Fluids/Electrolytes/Nutrition

Firas Madbak

TEST TAKING TIPS

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Test Taking Tips

Manifestations of trace element deficiencies (eg, chromium, zinc, copper, etc) tend to be a recurring theme on the test.
Know the basics of TPN. Learn the indications, content, and adverse effects.
Do not confuse the ECG findings associated with various electrolyte abnormalities.

FLUIDS

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Name the 2 major body fluid compartments:

Intracellular and extracellular

Extracellular fluid is divided into these 2 subcompartments:

Interstitial fluid and intravascular fluid

Mnemonic for the composition of body fluid:

60, 40, 20; 60% total body weight fluid, 40% total body weight intracellular, 20% total body weight extracellular

Approximate percentage of body weight that is fluid:

Approximate percentage of body fluid that is extracellular:

Approximate percentage of body weight that is intracellular:

Percentage of extracellular fluid within the vascular compartment in the venous system:

Percentage of extracellular fluid within the vascular compartment in the arterial system:

The approximate percentage of body weight that blood accounts for in an adult:

7% (so to estimate how many liters of blood in a 70-kg man; 0.07 × 70 kg = 5 liters)

Requirement of water per 24-hour period:

~30 to 35 mL/kg

FIGURE 7-1.

Chemical composition of body fluid compartments. (Reproduced form Brunicardi FC, Anderson DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Requirement of sodium per 24-hour period:

~1 to 2 mEq/kg

Requirement of chloride per 24-hour period:

~1.5 mEq/kg

Requirement of potassium per 24-hour period:

~1 mEq/kg

Name the sources and the amount of normal daily water loss:

Respiratory losses: 500 to 700 cc
Sweat: 200 to 400 cc
Urine: 1200 to 1500 cc
Feces: 100 to 200 cc

Name the sources and the amount of insensible fluid loss:

Skin: ~300 cc/24 h
Breathing: 500 to 700 cc/24 h
Feces: 100 to 200 cc/24 h

General rate of fluid loss during an open abdominal procedure in the absence of measurable blood loss:

0.5 to 1.0 L/h

Name the sources and the amount of normal daily electrolyte loss:

Chloride: 150 mEq, sodium: 100 mEq, potassium: 100 mEq

Name the sources and the amount of daily secretions:

Saliva: ~1500 cc/24 h
Gastric: ~2000 cc/24 h
Small intestine: ~3000 cc/24 h
Bile: ~1000 cc/24 h
Pancreatic: ~600 cc/24 h

State the electrolyte composition of sweat:

30 to 50 mEq sodium, 5 mEq potassium, 45 to 55 mEq hydrogen

State the electrolyte composition of gastric secretions:

40 to 65 mEq sodium, 90 mEq hydrogen, 100 to 140 mEq chloride

State the electrolyte composition of biliary secretions:

135 to 155 mEq sodium, 5 mEq potassium, 80 to 110 mEq chloride, 70 to 90 mEq bicarbonate

State the electrolyte composition of pancreatic secretions:

135 to 155 mEq sodium, 5 mEq potassium, 55 to 75 mEq chloride, 70 to 90 mEq bicarbonate

State the electrolyte composition of ileostomy output:

120 to 130 mEq sodium, 10 mEq potassium, 50 to 60 mEq chloride, 50 to 70 mEq bicarbonate

State the electrolyte composition of diarrhea:

25 to 50 mEq sodium, 35 to 60 mEq potassium, 20 to 40 mEq chloride, 30 to 45 mEq bicarbonate

Define the "third space."

Fluid accumulation in the interstitium of tissues (first 2 spaces: intravascular and intracellular)

When does third-spaced fluid tend to mobilize back into the intravascular space?

Postoperative day #3

What is the earliest sign of volume excess during the postoperative period?

Weight gain

Classic finding with overaggressive nasogastric tube suctioning or long-standing vomiting:

Hypokalemic hypochloremic metabolic alkalosis

Name the various mechanisms that loop diuretics employ to decrease pulmonary edema:

Inhibit active sodium absorption in the thick ascending loop of Henle, increase venous capacitance, stimulate vasodilatory prostaglandins leading to increased renal blood flow

Formula to calculate serum osmolality:

2 × sodium + urea/2.8 + glucose/18

How much sodium and chloride are in normal saline?

