Fundamentals of Fluid Balance
I am the fluid compartment that contains the highest amount of fluid. Who am I ?
What is the intracellular fluid compartment?
I have a pH of 4.5-7, considered isotonic with the equal amounts of sodium and chloride and am useful in patients with hyponatremia, but be careful using me in patients with hyperchloremic metabolic acidosis. Who am I ?
What is normal saline?
The phenomenon of twitching of facial muscles when tapped is known as _____
Chvostek's sign
The nomogram used to remember all the causes of me are CAT MUDPILES. Who am I ?
What is High anion gap metabolic acidosis
I am the most frequently encountered electrolyte abnormality in acute care and when I am caused by volume depletion with solute loss I am called _________
What is Hypovolemic hypotonic hyponatremia?
We use pressure to allow for the movement of fluid between the interstitial space and plasma. Who are we? (Two answers)
What is hydrostatic pressure and colloid oncotic pressure?
I have a normal serum osmolarity, pH 6-7.5, 4 mEq of potassium per liter and my sodium content is closer to the normal serum content and less prone to cause acidosis, but be careful when using me in patients with liver failure or liver transplant patients. Who am I?
What is Lactated Ringers?
A carpal spasm when blood flow to the arm is restricted is known as: _________.
Trousseau's sign
I am a formula used to calculate the expected carbon dioxide level in a patient with metabolic acidosis (after 12-24 hours) and help to determine if the patient's respiratory compensation is adequate to normalize the metabolic acidosis. Who am I ?
Winter's formula
PaCO2= 1.5 [HCO3 -] +8 + 2
To treat me go slow and don't correct me to fast or you will have trouble. Use this formula to guide your treatment. What am I and what is the formula?
What is 1. Hypernatremia 2. Free Water Deficit- TBW = 0.6 x body wt (kg) x [(measured Na+/normal Na (140 mEq/L) -1]
Fluid tension or tonicity in the body is regulated by us. What organs are we (2)?
What is the pituitary gland and the kidneys?
I am a fluid that has glucose but I do not contain a significant source of nutrition. I am hypertonic initially but become hypotonic after infusion. Who am I ?
D5 0.45% NS
Circumoral numbness is located in this region and is a sign of ________. (Two answers)
Numbness around the mouth; hypocalcemia
I am seen in patients as a primary response to a respiratory acidosis and seen as a secondary response to a metabolic acidosis. What am I ?
Hyperventilation
I am a hypertonic crystalloid and I am used for which two types of clinical situations? (Three answers who and I and what am I used for)
What is 1. 3% Sodium Chloride 2. symptomatic hyponatremia, and 3. increased intracranial pressure?
We are three transport mechanisms responsible for intercompartmental fluid movement. Who are we? (Three answers)
What is 1. ATP (active transport), 2. Diffusion (passive transport) 3. Osmosis (passive transport)
I have supraphysiologic concentrations of sodium and chloride. Who am I and what am I used for?
What is 1. 3% Sodium Chloride or 23.4% sodium chloride. 2. Used as volume expanders to promote the movement of water into the intravascular space from the extravascular space for patients with increased intracranial pressures (purposely dehydrate cells in cerebral edema) or with severe symptomatic hyponatremia (i.e., in SIADH)
I am toxic to the heart when I am elevated.
Potassium.
When I am acidotic what 2 organs in my body help to correct it?
What is Lungs and kidneys
The determination of the need for the urgency of treatment of a patient is based on _________
What is the patient's symptoms
We are the 6 mechanisms that regulate extracellular volume. Who are we? (6 answers)
What is 1. Thirst 2. ADH3. Renin angiotensin system (RAS), 4. Atrial naturetic factor (ANF), 5. Volume stretch receptors (in the carotid sinus, aortic arch, cardiac atria, changes in in cardiac output, vascular resistance) 6. Sympathetic nervous system (release of epinephrine)
I contain large, insoluble molecules that do not readily cross the the cell membrane. I create high oncotic pressure and promote movement of fluid from the extravascular to the intravascular space. Who am I and am do I decrease mortality risk if I am used in acutely ill patients vs an isotonic solution
What is 1. Colloid solutions Albumin 25% 12.5g in 50 ml and Albumin 5% in 250 ml. 2. No. •While this volume expansion is appealing when attempting to avoid fluid volume overload in acutely ill patients, randomized control trials have yet to consistently demonstrate reduced mortality risk with the use of albumin versus an isotonic solution.
I can cause these 3 changes to the ECG and if I remain high can eventually cause this (4 answers)
1. Peaked T waves, 2. prolongation of PR, QRS 3. Merging of the T wave- sinewave 4. asystole
I have type 2 DM and have been vomiting for 2 days and have not been taking my insulin. I look pretty sick. HR 120 RR 40 BP 124/84. VBG is 7.08/15/56/3.9 with a lactate of 5.4. Other labs are Na+ 130, K+ 5.4, Cl- 89 CO2 <5, BUN 51, Cr 2.2, glucose 815, Ca++ 8.6, anion gap 36 and positive serum acetone. What is the interpretation of my lab results and my diagnosis?
What is 1. VBG- metabolic acidosis with some resp compensation, hyperglycemia, hyponatremia, hypochloremia, and hyperkalemia. 2. DKA
For every 100mg/dl increase in ____, there is a 1.6 mEq/L decrease in serum _____.
Sodium & glucose
Correction Factor: For every 100 mg/dL (5.6 mmol/L) increase in glucose concentration, there is a 1.6 mEq/L decrease in serum sodium12.