Fluids Flashcards by Nayla Mansoor

Why do we replace fluids

to maintain homeostasis

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What is total body water

60% of total body weight
2/3 ICF, 1/3 ECF (of the ECF, 3/4 is interstitial, 1/4 is plasma)
Newborns have the most (80%)
In adults, M>W (more adipose= less water)

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How do we remember fluid levels

TIE 60 40 20

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What ions are intracellular

Potassium
PO4
protein
magnesium

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What ions are extracellular

Sodium
Chloride
HCO3

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What do we need to know about daily water balance

Input should equal output (Euvolemia)

Output is usual insensible loss (lungs, skin NOT sweat), sweat, feces, urine

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What causes hypovolemia

GI loss (vomit, bleeding, diarrhea) 
Renal loss (diuretics, diabetes insipidus) 
Skin loss 
Sequestered w/ loss (rhabdo, pancreatitis)

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What are symptoms of Hypovolemia

thirst 
decreased sweating/skin turgor
DMM
Oliguria (concentrated pee)
CNS depression 
weakness, muscle cramps 
Hypotension
Tachycardia

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What is third spacing

fluid in the interstitium (where it shouldn't be) 
AKA edema (ascites, burns, pleural effusion)

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What is significant about third spacing

They can still be hypovolemic

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What are the types of fluids

Crystalloid (electrolytes, pass thru endothelial membrane, water follows) 
Colloid (lytes and org. molecules, don't pass endothelium, stay in intravascular space) 
Blood products (like colloids, stay in vascular space)

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What is the most common fluid used

Crystalloid- it’s isotonic

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What are types of crystalloids

Isotonic (name Na as normal cells): LR, 0.9% NS, plasma-lyte- distribute evenly thru ECF
Hypertonic (higher salt than our cells): 3% NS
Hypotonic (lower salt): 0.5%, 0.25% NS
Dextrose 5% in water (D5W)/ D5 1/2NS

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What is in isotonic crystalloids

LR: lactate, K+, Ca, NaCl

plasma lyte: less Chloride to prevent acidosis (more physiologic)

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What are Isotonic crystalloids used for

dehydration
hypovolemia
hypovolemic shock (CAN IV BOLUS)

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What are hypertonic crystalloids used for

life threatening hyponatremia (causing seizure)

To decrease cerebral edema in neurosurg patients

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Why do we need to be careful with hypertonic crystalloids

If administered too quickly can cause CPM

What are hypotonic crystalloids used for

maintenance fluid- they distribute thru TBW so not good for replacing INTRAvascular fluid deficit, dehydration, or hypovolemia

What is D5W used for

hypoglycemia
hypernatremia w/ free water deficit
(distributes like hypotonic- caution in DM patients)

Colloids are basically

likely to expand vascular compartment- use them when crystalloids fail to sustain plasma volume 2/2 decreased osmotic pressure

Who would colloids be beneficial in

burn pts
peritonitis (protein loss)
malnourished
(NOT for severe hypovolemia)

What are the types of colloids

Albumin (5%, 25%)

Dextran and Hetastarch (not used a lot)

When is albumin used

In edematous patients, to mobilize interstitial fluid (NOT if albumin >2.5 mg)
Liver disease
peritonitis
burns
3rd spacing
–AKA, we want to try to shift fluid to intravascular space from the interstitium

What are blood products

Packed RBC*
platelets
FFP
cryoprecipitate

What are packed RBC and when are they used

Made from whole blood, they stay in vascular space Used for transfusion to increase oxygen to tissues (hemorrhage or severe anemia) 1 PRBC unit will increase Hgb by 1g

What do patients need if they get packed RBC

Type and screen (blood type) | Type and cross (at time of transfusion to specifically check for a reaction)

When are platelets used

to prevent or treat bleeding In patients with: thrombocytopenia bad platelet function (on ASA/plavix)

What is FFP and when is it used

Has all factors of soluble coagulation system. Used to correct major bleeding if patient is on warfarin OR hypokalemic Also in hereditary angioedema

What is the difference between FFP and vitamin K

FFP works right away but is only effective for a short time | Vitamin K takes a while to be effective but lasts way longer

What is cryoprecipitate and when is it used

Thawed FFP and collect precipitate- has higher fibrinogen and factor 8, factor 10, and VWF Use if low fibrinogen d/t massive hemorrhage, liver failure, or consumptive coagulopathy

What is a bolus

``` 1 large amount (250mL-1L) isotonic crystalloids (2/2 hypovolemia) Packed RBC (2/2 massive hemorrhage) ```

Who do we need to use caution in when giving a bolus

Heart Failure patients (may already be fluid overloaded)

What are maintenance IV fluids

they account for ongoing water and electrolyte loss, under normal physiologic conditions (urine, feces, sweating, respirations) - we give them when patients are not eating or drinking normally, to maintain balance - NS, plasma lyte, LR, D5 1/2NS +/- 20mEq KCl

How do we calculate rate at which to give maintenance fluids (adults)

based on the clinical scenario! usually: 1st 10kg= 100 mL/kg 2nd 10kg= 50 mL/kg rest= 20 mL/kg divide all by 24 hours and you get your average hourly infusion rate

Most hourly infusion rates are

75 ml, 100 ml, 125 ml | if you get a weird number thru calculation, ROUND

What can you add to maintenance IV fluids

K to treat hypokalemia (potassium is osmotically like Na) BUT, you cant bolus potassium. so if you add K to 0.9% NS, you can no longer bolus also, use caution with K in renal disease patients

How are replacement IV fluids used

to correct existing water/electrolyte deficiency d/t pathologic conditions must monitor vitals, UO, and clinical picture use CAUTION if very hypo or hypernatremic (correcting too fast can lead to CPM)

Who often needs replacement fluids

surgical patients (low UO, 3 spacing, blood loss, etc.)

What is parkland formula (burn patients)

``` total fluid needed in first hour= (% of 2-3 degree burn) x (kg) x 4mL replace with LR! first 8 hr: 1/2 of total fluid 8 hr: 1/4 of total 8 hr: 1/4 of total ```

What is the rule of 9's

``` Head: 9 Arms: 9 each legs: 18 each front torso: 18 back: 18 perineum: 1 ```