154 mEq Na⁺ and 154 mEq Cl^–

Composition of lactated Ringer's:

130 mEq Na⁺, 109 mEq Cl^–, 4 mEq K⁺, 28 mEq lactate, and 3 mEq calcium

How many grams of dextrose in a liter of D5W?

50 g; D5W is a 5% solution of dextrose (5 g dextrose/100 cc × 1000 cc/1 L = 50 g dextrose)

The 2 "rules" for the calculation of maintenance fluids:

100/50/20 rule and 4/2/1 rule; for both rules cc/kg for first 10 kg/cc/kg for next 10 kg/cc/kg for every kg >20 kg

Name the standard maintenance fluid used in an adult:

D5 1/2 normal saline (NS) with 20 mEq KCl

Name the standard maintenance fluid used in a pediatric patient:

D5 1/4 NS with 20 mEq KCl

Usual minimal urine output for an adult:

~30 mL/h or 0.5 mL/kg/h

How much of a 1-L NS bolus will stay intravascular in a 5-hour period?

~200 cc or 20%

ELECTROLYTES

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Normal range for sodium:

135 to 145 mEq/L

Define pseudohyponatremia and list causes:

Spuriously low lab result for sodium; hyperglycemia, hyperlipidemia, hyperproteinemia

Name the 3 types of hyponatremia:

Hypovolemic, euvolemic, hypervolemic

Name surgical causes of hypovolemic hyponatremia:

Burns, diaphoresis, diuretics, hypoaldosteronism, NG suctioning, pancreatitis, vomiting

Name surgical causes of euvolemic hyponatremia:

CNS abnormalities, drugs, syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

Name surgical causes of hypervolemic hyponatremia:

Congestive heart failure, cirrhosis, iatrogenic, renal failure

Signs and symptoms of hyponatremia:

Coma/confusion, ileus, lethargy, nausea/vomiting, seizure, weakness

Treatment of hypovolemic hyponatremia:

Correct the underlying cause, give IV NS

Treatment of euvolemic hyponatremia (SIADH):

Acute treatment with furosemide and normal saline; fluid restriction

Treatment of hypervolemic hyponatremia (dilutional):

Fluid restriction and diuretics

Grave consequence of correcting hyponatremia too quickly:

Myelinolysis (formerly known as central pontine myelinolysis)

Formula to calculate the sodium deficit:

(normal sodium concentration – observed sodium concentration) × total body water; Remember: total body water = 0.6 × weight (kg)

Approximately how much does the apparent serum sodium concentration fall for each 100 mg/dL rise in blood glucose level above normal?

1.6 to 3.0 mEq/L

Maximal rate of sodium correction for acute hyponatremia:

1 to 2 mEq/L/h for 3 to 4 hours until neurologic symptoms subside or until plasma Na is >120 mEq/L

Maximal rate of sodium correction for chronic hyponatremia:

0.5 to 1 mEq/L/h or no faster than 10 to 12 mEq/L in the first 24 hours and 18 mEq/L in the first 48 hours

Name surgical causes of hypernatremia:

Dehydration, diabetes insipidus, diaphoresis, diarrhea, diuresis, iatrogenic, vomiting

Signs and symptoms of hypernatremia:

Confusion, peripheral/pulmonary edema, respiratory paralysis, stupor, seizures, tremors

Treatment of hypernatremia:

Slow supplementation of 1/4 NS or 1/2 NS over days

Formula to calculate the free water deficit:

Total free water deficit = 0.6 × weight (kg) × [(Serum Na⁺/140) – 1]

What is the normal range for potassium:

3.5 to 5.0 mEq/L

Critical values for potassium:

K⁺ <2.8 mEq/L or >6.0 mEq/L

Name some surgical causes of hypokalemia:

Alkalosis, diuretics, drugs (steroids/antibiotics), diarrhea, iatrogenic, insulin, intestinal fistula, NG suctioning, vomiting

Signs and symptoms of hypokalemia:

Ileus, weakness, tetany, nausea/vomiting, paresthesia

EKG findings of hypokalemia:

Flattened T waves, U waves, ST segment depression, atrial fibrillation, premature atrial complexes/premature ventricular complexes

Acute treatment for hypokalemia:

IV KCl

Maximum amount of potassium that can be administered through a peripheral IV:

10 mEq/h

FIGURE 7-2.

