1 - Fluid and Electrolytes (Absite 2024)

Glutamine

Comprises 2/3 of the free intracellular amino acid pool

The most abundant amino acid in the human body is _____

Acid administration; loss of bicarbonate

Metabolic acidosis with a normal anion gap (AG) results from either _____ administration or a loss of ____ from gastrointestinal (GI) losses

Peaked T waves

ECG changes that may be seen with hyperkalemia include:

Peaked T waves (early change)

Flattened P wave

Prolonged PR interval (first- degree block)

Sine wave formation

Ventricular fibrillation

_____ waves on ECG are an early sign of hyperkalemia

Congestive heart failure

This is due to decreased cardiac contractility

Severe hypocalcemia can lead to _____ heart failure

Serum bicarbonate

Helps determine whether the acidosis is due to increased acid generation or loss of bicarbonate

What is the best test to order in a patient showing clinical signs of metabolic acidosis with increased anion gap?

100 mL/kg/day for the first 10 kg

+

50 mL/kg/day for the second 10 kg

+

20 mL/kg/day for every kg after the first 20 kg

What is the formula to calculate daily maintenance fluid?

Trousseau sign

____ sign is a spasm resulting from pressure applied to the nerves and vessels of the upper extremity, as when obtaining a blood pressure

Chvostek sign

____ sign is a spasm resulting from tapping over the facial nerve

Protein

The effective osmotic pressure between the plasma and interstitial fluid compartments is primarily controlled by ______

Hypochloremic, hypokalemic metabolic alkalosis

Vomiting with an closed pylorus results only in the loss of gastric fluid, which is high in chloride and hydrogen, and therefore results in a hypochloremic alkalosis. Initially the urinary bicarbonate level is high in compensation for the alkalosis. Hydrogen ion reabsorption also ensues, with an accom­panied potassium ion excretion. In response to the associated volume deficit, aldosterone-mediated sodium reabsorption increases potassium excretion

The metabolic derangement most commonly seen in patients with profuse vomiting is _______

Arterial pH (ABG)

This is the only test that can confirm

What is the best determinant of whether a patient has a metabolic acidosis versus alkalosis?

Metabolic acidosis

Sodium chloride is mildly hypertonic, containing 154 mEq of sodium that is balanced by 154 mEq of chloride. The high chloride concentration imposes a significant chloride load on the kidneys and may lead to a hyperchloremic metabolic acidosis.

Excessive administration of normal saline for fluid resuscitation can lead to what metabolic derangement?

Correct extracellular fluid deficit

This is the most important step in treatment in order to prevent poor prognosis

In a patient with acute hypercalcemia, the first step in management is _____

PLR

PLR will allow restoration of perfusion and correct the metabolic acidosis by ending anaerobic metabolism

What is the best IVF to give in a patient with hemorrhagic shock and metabolic acidosis?

1. Hypophosphatemia

2. Hypomagnesemia

3. Hypokalemia

This is due to insulin that gets released as a result of carbohydrate intake

Refeeding syndrome is associated with the following electrolyte derangements:

1.

2.

3.