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APA Fundamentals > Fluid Management > Flashcards

Fluid Management Flashcards

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1
Q

What % of body weight is total body water?

A

60% average.
55% Man
45% Woman
80% Infant

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2
Q

What percent of total body water is intracellular volume?

Extracellular volume?

A

Intracellular 40%.

Extracellular 20%.

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3
Q

The extracellular volume (ECV) is broken into two fluid compartments, what are they are how are they distributed?

A

Interstitial fluid volume 75% of ECV.

Plasma Volume 25% of ECV.

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4
Q

What separates the two extracellular fluid compartments?

A

Vascular endothelium.

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5
Q

Do obese individuals have more or Total Body Water (TBW) than non-obese individuals?

A

Less TBW

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6
Q

What separates the intracellular space from the extracellular space?

A

Cell membrane

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7
Q

Which three electrolytes does the intracellular fluid compartment contain in high concentration?

A

Potassium.
Phosphate.
Magnesium.

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8
Q

What is responsible for maintaining the high concentration of K+ in ICF?

A

Na+K+ATPase.

Sodium potassium pump.

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9
Q

What two electrolytes are in high concentration in the EFC?

A

Sodium and Chloride.

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10
Q

Is there a larger concentration of proteins (particularly Albumin) in the blood vessels or in the interstitial space?

A

Inside the capillary.

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11
Q

What is the formula for serum osmolality?

A

2 (Na+) + (BUN/2.8) + (Glucose/18)= Serum osmolality.

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12
Q

What is a normal serum osmolality?

A

285-295

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13
Q

Fluid movement across a fluid compartment is affected by what two things?

A
  1. Properties of membranes separating compartments.

2. Concentration of osmotically active substances within a compartment.

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14
Q

Hydrostatic pressure in capillary (Pc). Pushing/pulling/where?

A

Pushing pressure out.

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15
Q

Hydrostatic pressure in the interstitium (Pi). Pushing/pulling/where?

A

Low pressure, typically negative d/t lymphatics

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16
Q

Oncotic pressure in the capillary (pc).

Pushing/pulling/where

A

Pulling into the capillary.

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17
Q

Oncotic pressure in the interstitium (pi).

Pushing/pulling/where?

A

Pulling out of the capillary.

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18
Q

A net driving force that is positive moves fluid into the capillary- T/F?

A

False.

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19
Q

How a solution affects cell volume is a measurement of its _____?

A

Tonicity:

i.e. hypotonic, hypertonic, isotonic.

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20
Q

What does a hypotonic solution do to a sell?

A

Causes cell engorgement, it fills with fluid.

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21
Q

What does a hypertonic solution do to a cell?

A

Causes cell shrinkage, it pulls fluid out of the cell.

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22
Q

Difference between hypovolemia and dehydration?

A

Hypovolemia is loss of extracellular fluid/reduced circulating volume.

Dehydration is a concentration disorder/osmolality issue/insufficient water present in relation to sodium levels (can be caused by too much Na+ or too little water).

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23
Q

What is the most abundant electrolyte in the ECF?

A

Na+

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24
Q

Which two electrolytes are responsible for normal osmotic activity of the ECF?

