Mechanism of F&E balance
RAAS- Renin angiotensin aldosterone system
What are hypertonic solutions?
D5NS, D5LR, D51/2NS
Solutions with higher concentrations of salt or sugar
What is normal osmolarity?
280-290 mOsm/L
What is hyponatremia most significant effect?
cerebral edema
A common cause for this imbalance is a transcellular shift
Hyperkalemia
What functions to regulate water balance? It is also a potent arterial vasoconstrictor when released to decreased blood volume by baroreceptors.
ADH- Antidiuretic hormone
What are isotonic solutions?
NS, LR, plasmalyte
Has most favorable acid-base profile
Plasmalyte
What electrolyte is primarily maintained by the parathyroid hormone
Calcium
This imbalance is most likely caused by intraoperative hyperventilation and rapid mass transfusion
hypocalcemia
This hormone is stimulated by the stretch receptors located in the atrial walls.
ANP- atrial natriuretic peptide
Not recommended for diabetics
LR (in large amounts)- cause metabolic byproducts of lactate are gluconeogenic
Used in anesthetic practice as a volume expander in active blood loss not requiring transfusion
Albumin
The main causes for this imbalance are intestinal malabsorption and increased renal excretion
How fast should sodium be replaced?
No more than 1-2 meq/l/hr with 3% saline at 1-2 ml/kg/hr and not raised more than 10-15mmol/L in 24 hrs
This hormone is stimulated by increased preload or a hypervolemic state
ANP
What is a risk of a hypertonic solution?
Dehydration of neural cells causing osmotic demyelination syndrome
This fluid can contribute to the development of hyperchloremic metabolic acidosis
NS
What imbalance would be seen on an EKG with a slightly prolonged PR interval, a slightly peaked P wave, ST depression, a shallow T wave, and a prominent U wave
Hypokalemia
Hypermagnesemia
4-5 decreased DTR
5-7 hypotension
10 resp paralysis, coma
10-20 heart block & cardiac arrest
Renin interacts with angiotensinogen to produce angiotensin 1. Angiotensin 1 works with angiotensin-converting enzyme (ACE) to make angiotensin 2.
Osmolarity is 560, ph 4, calories 170, glucose 50. What am i?
D5NS
what is the Black box warning for hydroxyethyl starches
renal injury and increased mortality
This electrolyte imbalance has a serum osmolality of <270 and it involves three subcategories.
Hyponatremia
this imbalance inhibits the Na/K pump, decreasing ICV potassium
Hypomagnesemia