Evaluation of sodium abnormalities. ADH, antidiuretic hormone; SIADH, syndrome of inappropriate secretion of antidiuretic hormone. (Reproduced form Brunicardi FC, Anderson DK, Billiar TR, et al. Schwartz's Principles of Surgery. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Maximum amount of potassium that can be administered through a central line:

20 mEq/h

Most common cause for an electrolyte mediated ileus in a surgical patient:

Hypokalemia

Digitalis toxicity is worsened by this electrolyte condition:

Hypokalemia

Name surgical causes of hyperkalemia:

Iatrogenic, diuretics, acidosis, trauma, hemolysis, renal failure, blood transfusion

Signs and symptoms of hyperkalemia:

Areflexia or decreased deep tendon reflexes, paresthesia, paralysis, weakness, and respiratory failure

EKG findings of hyperkalemia:

Peaked T waves, prolonged PR, wide QRS, depressed ST segment, ventricular fibrillation, bradycardia

What is the treatment for hyperkalemia?

IV calcium, sodium bicarbonate, dextrose and insulin (1 amp 50% dextrose and 10 U insulin), albuterol, kayexalate, furosemide, dialysis

Most of the calcium in the body is contained within:

Bone

Percentage of serum calcium that is nonionized and bound to plasma protein:

~50%

Percentage of serum calcium that is nonionized and bound to substances other than plasma protein in the plasma:

How much does a 1-g drop in protein decrease the measured total serum calcium?

0.8 mg/dL

In the setting of rapid transfusion, how much calcium should be given per 500 cc of transfused blood?

0.2 g/500 cc transfused blood

Name some surgical causes of hypocalcemia:

Acute pancreatitis, aminoglycosides, diuretics, hypomagnesemia, intestinal bypass, osteoblastic metastasis, renal failure, rhabdomyolysis, sepsis, short bowel syndrome, vitamin D deficiency

Formula to determine the calcium level with hypoalbuminemia:

Serum calcium + [(4 – measured albumin) × 0.8]

Signs and symptoms of hypocalcemia:

Abdominal cramping, Chvostek signs, confusion, depression, hallucinations, increased deep tendon reflexes, laryngospasm, paranoia, perioral paresthesia, seizures, stridor, tetany, Trousseau sign

Define Chvostek sign:

Tapping of facial nerve with resultant facial muscle spasm

Define Trousseau sign:

Utilization of a blood pressure cuff to occlude blood flow to the forearm with resultant latent tetany evidenced by carpal spasm

EKG findings hypocalcemia:

Peaked T waves, prolonged QT and ST intervals

Acute treatment of hypocalcemia:

IV calcium supplementation

Chronic treatment of hypocalcemia:

PO calcium and vitamin D supplementation

Mnemonic for hypercalcemia:

Chimpanzees: Calcium supplementation, hyperparathyroidism (primary/tertiary)/hyperthyroidism, iatrogenic/immobility, milk alkali syndrome/mets, Paget disease, Addison disease/acromegaly, neoplasm, Zollinger-Ellison syndrome, excessive vitamin A, excessive vitamin D, sarcoid

Signs and symptoms of hypercalcemia:

Polydipsia, polyuria, and constipation and the classic "stones, bones, abdominal groans, and psychiatric overtones"

EKG findings of hypercalcemia:

Prolonged PR interval and shortened QT interval

Acute treatment for hypercalcemic crisis:

Normal saline volume expansion with furosemide diuresis

Additional options for treating hypercalcemia:

Bisphosphonates, calcitonin, mithramycin, steroids, and dialysis

What kind of diuretic should be avoided in the face of hypercalcemia?

Thiazide diuretics (calcium-sparing diuretic)

Normal range for magnesium:

1.5 to 2.5 mEq/L

Electrolyte abnormality associated with "impossible to correct" hypokalemia and hypocalcemia:

Hypomagnesemia

Name surgical causes of hypomagnesemia:

Aminoglycosides, diarrhea, gastric suctioning, hypocalcemia, renal failure, total parenteral nutrition (TPN), vomiting

Signs and symptoms of hypomagnesemia:

Asterixis, Chvostek sign, dysrhythmias, increased deep tendon reflexes, tachycardia, tetany, tremor, ventricular ectopy, vertigo

Treatment for acute hypomagnesemia:

IV magnesium sulfate (or magnesium chloride)

