma osmolarity and the normal values
- (2xNa) + (glucose/18) + (BUN/2.8)
- 280-295
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Amount of fluid loss in an open operation:
~1 L per hour
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What are insensible fluid losses for an average person (in cc/kg/day)? What is the composition of these fluid losses?
10 cc/kg/day all free water
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GI fluid secretion (in L/day):
Stomach:
Biliary:
Pancreas:
Duodenum:
- Stomach: 1-2 L/d
- Biliary: .5-1 L/d
- Pancreas: .5-1 L/d
- Duodenum: .5-1 L/d
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Daily Na+ requirement:
Daily K+ requirement:
- Daily Na+ requirement: 2 mEq/kg/d
- Daily K+ requirement: 1 mEq/kg/d
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Acronym for treatment of hyperkalemia:
- DC BIG K
- Dialysis if refractory to the following:
- Calcium
- Bicarb
- Insulin with Glucoe
- Kayexalate
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Maximum rate at which you can correct hyponatremia?
1 mEq/hr
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Formula for TBW:
TBW = 0.6 x weight in Kg (duh!)
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What is pseudohyponatremia? What are 2 causes?
- pseudohyponatremia results when excessive osmoles interfere with testing of serum Na concentration. Two causes:
- 1 - Hyperglycemia (i.e. DKA)
- 2 - Hyperlipidemia (as in pancreatitis)
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Formula for FeNa?
- Pee nacr over blood nacr:
- (urine na/ urine cr)/(serum na/serum cr)
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How many grams of dextrose in D10W? How many Kcal?
D10 = 10 g/100 cc = 100 g/liter
100 g x 3.4 kcal/g = 340 kcal in 1 liter D10W
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Effect of loop diuretics on CALCIUM:
Effect of thiazide diuretics on CALCIUM:
- Loops Lower Ca
- ↑hiazides increase Ca
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Treatment of hypercalcemia:
- NS at ~200 cc/h (patients are volume down)
- Lasix (loops lower!)
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Acronym for treatment of hypercalcemia caused by malignancy:
- D/C M Ad calcium:
- -Dialysis if the folowing don't work:
- -Calcitonin
- -Mithramycin
- -AlDaronic acid
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Treatment of hypocalcemia:
Replace magnesium, calcium
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Most common malignancy to cause hypercalcemia:
breast cancer
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Anion Gap formula:
AG = Na - (HCO3- + Cl-)
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Causes of anion gap acidosis (acronym)
- MUD PILES
- Methanol
- Uremia
- DKA
- Paraldehydes
- INH
- Lactic acidosis
- Ethylene glycol
- Salicylates
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Typical, surgical cause of normal AG acidosis:
- High output ileostomy: loss of Na/HCO3-
- Also: Excessive ressucitation with NaCl
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Describe the metabolic derrangement seen with excessive NGT fluid losses (also seen in pyloric stenosis...) Explain why this occurs:
- Hypochloremic, hypokalemic metabolic alkalosis:
- Loss of HCl from GI causes alkalosis and low Cl-
- Loss of volume>reabsorb Na instead of K>low K
- Low K+>try to reabsorb K, excrete H+>paradoxical aciduria
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What is tumor lysis syndrome? What metabolic derrangement results? What is the treatment?
- Tumor lysis>purines/pyrimidines> ↑ PO4-, ↑uric acid, ↓ Ca++. This can increase BUN/Cr, cause EKG changes.
- Tx: bolus with NS, allopurinol (decreased uric acid), diuretics (↑hiazides!), alkalinize pee
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