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clinical toxicology > IV FLUIDS > Flashcards

IV FLUIDS Flashcards

1
Q

Factors that determine body water content

A

Age
Sex
Hydration level

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2
Q

Average amount of water in an adults body

A

60%

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3
Q

Proportion of water in new borns

A

80%

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4
Q

Proportions of intercellular and extracellular fluid out of total body water

A

2/3- Intracellular
1/3- extracellular

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5
Q

Percentage of water in blood and kidneys, muscles and adipose tissue

A

Blood and kidneys- 83%
Muscle- 76%
Adipose tissue- 10%

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6
Q

Two important measures of body fluid balance

A

Oral or IV fluid intake
Urine output

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7
Q

Insensible fluid input

A

300ml due to oxidation

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8
Q

Insensible fluid loss

A

500ml- Skin
400ml- Lungs
100ml- Stool

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9
Q

Examples of abnormal fluid loss

A

Diarrhea
Abnormal sweating
Burns

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10
Q

Formula for daily fluid requirement in a normal person

A

Sum of urine output and insensible loss

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11
Q

Role of the major cations

A

Sodium- Fluid balance and Osmotic pressure
Potassium - Neuromuscular excitability and Acid base balance
Calcium- bone and blood clotting
Magnesium- Enzymes

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12
Q

Role of the major anions

A

Chloride - Fluid balance and Osmotic pressure
Bicarbonate - Acid base balance
Proteins- Osmotic pressure
Phosphate - Energy storage
Sulfate- Protein metabolism

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13
Q

Major intercellular cations and anions

A

Cations- Potassium and Magnesium
Anions- Phosphate

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14
Q

Major extracellular cations and anions

A

Cations - Sodium
Anions - Chloride and Bicarbonates

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15
Q

Why determines the distribution of water Amon the different fluid compartments

A

Osmotic pressure

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16
Q

Three basic principles to know for proper fluid therapy

A

Aetiology fluid deficit and type of electrolyte imbalance present
Associated illness
Clinical status

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17
Q

Contraindications of IV fluids

A

Avoid if patient can take oral fluids
Patients with congestive heart failure or volume overload

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18
Q

Local complications of IV fluids

A

Haematoma
Infusion phlebitis
Infiltration or Extravasation

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19
Q

Systemic complications of IV fluids

A

Circulation overload

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20
Q

Patients at high risk of circulation overload with IV fluids

A

Cardiac problems
Rigors
Air embolism
Septicaemia

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21
Q

Explain the types of IV lines

A

Central lines end in a large vein close to the heart

Peripheral end in a small vein in the periphery

Peripherally inserted central catheter / PICC- An IV line threaded through a peripheral vein to end near the heart

Tunneled line- Catheter is inserted into a central vein through the chest

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22
Q

What determines the type of catheter used and site of insertion for IV fluids

A

Desired substance to be administered

Health of the veins in the desired site of insertion

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23
Q

Explain the news score

A

The National Early Warning Score (NEWS2) is a system for scoring the physiological measurements that are routinely recorded at the patient’s bedside. Its purpose is to identify acutely ill patients

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24
Q

Parameters in the NEWS score

A

AB
Respiratory rate
O2 saturation
Any supplemental oxygen

C
Systolic BP
Pulse

D
AVPU score

E
Température

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25
Q

Classes in the NEWS score

A

Low 1-4
Medium 5-6
High 7 and above

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26
Q

Types of IV fluids

A

Hypertonic : more than 375mOsm/L
Isotonic: 250- 375
Hypotonic: less than 250

27
Q

Examples of isotonic solutions

A

0.9% Normal saline
Ringers Lactate
Blood component
5% Dextrose Water D5W

28
Q

Indications of isotonic solutions

A

Direct fluid replacement in
Diarrhea
Bleeding

29
Q

Examples of hypotonic solutions

A

Half or 45% Normal Saline
0.33% NaCl

30
Q

Examples of hypertonic solutions

A

D5W in Normal Saline
D5W in Half Normal Saline
10% Dextrose in Water (D10W)