Treatment for chronic hypomagnesemia:

PO magnesium oxide

Name surgical causes of hypermagnesemia:

Iatrogenic, renal failure, TPN

Signs and symptoms of hypermagnesemia:

IV calcium, dextrose and insulin, dialysis, Lasix

Normal range for phosphorus:

2.5 to 4.5 mg/dL

Critical value for phosphorus:

<1.0 mg/dL

Name surgical causes of hypophosphatemia:

Alcohol abuse, gastrointestinal losses, inadequate supplementation, medications, renal loss, sepsis

Signs and symptoms of hypophosphatemia:

Ataxia, cardiomyopathy, hemolysis, poor response to pressors, rhabdomyolysis, neurologic dysfunction, weakness

Treatment for acute hypophosphatemia:

IV sodium phosphate or potassium phosphate

Treatment for chronic hypophosphatemia:

PO replacement (Neutra phos)

Name surgical causes of hyperphosphatemia:

Chemotherapy, hyperthyroidism, renal failure, sepsis

Signs and symptoms of hyperphosphatemia:

Calcification, heart block

List the disturbances seen with tumor lysis syndrome:

Hypocalcemia, hyperkalemia, hyperuricemia, hyperphosphatemia

Name the important intracellular buffer:

Phosphate buffer system and proteins

Name the primary extracellular buffering system:

Bicarbonate-carbonic acid system

Henderson-Hasselbalch equation:

pH = pK + log [HCO^–₃]/[CO₂]

Formula to calculate the anion gap:

Anion gap = Sodium – (bicarbonate + chloride)

Mnemonic for anion gap acidosis:

Mudpiles: methanol, uremia, diabetic ketoacidosis, paraldehyde, isoniazid, lactic acidosis, ethylene glycol, salicylates

Formula for functional excretion of sodium (FeNa):

FeNa = (urine sodium/urine creatinine)/(plasma sodium/plasma creatinine)

List some common laboratory values seen in a prerenal state:

BUN/Cr ratio >20, FeNa <1%, urine sodium <20, urine osmolality >500 mOsm

NUTRITION

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The term for the initial period during the activation of stress hypermetabolism where there is a decrease in oxygen consumption, cellular shock, and fluid imbalance lasting 24 to 36 hours:

Ebb phase

The term for the adaptation of the body to the ebb phase of stress hypermetabolism where body temperature, metabolic rate, and nitrogen loss are increased:

Flow phase

Sepsis/surgery/trauma can increase the kcal requirement by:

20% to 40%

The percentage increase of the basal metabolic rate for every degree above 38°C:

General method to calculate the calorie requirement for a burn patient:

25 kcal/kg/d + (30 kcal/d × %burn)

General method to calculate the protein requirement for a burn patient:

1 to 1.5 g/kg/d + (3 g × %burn)

Level of albumin that is a strong risk factor for morbidity/mortality after surgery:

<3.0 g/dL

Pregnancy can increase the kcal requirement by:

300 kcal/d

What fuel source does the brain use during progressive starvation?

Ketones

Most efficient form for the storage of calories:

Triglycerides

Amino acid that is the primary substrate for gluconeogenesis:

Alanine

Only amino acids to increase during stress:

Alanine and phenylalanine

Primary enzyme responsible for the transamination of amino acids (ammonia, α-ketoglutarate):

Glutamate dehydrogenase

Where does gluconeogenesis occur during late starvation?

Kidney

Name the places where glycogen is stored and the rough percentages:

One-third in liver and two-thirds in skeletal muscle

How long does it take to deplete glycogen stores during starvation?

24 to 36 hours

List obligate glucose users in the body:

Adrenal medulla, peripheral nerves red blood cells, white blood cells

Carbohydrate digestion begins with this enzyme:

Salivary amylase

What is the protein requirement for an average healthy adult male?

1 g protein/kg/d; 20% from essential amino acids

Protein digestion begins with this enzyme:

Pepsin

1 g of nitrogen is contained in how many grams of protein:

6.25 g of protein contains 1 g nitrogen

Formula to calculate the nitrogen balance:

(N_in – N_out) = [(protein/6.25) – (24 hour urine N + 4 g)]

Name the branched chain amino acids:

Isoleucine, leucine, valine

Where are branched chain amino acids metabolized?

