Calculate the daily maintenance fluids needed for a 60-kg female
A 60-kg female would receive a total of 2100 mL of fluid daily: 1000 mL for the first 10 kg of body weight ( 10 kg x 100 mL/kg/ day), 500 mL for the next 20 kg (10 kg x 50 mL/kg/day), and 80 mL for the last 40 kg (40 kg x 20 mL/kg/day).
A patient who has spasms in the hand when a blood pressure cuff is blown up most likely has
Asymptomatic hypocalcemia may occur with hypoproteinemia (normal ionized calcium), but symptoms can develop with alkalosis (decreased ionized calcium). In general, symptoms do not occur until the ionized fraction falls below 2.5 mg/ dL, and are neuromuscular and cardiac in origin, in duding paresthesias of the face and extremities, muscle cramps, carpopedal spasm, stridor, tetany, and seizures. Patients will demonstrate hyperreflexia and positive Chvostek sign (spasm resulting from tapping over the facial nerve) and Trousseau sign (spasm resulting from pressure applied to the nerves and vessels of the upper extremity, as when obtaining a blood pressure). Decreased cardiac contractility and heart failure can also accompany hypocalcemia.
The actual AG of a chronic alcoholic with Na 133, K 4, CI-101, HC03 - 22, albumin of2.5 mg/dL is:
The normal AG is <12 mmol/L and is due primarily to the albumin effect, so that the estimated AG must be adjusted for albumin (hypoalbuminemia reduces the AG).
Corrected AG = actual AG + [2.5(4.5 - albumin)]
The effective osmotic pressure between the plasma and interstitial fluid compartments is primarily controlled by:
The dissolved protein in plasma does not pass through the semipermeable cell membrane, and this fact is responsible for the effective or colloid osmotic pressure.
The metabolic derangement most commonly seen in patients with profuse vomiting:
Hypochloremic, hypokalemic metabolic alkalosis can occur from isolated loss of gastric contents in infants with pyloric stenosis or in adults with duodenal ulcer disease. Unlike vomiting associated with an open pylorus, which involves a loss of gastric as well as pancreatic, biliary, and intestinal secretions, vomiting with an obstructed 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 resulting hypokalemia leads to the excretion of hydrogen ions in the face of alkalosis, a paradoxic aciduria. Treatment includes replacement of the volume deficit with isotonic saline and then potassium replacement once adequate urine output is achieved.
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