31
Q

Classify IV fluids

A

Two types
1. Blood and Products

  1. Non blood IV fluids
    2.a Colloids
    2. a.i. Proteinious
    2.a.ii. Non proteinous
     2.b Crystalloids
32
Q

Examples of crystalloids

A

Glucose containing
Electrolyte Solutions
Mixed solutions

33
Q

Types of proteinous colloids and examples

A
  1. Gelatins
    Heamacel
    Gelofusin
  2. Albumin
    20% and 5%
34
Q

Types of non proteinous colloids and examples

A
  1. Starch
    HES
    Pentastarch
    Tatrastarch

2.Dextrans

35
Q

Factors that drive fluid movement

A

Diffusion
Active Transport
Osmosis
Capillary filtration

36
Q

What is the driving force for capillary filtration

A

Hydrostatic pressure

37
Q

What balances out hydrostatic pressure

A

Colloid osmotic pressure from albumin

38
Q

Components of the juxtaglomerular apparatus

A

Macula densa of the thick ascending limb

Juxtaglomerular or Granular cells of the afferent arteriole
Extraglomerular mesangial cell

39
Q

Functions of the cells in the juxtaglomerular apparatus

A

Juxtaglomerular cells secrete renin
Macula sends cells osmoreceptors
Mesanglial cells regulate GFR

40
Q

Functions of ANP

A

Suppresses release of renin, aldosterone and ADH
Increases glomerular filtration
Causes vasodilation

41
Q

Why are older people more prone to dehydration

A

Thirst mechanism is less effective in older people

42
Q

Three phases of rehydration

A
  1. Fluid resuscitation or emergency phase
  2. First 8 hours of Maintenance phase
  3. Next 16 hours of Maintenance phase
43
Q

How to calculate degree of dehydration

A

Difference in pre-illness and illness weights divided by pre-illness weight multiplied by 100

44
Q

Various degrees of dehydration based on body weight

A

Mild (less than 3% change in body weight), Moderate (3%–9% change in body weight)
Severe (greater than 9% change in body weight).

45
Q

Types of dehydration

A

Isotonic dehydration
Hypotonic dehydration
Hypertonic dehydration

46
Q

Treatments for mild and moderate dehydration

A

Oral fluid therapy
Mild 50ml/kg over 4 hours
Moderate 100ml/kg over 4 hours

47
Q

Content of oral rehydration solutions

A

140mmol/L of carbohydrate
45mmol/l of sodium
20mmol/l of potassium

48
Q

IV fluid delivery systems

A

Infusion pump
Gravity

49
Q

Initial approach for children with moderate to severe dehydration

A

Isotonic fluid blouses (NS) in 20ml/kg max of 1L given over 20mins in moderate dehydration and given as fast as possible in severe dehydration

Blouses should be repeated until the child has restoration of intravascular volume

50
Q

Maintenance phase for children with moderate to severe dehydration

A

Phase 2- 1/2 remaining deficit + 1/3 daily maintenance

Phase 3- 1/2 remaining deficit + 2/3 daily maintenance

51
Q

When are maintenance fluids used

A

When patient is NPO (nil per oral)

52
Q

Components of maintenance fluids

A

Water
Glucose
Sodium
Potassium

53
Q

Role of glucose in maintenance fluids

A

Prevents starvation, ketoacidosis and hypoglycemia

54
Q

Types of body sizes that can be used

A

Ideal body weight or dry body weight
Body surface area
Actual body weight

55
Q

Preferred fluid for maintenance fluids

A

Isotonic fluids ( N/S OR LR)

56
Q

Contraindications to isotonic fluids

A

Volume overload
Hypernatremia

57
Q

Standard dextrose composition of maintenance fluids

A

D5W

58
Q

Strategy for fluid replacement in oliguria

A

Provide maintenance fluids at a rate that replaces insensible loss

59
Q

Maintenance fluid therapy for 0-10kg

A

100ml/oh at a rate of 4ml/kg/hour

60
Q

Maintenance fluid therapy for 11-20kg

A

Volume/24 hours
1000ml + 50ml/kg for each kg over 10kg

Rate/hour
40ml + 2ml/kg for each kg over 10kg

61
Q

Maintenance fluid therapy for more than 20kg body weight

A

Volume/24hours
1500ml + 20ml/kg for each kg over 20kg

Rate/hour
60ml +1ml/kg for each kg over 20kg

62
Q

Maximum volume and rate for maintenance fluids

A

Volume/24 hours
2.4-3L

Rate/hour
100-120ml

63
Q

Examples of elctrolyte solutions

A

Normal saline
Ringers solution (Na, K, Cl and Ça)
Lactated ringers ( Na, K, Cl, Ça and Lactate)

64
Q

Ph and osmolarity of D5W

A

Ph- 3.2-6.5
Osmolarity - 252mosml/l

clinical toxicology (14 decks)

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