Muscle

List the nutrients included in immune-enhancing formulas:

Arginine, glutamine, ω-3 fatty acids, ω-6 fatty acids

Where is iron absorbed?

Most in duodenum and some in jejunum

Where is Vitamin B12 (cobalamin) absorbed?

Terminal ileum

Where are bile salts absorbed?

Terminal ileum

Where are fat soluble vitamins absorbed?

Terminal ileum

Name the fat soluble vitamins:

Vitamin A, D, E, K

Where is calcium absorbed?

Actively in the duodenum and passively in the jejunum

What vitamin increased the oral absorption of iron?

Vitamin C

Fuel for colonocytes:

Short-chain fatty acids (butyrate)

Fuel for small bowel enterocytes:

Glutamine

Primary fuel for cancer cells:

Glutamine

Term for an acute form of childhood protein-energy malnutrition characterized by anorexia, edema, enlarged liver with fatty infiltrates, irritability, and ulcerating dermatoses:

Kwashiorkor

Term for severe protein-energy malnutrition characterized by energy deficiency and characterized by extensive tissue/muscle wasting and variable edema:

Marasmus

How many kcal are there in a gram of dextrose?

3.4 kcal/g

How many kcal are there in a gram of oral carbohydrates?

4 kcal/g

How many kcal are there in a gram of protein?

4 kcal/g

How many kcal are there in a gram of fat?

9 kcal/g

List metabolic complications from TPN:

Acid-base abnormalities
Excessive glucose resulting in hyperosmolar nonketotic coma with resultant dehydration
Increase in CO₂ production
Lipogenesis with resulting fatty liver/hepatic abnormalities

Maximal glucose administration for TPN delivered through a central line:

3 g/kg/h

For an average healthy adult male, what percentage of calories should come from fat?

Rate that should not be exceeded with fat infusion:

2.5 g/kg/d

Name an amino acid solution that contains an increased percentage of branched chain amino acids that is used in patients with encephalopathy:

Hepatamine 8% amino acid solution

The caloric value from the lipid propofol is stored in:

1 kcal/cc

Formula to calculate the ideal body weight for a man:

106 lb + 6 lb for every inch over 5 ft

Formula to calculate the ideal body weight for a woman:

105 lb + 5 lb for every inch over 5 ft

List the rough percentage of calories from carbohydrates in TPN:

50% to 60%

List the rough percentage of calories from proteins in TPN:

10% to 20%

List the rough percentage of calories from lipids in TPN:

20% to 30%

Electrolyte abnormalities found with refeeding syndrome:

Hypokalemia, hypomagnesemia, hypophosphatemia; occurs when feeding after prolonged malnutrition/starvation

The best parameter to check for adequate nutritional status:

Prealbumin

Half-life of retinol-binding protein:

~12 hours

Half-life of prealbumin:

2 to 3 days

Half-life of transferrin:

8 to 9 days

Half-life of albumin:

14 to 20 days

Formula for the respiratory quotient:

RQ = CO₂ produced/O₂ consumed

Respiratory quotient for carbohydrate:

Respiratory quotient for ethanol:

0.67

Respiratory quotient for fat:

Respiratory quotient during hyperventilation:

>1.1

Respiratory quotient to indicate lipogenesis or overfeeding:

>1.0

Respiratory quotient in starvation:

0.6 to 0.7 (fat is fuel source during starvation)

Ideal respiratory quotient during mixed substrate oxidation:

0.85 to 0.95

Respiratory quotient <0.82 indicates:

Occurrence of protein oxidation; increase total energy intake by increasing carbohydrates and caloric intake

Respiratory quotient >1 indicates:

Excessive calorie load; decrease carbohydrate intake and caloric intake

List the effects seen with chromium deficiency:

Encephalopathy, hyperglycemia, neuropathy

List the effects seen with cobalamin (B₁₂) deficiency:

Beefy tongue, megaloblastic anemia, peripheral neuropathy

List the effects seen with copper deficiency:

Pancytopenia

List the effects seen with essential fatty acids deficiency:

Dermatitis, hair loss, thrombocytopenia

List the effects seen with folate deficiency:

Glossitis, megaloblastic anemia

List the effects seen with niacin deficiency:

Diarrhea, dermatits, dementia (Pellagra)

List the effects seen with phosphate deficiency:

Encephalopathy, decreased phagocytosis, weakness

List the effects seen with pyridoxine (B₆) deficiency:

