Fluids 1

Question 1

What makes up the interstitial space?

Answer 1

Lymph, Electrolytes (Na, Cl, K, HCO3-, etc.), Proteins, Water

Question 2

What makes up the intravascular space?

Answer 2

Blood, Red blood cells, Electrolytes (Na, Cl, K, HCO3-, etc.), Platelets, White blood cells, Proteins (albumin, etc.)

Question 3

What makes up the intracellular fluid?

Answer 3

Cell components (ex. mitochondria), Electrolytes (Magnesium, Potassium, Na), Phosphate, Water

Question 4

What makes up the extracellular fluid?

Answer 4

The interstitial space and intravascular space

Question 5

Name the five main osmotically active particles.

Answer 5

Electrolytes, Ketones, Glucose, Urea, Mannitol

Question 6

What is a crystalloid fluid? Name some examples.

Answer 6

A clear solution that contains mostly electrolytes and water. Examples include 0.9% NaCl, plasmalyte, or Lactated Ringers.

Question 7

What is osmolality?

Answer 7

The concentration of a solution expressed as a total number of solute particles that are osmotically active

Question 8

What is the osmolality formula?

Answer 8

Osmolality = 2 (Na + K) + glucose + BUN

Question 9

What is a hypotonic crystalloid?

Answer 9

A fluid that has a lower osmolality than blood.

Question 10

What is an isotonic crystalloid?

Answer 10

A fluid that has about the same osmolality as blood.

Question 11

What is a hypertonic crystalloid?

Answer 11

A fluid that has a higher osmolality than blood.

Question 12

What is dehydration?

Answer 12

A decrease in (mostly) the extracellular fluid components.

Question 13

When should you use isotonic crystalloids and why?

Answer 13

Use as a replacement fluid for hypovolemia or dehydration.

Question 14

What happens when you give isotonic crystalloids IV?

Answer 14

It generally serves to replenish intravascular volume without causing shifts of fluid in or out of the body’s cells.

Question 15

What are the three buffers commonly added to fluids and what is their function?

Answer 15

Lactate, acetate, and gluconate. They produce bicarbonate which limits the change in pH.

Question 16

What are crystalloid fluids that contain buffers called?

Answer 16

Balanced crystalloids.

Question 17

What are unbalanced crystalloids?

Answer 17

Crystalloids that contain only Na and Cl with no extra electrolytes or buffers (ex. 0.9% NaCl).

Question 18

Why doesn’t 0.9% NaCl have buffers added?

Answer 18

It has the highest amount of chlorine and sodium, which can cause acidosis.

Question 19

Crystalloid fluids increase _____________ volume.

Answer 19

Intravascular volume.

Question 20

How long will it take for crystalloid fluids to diffuse into the interstitial space and correct dehydration?

Answer 20

45 minutes.

Question 21

45 minutes after a bolus, ______ percent of the volume has moved into the interstitial space and _____ percent remains inside the intravascular space.

Answer 21

75%, 25%.

Question 22

What are the three electrolytes commonly added to fluids and what is their function?

Answer 22

Potassium, calcium, and magnesium. They balance plasma values and improve contractility.

Question 23

True or False: It is okay to give potassium in fluids as a bolus in very small quantities.

Answer 23

True.

Question 24

What is the difference between 0.9% NaCl, Lactated Ringers, and plasmalyte?

Answer 24

NaCl has neither buffers or electrolytes, plasmalyte has mainly acetate added, and Lactated Ringers has mainly lactate added.

Question 25

Name two contraindications of using fluids with extra electrolytes.

Answer 25

Do not give to patients with hyperkalemia or concurrently with a blood transfusion.

Question 26

Isotonic fluids are good for ____________ dehydration but not good for ____________ dehydration.

Answer 26

Interstitial, intracellular.

Question 27

What are six diseases that contraindicate the use of isotonic fluids?

Answer 27

Hypoalbuminemic patients, anuric renal failure, cardiac disease, pulmonary contusion, cerebral injury, sepsis.

Question 28

What happens when you give hypotonic crystalloids IV?

Answer 28

They cause water to move into cells via osmosis, leading to swelling.

Question 29

What are two indications for hypotonic crystalloids?

Answer 29

Intracellular dehydration, Maintenance fluid.

Question 30

Hypotonic fluids are good for ____________ dehydration but not good for ____________ dehydration.

Answer 30

Intracellular, intercellular.

Question 31

What is an advantage of hypotonic fluid over isotonic fluid?

Answer 31

The low sodium decreases risk of volume overload.

Question 32

What is a major contraindication for hypotonic fluids?

Answer 32

Never use to treat shock!

Question 33

What is the effect of dextrose in fluids?

Answer 33

Dextrose is immediately taken up by cells, leaving pure water.

Question 34

What are the indications of giving fluids with dextrose?

Answer 34

Severe hypoglycemia.

Question 35

Which fluids cannot be bolused and why?

Answer 35

KCl, due to the risk of fatal hyperkalemia.

Question 36

What is a disadvantage to dextrose?

Answer 36

Can cause RBCs to explode and phlebitis.

Question 37

What happens when you give hypertonic crystalloids IV?

Answer 37

There is a massive movement of water into the vascular space.

Question 38

What is an indication for hypertonic crystalloids?

Answer 38

Hyponatremia, Cerebral edema, Extreme hypovolemia.

Question 39

What are colloids?

Answer 39

Fluids that contain BOTH large organic macromolecules and electrolytes.

Question 40

What are two natural colloids?

Answer 40

Albumin, Fresh frozen and frozen plasma.

Question 41

What happens when you give colloids IV?

Answer 41

The colloid attracts a small amount of water back into the intravascular space.

Question 42

What are the indications of colloids?

Answer 42

They may be used for short-term blood pressure support in anesthesia.

Question 43

What are the disadvantages of colloids?

Answer 43

Causes acute kidney injury, coagulation issues, increased morbidity and mortality.