Clerkship

1. 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.
2. List at least four endogenous factors that affect renal control of sodium and water excretion.
3. List least six symptoms or physical findings of dehydration.
4. List and describe the objective ways of measuring fluid balance.
5. List the electrolyte composition of the following solutions:
   • normal (0.9%) saline
   • ½ normal saline
   • 1/3 normal saline
   • 5% dextrose in water
   • Ringer’s lactate
6. In the following situations, indicate whether serum Na, K, HCO3, Cl and blood pH will remain stable (0), rise considerably (++), rise moderately (+), fall moderately (-), or fall considerably (--):
   • excessive gastric losses
   • high volume pancreatic fistula
   • small intestine fistula
   • biliary fistula
   • diarrhea
7. In the following situations, indicate whether serum and urine Na, K, HCO3, Cl and osmolality will remain stable (0), rise considerably (++), rise moderately (+), fall moderately (-), or fall considerably (--):
   • acute tubular necrosis
   • dehydration
   • secretion (SIADH)
   • diabetes insipidus
   • congestive heart failure
8. Describe the possible causes, appropriate laboratory studies needed, and treatment of the following conditions:
   • hypernatremia
   • hyponatremia
   • hyperkalemia
   • hypokalemia
   • hypochloremia
9. Describe the concept of a “third space” and list those conditions that can cause fluid sequestration of this type.

ACID BASE BALANCE

1. List the physiological limits of normal blood gases.
2. List the factors that effect oxygen delivery and consumption.
3. 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