Glossitis, peripheral neuropathy, sideroblastic anemia

List the effects seen with thiamine (B₁) deficiency:

Cardiomyopathy, peripheral neuropathy, Wernicke encephalopathy

List the effects seen with zinc deficiency:

Hair loss, rash, poor healing

List the effects seen with vitamin A deficiency:

Night blindness

List the effects seen with vitamin D deficiency:

Rickets, osteomalacia

List the effects seen with vitamin E deficiency:

Neuropathy

List the effects seen with vitamin K deficiency:

Coagulopathy

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TEST TAKING TIPS

FLUIDS

Name the 2 major body fluid compartments:

Extracellular fluid is divided into these 2 subcompartments:

Mnemonic for the composition of body fluid:

Approximate percentage of body weight that is fluid:

Approximate percentage of body fluid that is extracellular:

Approximate percentage of body weight that is intracellular:

Percentage of extracellular fluid within the vascular compartment in the venous system:

Percentage of extracellular fluid within the vascular compartment in the arterial system:

The approximate percentage of body weight that blood accounts for in an adult:

Requirement of water per 24-hour period:

FIGURE 7-1.

Requirement of sodium per 24-hour period:

Requirement of chloride per 24-hour period:

Requirement of potassium per 24-hour period:

Name the sources and the amount of normal daily water loss:

Name the sources and the amount of insensible fluid loss:

General rate of fluid loss during an open abdominal procedure in the absence of measurable blood loss:

Name the sources and the amount of normal daily electrolyte loss:

Name the sources and the amount of daily secretions:

State the electrolyte composition of sweat:

State the electrolyte composition of gastric secretions:

State the electrolyte composition of biliary secretions:

State the electrolyte composition of pancreatic secretions:

State the electrolyte composition of ileostomy output:

State the electrolyte composition of diarrhea:

Define the "third space."

When does third-spaced fluid tend to mobilize back into the intravascular space?

What is the earliest sign of volume excess during the postoperative period?

Classic finding with overaggressive nasogastric tube suctioning or long-standing vomiting:

Name the various mechanisms that loop diuretics employ to decrease pulmonary edema:

Formula to calculate serum osmolality:

How much sodium and chloride are in normal saline?

Composition of lactated Ringer's:

How many grams of dextrose in a liter of D5W?

The 2 "rules" for the calculation of maintenance fluids:

Name the standard maintenance fluid used in an adult:

Name the standard maintenance fluid used in a pediatric patient:

Usual minimal urine output for an adult:

How much of a 1-L NS bolus will stay intravascular in a 5-hour period?

ELECTROLYTES

Normal range for sodium:

Define pseudohyponatremia and list causes:

Name the 3 types of hyponatremia:

Name surgical causes of hypovolemic hyponatremia:

Name surgical causes of euvolemic hyponatremia:

Name surgical causes of hypervolemic hyponatremia:

Signs and symptoms of hyponatremia:

Treatment of hypovolemic hyponatremia:

Treatment of euvolemic hyponatremia (SIADH):

Treatment of hypervolemic hyponatremia (dilutional):

Grave consequence of correcting hyponatremia too quickly:

Formula to calculate the sodium deficit:

Approximately how much does the apparent serum sodium concentration fall for each 100 mg/dL rise in blood glucose level above normal?

Maximal rate of sodium correction for acute hyponatremia:

Maximal rate of sodium correction for chronic hyponatremia:

Name surgical causes of hypernatremia:

Signs and symptoms of hypernatremia:

Treatment of hypernatremia:

Formula to calculate the free water deficit:

What is the normal range for potassium:

Critical values for potassium:

Name some surgical causes of hypokalemia:

Signs and symptoms of hypokalemia:

EKG findings of hypokalemia:

Acute treatment for hypokalemia:

Maximum amount of potassium that can be administered through a peripheral IV:

FIGURE 7-2.

Maximum amount of potassium that can be administered through a central line:

Most common cause for an electrolyte mediated ileus in a surgical patient:

Digitalis toxicity is worsened by this electrolyte condition:

Name surgical causes of hyperkalemia:

Signs and symptoms of hyperkalemia:

EKG findings of hyperkalemia:

What is the treatment for hyperkalemia?

Most of the calcium in the body is contained within:

Percentage of serum calcium that is nonionized and bound to plasma protein: