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Urinary > 11 - Fluid Replacement Therapy > Flashcards

11 - Fluid Replacement Therapy Flashcards

1
Q

What percentage of body weight is water in the following:

  • Males
  • Females
  • Infants
  • Elderly
A
  • Males = 60%
  • Females = 50-55%
  • Infants = 73%
  • Elderly = 45-50%
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2
Q

What is the major anion in ECF and ICF?

A
  • Phosphate in ICF
  • Cl- in ECF
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3
Q

How much water is in each body compartment in a 70kg man?

A
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4
Q

What happens to cells in hypernatremia and hyponatremia?

A

The sodium only shifts between interstitial and intervascular so it is water that moves to correct this

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5
Q

What happens if you give someone 1L of 5% Dextrose?

A
  • If low b.p don’t give this as won’t raise intravascular very much
  • Glucose can be taken up along all compartments
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6
Q

What happens if you give someone 1L of 0.9% saline?

A

Give if someone has low b.p as saline stays in ECF

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7
Q

What happens if you give someone 1L of Hartman’s solution??

A
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8
Q

Why would you give Hartman’s over saline?

A
  • Less Na and Cl
  • Lactate to get HCO3-
  • Used to mirror blood more
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9
Q

What are the contents of Hartmann’s?

A
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10
Q

Why would you give someone dextrose saline over dextrose?

A
  • Dextrose saline used to replace water losses
  • Dextrose and saline can just be maintenance fluids if can’t take orally
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11
Q

What would happen if you gave someone 1L of 4% dextrose, 0.18% saline?

A
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12
Q

Why is glucose fluids isoosmotic but not isotonic?

A
  • Isoosmotic as glucose metabolised quickly to water and CO2 so no change in osmoles but more water in cell changes tonicity
  • Tonicity is what the solution will do to the cells
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13
Q

Why may patients need IV fluids?

A
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14
Q

What are some factors you need to think about when giving patients maintenance fluids?

A
  • Maintenance fluids fill daily requirement and replace any losses, e.g from vomiting, but factors can change requirements
  • Easy to cause fluid overload
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15
Q

How much water, sodium, potassium, chloride and glucose is needed for maintenance and what are some processes that can change this maintenance requirement?

A
  • Diarrhoea
  • Vomiting
  • Sweaing
  • Urine
  • Bile and pancreatic drainage loss
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16
Q

If someone with insulin-dependent diabetes presents with needed IV fluids what should you ensure?

A
  • They always have a constant fluid with glucose in
  • If not insulin dependent don’t have glucose in fluids unless it is low
17
Q

What are some important things you need to consider when prescribing patients with fluids?

A
  • Do I need to do anything to stop losses, e.g antiemetic?
  • Max KCl in 1 hour is 10mmol
  • Consider size and age of patient
  • Have they lost electrolytes or just fluid?
18
Q

What are the contents of the following solutions and what is their tonicity?

A

* Solutions are made with differing amounts of potassium in them and usually more appropriate for maintenance needs

19
Q

Complete the following table.

A
20
Q

What do isotonic fluids do to blood volume?

A

Don’t raise it by much just adds mainly to ICF. If want to raise blood volume by 1l would need 4l fluid. Hypotonic solutions better for raising blood volume

21
Q

What is colloid?

A

IV fluid that has oncotic pressure due to the presence of large molecules. Will draw water from ICF and ECF as molecules cannot leave blood

22
Q

How do you work out the net filtration rate at the arterial end of this capillary?

A
23
Q

How does cancer and radiation lead to oedema?

A

Radiation can cause inflammation and blockage of lymph vessels, as well as cancer, so less interstitial fluid can be reabsorbed into the lymphatics like normal

24
Q

Complete the following table.

A

All 4kg lost is purely fluid

25
Q

What pathology do you suspect in this woman, and explain how this conditions leads to all of the signs and symptoms she is experiencing?

A

- Addision’s disease (autoimmune low cortisol)

  • Hyperpigmentation due to breakdown of POMC to make ACTH, releasing a-MSH which hyperpigments and lowers appetite
  • Adrenal glands attacked so also low aldosterone which explains low sodium and high potassium
26
Q

In Addison’s disease, what will you expect the acid-base balance of the blood to be and why?

A
  • Acidic
  • Hyperkalemia drives H+ out of cells and K+ in
27
Q

How can thiazides lead to hypokalaemia?

A

- Inhibit NaCl symporter

  • ENaC increased activity so Na/K pump has to work harder meaning more potassium is lost

Urinary (21 decks)

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