42 Questions
Which compartment in the body contains ⅔ of the total water weight?
Intracellular
What is the primary determinant of intracellular/extracellular osmotic pressure?
Sodium (Na)
Which type of fluid overload is most commonly caused by medical treatment?
Intravascular fluid overload
What is the ionic composition of Lactated Ringer's solution (LR) similar to?
Plasma
What formula is used to calculate serum osmolality?
(2 × Na) + (glucose/18) + (BUN/2.8)
What type of fluid should be used for IV maintenance after major adult gastrointestinal surgery during the first 24 hours?
Lactated Ringer's (LR)
Which medication is recommended for treating hyperphosphatemia associated with renal failure?
Sevelamer hydrochloride (Renagel)
What is the most likely cause of hypophosphatemia associated with failure to wean from the ventilator and muscle weakness?
PO4 shift from extracellular to intracellular
What is the recommended treatment for respiratory acidosis due to high CO2 from low tidal volumes or low respiratory rate?
Increase minute ventilation
What is the primary cause of high anion gap acidosis known as 'MUDPILES'?
Excessive production of fixed acids
What is the usual cause of normal anion gap acidosis?
Loss of Na/HCO3 −
What can correction of acidosis lead to?
Hypokalemia
What is the most important treatment for correcting the Cl− deficit in metabolic alkalosis?
Normal saline
Which of the following is the best indicator of adequate volume replacement during open abdominal operations?
Urine output
What is the daily gastrointestinal fluid secretion range for the stomach?
1-2 L/day
Which solution is recommended for replacement of fluid losses from sweat or gastric losses?
Normal saline
What are the symptoms of hypernatremia?
Restlessness, irritability, seizures
Which electrolyte can cause peaked T waves on EKG and arrhythmias when present in high levels?
Potassium
What are the symptoms of hypokalemia?
Disappearing T waves, muscle cramps, fatigue, weakness
Which electrolyte imbalance may be caused by parathyroidectomy or magnesium deficiency?
Calcium imbalance
What is the normal body potassium requirement per day in mEq/kg?
0.5-1.0 mEq/kg/day
Which electrolyte imbalance can lead to perioral tingling and numbness, hyperreflexia, and prolonged QT interval?
Hypocalcemia
What is the normal body sodium requirement per day in mEq/kg?
1–2
What is the most important treatment for correcting hyperkalemia?
Insulin
What is the primary cause of high anion gap acidosis known as 'MUDPILES'?
Ethanol abuse
What type of fluid should be used for IV maintenance after major adult gastrointestinal surgery during the first 24 hours?
Lactated Ringer's solution
Which compartment in the body contains ⅔ of the total water weight?
Intracellular compartment
What are the symptoms of hypernatremia?
Restlessness, irritability, seizures
Which electrolyte can cause peaked T waves on EKG and arrhythmias when present in high levels?
Potassium
What is the ionic composition of normal saline (0.9%) solution?
Na 154 and Cl 154
Which fluid should be used for IV maintenance after major adult gastrointestinal surgery during the first 24 hours?
Lactated Ringer’s
What is the recommended fluid to switch to after 24 hours of major adult gastrointestinal surgery?
D5 ½ NS with 20 mEq K+
What is the formula for calculating serum osmolality?
(2 × Na) + (glucose/18) + (BUN/2.8)
What is the most common cause of volume overload?
Iatrogenic
Where does third space fluid reside in the body?
Interstitial space
What determines the plasma/interstitial compartment oncotic pressures?
Proteins
Where does two-thirds of the extracellular water reside in the body?
Interstitial
What is the primary cause of high anion gap acidosis known as 'MUDPILES'?
Rapid infusion of HCO3-deficient fluids
What is the usual cause of normal anion gap acidosis?
Loss of Na/HCO3-
Which electrolyte imbalance may be caused by parathyroidectomy or magnesium deficiency?
Hypocalcemia
What can correction of acidosis lead to?
Hypokalemia
What is the most important treatment for correcting hyperkalemia?
Bicarbonate
Study Notes
-
5% dextrose infusion stimulates insulin release and prevents protein breakdown, providing 150 g glucose per day (525 kcal/day).
-
During open abdominal operations, normal fluid loss is 0.5–1.0 L/h, with insensible losses being 10 cc/kg/day (30 L/day for a 70 kg person).
-
Best indicator of adequate volume replacement is urine output, with the goal being at least 0.5 cc/kg/h.
-
Insensible losses increase with fever, burns, large open wounds, or ventilated patients.