A

Na+ and Cl-

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25
Unlike the rest of the body/organs, the blood-brain barrier lacks premeability and instead of protein being the major determinant of water movement, what is?
Sodium
26
What is a normal ECV Sodium? | ICV?
ECV 140 | ICV 25
27
Hyponatremia can be caused by what?
``` Vomiting. Diarrhea. Diuretics. Adrenal insufficiency. SIADH. Renal failure. Water intoxication. CHF. Liver failure. Nephrotic Syndrome. ```
28
Major clinical manifestations of hyponatremia:
Cerebral edema is most significant factor for us. Coma. Confusion. Headache. Malaise. Agitation. Anorexia. N/V. Cramps. Weakness.
29
What three methods of treatment can be used for hyponatremia?
1. Fluid restriction. 2. Hypertonic saline. 3. Osmotic/loop diuretic.
30
What is important to consider when correcting hyponatremia?
Needs to be corrected slowly. | No more than 1-2mEq/hr and no more than 10-15mEg change in 24 hrs.
31
What problem can be caused by too fast of a sodium increase?
Myelinolysis=demylenation.
32
What is the most common cause of hypernatremia?
Water deficiency d/t: - Excessive loss. - Inadequate intake.
33
What are some other causes of hypernatremia?
Exogenous Na+ load. Primary hyperaldosteronism. Diabetes Insipidus. Renal dysfunction.
34
Clinical manifestations of hypernatremia?
Weakness, seizure, hallucinations, irritability, disorientation, coma, intracranial bleed, hypervolemia, polyuria or oliguria, renal insufficiency.
35
How is hypernatremia treated?
Estimate water deficit and correct hypernatremia by replacing the water deficit. Correction should take place over 24hr period.
36
What electrolyte is in highest concentration within ICV?
Potassium
37
What is intracellular K+? | Extracellular K+?
``` Intracellular= 150-160mEq/L. Extracellular= 3.5-5.0mEq/L ```
38
What is the most common electrolyte abnormality we will see in clinical practice?
Hypokalemia.
39
What are causes of hypokalemia?
``` Gastrointestinal losses. Systemic alkalosis. Diabetic ketoacidosis. Diuretic therapy. Sympathetic nervous system stimulation. Poor dietary intake. ```
40
What are cardiovascular related clinical manifestations of hypokalemia?
1. ST-Segment depression. 2. Presence of U-wave. 3. Flattened or inverted T waves. 4. Ventricular ectopy.
41
What is typically the max replacement speed for potassium?
40mEq/hr
42
Why would you avoid dextrose containing solutions in hypokalemia?
Stimulates insulin production which will drive K+ into cells.
43
What are causes of hyperkalemia?
``` Two major categories 1.Increased total body potassium: Renal failure. Potassium-sparring diuretics. Excessive IV K+ supplements. Excessive use of Salt substitutes. ``` ``` 2. Altered distribution of potassium: Metabolic or respiratory acidosis. Digitalis toxicity. Insulin deficiency. Hemolysis. Tissue and muscle damage after burns. Administration of succinylcholine. ```
44
Cardiovascular related clinical manifestations of hyperkalemia?
1. Tall, peaked a elevated T waves. 2. Widened QRS complex. 3. Prolonged PR Interval. 4. Flattened or absent P wave. 5. ST Segment depression. 6. Cardiac arrest.
45
What is treatment of hyperkalemia?
``` Insulin/glucose. IV Calcium. Hyperventilate. Beta 2 agonist. Bicarb ```
46
What are the limits of Potassium levels for doing a case?
3.0-5.5
47
What are causes for hypomagnesemia?
Inadequate dietary intake. TPN w/o mag. Vomitting/diarrhea, NGT suctioning. Chronic alcoholism.
48
Cardiovascular related clinical manifestations of hypomagnesemia?
1. Flat T waves. 2. U Waves. 3. Prolonged QT interval. 4. Widened QRS. 5. Atrial/ventricular PVCs.
49
Ultimately, low magnesium has inhibitory effects in what cellular function?
Na-K- ATPase pump.
50
What is treatment for hypomagnesemia?
1-2g IV mag over 5 mins. | Followed by 1-2g/hr
51
Name three causes of hypermagnesemia?
1. Iatrogenic admin: preeclamptic, antacids 2. Renal failure. 3. Adrenal insufficiency
52
At what level of hypermagnesemia do we normally see CV effects begin?
5-10mEq/L
53
What other electrolyte can be used in treatment of hypermagnesemia?
Calcium as an antagonist to CV effects
54
What drug will magnesium potentiate?
NMBA
55
