Fluid Electrolyte and Acid Base Disorders

Surgery

Assumptions

The student understands: the distribution of fluids and electrolytes in the body compartments; the role of the kidneys in regulating fluid and electrolyte balance; the basic physiology and biochemistry of the process of respiration.

Knowledge Objectives

Through their reading and patient care experiences, at the end of the rotation students should be able to:

Fluids and Electrolytes

List the normal range of Na+, K+, HCO3-, Cl- in serum and indicate how these ranges change in perspiration, gastric juice, bile and ileostomy contents.
List at least four endogenous factors that affect renal control of sodium and water excretion.
List least six symptoms or physical findings of dehydration.
List and describe the objective ways of measuring fluid balance.
List the electrolyte composition of the following solutions:
normal (0.9%) saline
1/2 normal saline
1/3 normal saline
5% dextrose in water
Ringer’s lactate
In the following situations, indicate whether serum Na, K, HCO3, Cl and blood pH will remain stable, rise considerably, rise moderately, fall moderately, or fall considerably:
excessive gastric losses
high volume pancreatic fistula
small intestine fistula
biliary fistula
diarrhea
In the following situations, indicate whether serum and urine Na, K, HCO3, Cl and osmolality will remain stable, rise considerably, rise moderately, fall moderately, or fall considerably:
acute tubular necrosis
dehydration
inappropriate ADH secretion (SIADH)
diabetes insipidus
congestive heart failure
Describe the possible causes, appropriate laboratory studies needed, and treatment of the following conditions:
hypernatremia
hyponatremia
hyperkalemia
hypokalemia
hyperchloremia
hypochloremia
Describe the concept of a "third space" and list those conditions that can cause fluid sequestration of this type.
Acid Base Balance

List the physiological limits of normal blood gases.
List the factors that effect oxygen delivery and consumption.
Indicate the mechanisms, methods of compensation, differential diagnosis, and treatment of the following acid base disorders:
acute metabolic acidosis
acute respiratory acidosis
acute metabolic alkalosis
acute respiratory alkalosis