-
For significant dehydration, replace fluid losses with appropriate solutions based on the source: normal saline for sweat or gastric losses, and lactated Ringer's for pancreatic, biliary, or small bowel losses.
-
Gastrointestinal fluid secretion ranges from 1–2 L/day for the stomach, 500–1,000 mL/day for the biliary and pancreatic systems, and 500–1,000 mL/day for the duodenum.
-
Electrolyte losses include sodium, potassium, bicarbonate, and calcium, with various sources and methods for replacement depending on the electrolyte in question.
-
Kidneys can remove electrolytes such as potassium, calcium, magnesium, phosphate, urea, and creatinine.
-
Normal body potassium requirement is 0.5–1.0 mEq/kg/day, and normal sodium requirement is 1–2 mEq/kg/day.
-
Hyperkalemia symptoms include peaked T waves on EKG and arrhythmias, and can be treated with calcium gluconate, insulin, and sodium bicarbonate.
-
Hypokalemia symptoms include disappearing T waves, muscle cramps, fatigue, and weakness. It may also be due to pseudohyperkalemia.
-
Hypernatremia symptoms include restlessness, irritability, seizures, and usually result from poor fluid intake.
-
Hyponatremia symptoms include headaches, nausea, vomiting, seizures, and can be caused by fluid overload, isotonic fluid loss, or pseudohyponatremia.
-
Hypocalcemia symptoms include perioral tingling and numbness, hyperreflexia, and prolonged QT interval, and may be caused by parathyroidectomy or magnesium deficiency.
-
Hypomagnesemia symptoms include irritability, confusion, hyperreflexia, seizures, and may be caused by massive diuresis, chronic TPN without magnesium replacement, or ETOH abuse.
-
Phosphate imbalances can result in various symptoms and may require specific treatment approaches.
-
Calcium levels can be affected by various factors and can cause significant symptoms.
-
Electrolyte balance is important to prevent complications and maintain overall health.
-
5% dextrose infusion stimulates insulin release and prevents protein breakdown, providing 150 g glucose per day (525 kcal/day).
-
During open abdominal operations, normal fluid loss is 0.5–1.0 L/h, with insensible losses being 10 cc/kg/day (30 L/day for a 70 kg person).
-
Best indicator of adequate volume replacement is urine output, with the goal being at least 0.5 cc/kg/h.
-
Insensible losses increase with fever, burns, large open wounds, or ventilated patients.
-
For significant dehydration, replace fluid losses with appropriate solutions based on the source: normal saline for sweat or gastric losses, and lactated Ringer's for pancreatic, biliary, or small bowel losses.
-
Gastrointestinal fluid secretion ranges from 1–2 L/day for the stomach, 500–1,000 mL/day for the biliary and pancreatic systems, and 500–1,000 mL/day for the duodenum.
-
Electrolyte losses include sodium, potassium, bicarbonate, and calcium, with various sources and methods for replacement depending on the electrolyte in question.
-
Kidneys can remove electrolytes such as potassium, calcium, magnesium, phosphate, urea, and creatinine.
-
Normal body potassium requirement is 0.5–1.0 mEq/kg/day, and normal sodium requirement is 1–2 mEq/kg/day.
-
Hyperkalemia symptoms include peaked T waves on EKG and arrhythmias, and can be treated with calcium gluconate, insulin, and sodium bicarbonate.
-
Hypokalemia symptoms include disappearing T waves, muscle cramps, fatigue, and weakness. It may also be due to pseudohyperkalemia.
-
Hypernatremia symptoms include restlessness, irritability, seizures, and usually result from poor fluid intake.
-
Hyponatremia symptoms include headaches, nausea, vomiting, seizures, and can be caused by fluid overload, isotonic fluid loss, or pseudohyponatremia.
-
Hypocalcemia symptoms include perioral tingling and numbness, hyperreflexia, and prolonged QT interval, and may be caused by parathyroidectomy or magnesium deficiency.
-
Hypomagnesemia symptoms include irritability, confusion, hyperreflexia, seizures, and may be caused by massive diuresis, chronic TPN without magnesium replacement, or ETOH abuse.
-
Phosphate imbalances can result in various symptoms and may require specific treatment approaches.
-
Calcium levels can be affected by various factors and can cause significant symptoms.
-
Electrolyte balance is important to prevent complications and maintain overall health.
Test your knowledge about the composition of total body water, including the distribution between intracellular and extracellular compartments, and the factors affecting it such as proteins and sodium. Explore the dynamics of body water and its implications for various physiological processes.
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