Where is calcium found in the body?
99% Bones | 1% Blood cells/plasma
56
What is calcium's main role outside of bone integrity?
Second messenger that couples cell membrane receptors to cellular responses.
57
Why does massive blood transfusion decrease serum Ca++ levels?
Because the blood has citrate in it for storage. The citrate binds to Ca++.
58
What are causes of hypocalcemia?
Hypoparathyroidism. Malignancy. Chronic renal insufficiency
59
Which ones moves calcium into the bones and which moves it out- Calcitonin and parathyroid hormone?
Calcitonin moves it into the bones. Parathyroid hormone moves it out of the bones.
60
What is best treatment for hypocalcemia?
Calcium Chloride
61
Why is calcium chloride a better treatment for hypocalcemia than calcium gluconate?
More bioavailable and more rapid correction.
62
What is the conversion factor for CaCl and CaGluc infusions?
CaGluc 3gm=CaCl 1gm
63
What is most common cause of hypercalcemia?
Hyperparathyroidism. | because parathyroid hormones moves Ca++ out of the bones.
64
What cardiac effects may be seen with hypercalcemia?
Hypertension. Heart block. Dysrhythmias. Shorted QT interval
65
What is typical treatment of hypercalcemia?
Volume expansion with NS 0.9% and possibly loop diuretic
66
What patients do we consider "malnourished"?
Elderly, alcoholics, dialysis patients, major blood loss, anorexic/bullemic, liver disease, GI patients d/t bowel prep, bariatric from liquid diet
67
What are the three main ways there is intra-operative fluid loss?
1. Insensible loss. 2. Third space loss. 3. Blood loss
68
How do we historically replace typical insensible losses?
2ml/kg/hr Crystalloid
69
How do we historically replace 3rd space loss?
Minimal trauma: 3-4ml/kg/hr Moderate trauma: 5-6ml/kg/hr Severe trauma: 7-8ml/kg/hr
70
What day post-op do 3rd spaced fluids typically become mobilized?
3rd day post-op.
71
What is the new way of intra-op fluid therapy?
Perioperative Goal-Directed Fluid Therapy (PGDT).
72
What are some ways of determining fluid status on a patient when doing PGDT?
1. *Pulse contour: plethsmography 2. Echo 3. Dilution technique with PAC.
73
How do we assess the baseline for target hemodynamic measurements?
Give small fluid bolus and assess Frank-Starling curve
74
What is ERAS?
Enhanced Recovery After Surgery
75
How long do crystalloids stay intravascularly before moving extravascularly?
20 minutes
76
Which crystalloid can lead to hyperchloremic metabolic acidosis?
0.9% Sodium Chloride (NS)
77
Which crystalloid is used in trauma/head injuries?
3% Sodium Chloride.
78
Which crystalloid helps maintains neutral pH?
Lactated ringers
79
Which crystalloid promotes intravascular expansion?
3% Sodium Chloride
80
Why can LR never be hung with blood?
Calcium content in LR binds with Citrate in blood.
81
Which crystalloid should high doses be avoided in DM- NS, LR, 3%?
LR. | Lactate metabolite is gluconeogenic and causes high blood sugar over time.
82
What is the tonicity of LR?
Slightly hypotonic
83
What is the most isotonic balanced crystalloid?
Plasmalyte-A, Normosol-R, and Isolyte-S
84
If EBL is 350, how much crystalloid should be used to replace it?
3x EBL(350)=1050ml
85
Does surgical stress response cause hypo or hyper glycemia?
Hyperglycemia
86
How much Na+ and Cl- are in NS?
154mEq of each
87
How much Na+ and Cl- are in LR?
Na+=130mEq | Cl-=110mEq
88
What is blood loss replacement ratio of colloids?
1:1
89
Compared to blood, what are advantages and disadvantages of colloids?
``` Advantages: -Lack of risk of disease transmission. Disadvantages: -Lack of oxygen carrying capacity. -Lack of coagulation factors ```
90
What are issues with Dextran and Hetastarch administration in large volumes?
Dilutional coagulopathy and decrease platelet adhesiveness
91
T/F: Albumin can cause anaphylaxis?
True
92
What is the Donnon Effect?
Albumin binds to ions with increase plasma osmolality (and increases oncotic pulling pressure).
93
What is the primary indication of 5% albumin administration?
Rapid expansion of intravascular fluid volume.
94
What is the primary indication of 25% albumin administration?
Hypoalbuminemia

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