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Flashcards in Fluids and electrolytes Oguin Deck (73)
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1

daily fluid volume required to maintain TBW homeostasis in a a healthy adult

25 - 35 ml/kg per day
(2~3 Liters per day )

2

ICF concentrations of sodium/potassium/calcium

ICF Na = 10
ICF K = 150
ICF Ca = 1

Mag = 40
Chloride = 103

3

EVC concentrations of sodium/potassium/calcium

ECF Na = 140
ECF K = 4.5
ECF Ca = 5


ECF Mag = 2
ECF chloride = 117

4

First drug given in hyperkalemia

Calcium gluconate

to STABILIZE CARDIAC MEMBRANES

5

things that move potassium intracellularly

insulin, albuterol, hyperventilation,

6

Patients with ESRD don't always demonstrate

EKG changes as their potassium shifts

7

primary determinant of both capillary and interstitial oncotic pressure

albumin

8

under euvolemic conditions, net fluid filtration is equal

lympathic flow

9

things that can damage the endothelial glycocalyx

tons of crystalloid administration, uncontrolled long term DM2, hyperglycemia, infection, stress, critical illness

10

daily water fluctuation

0.2% TBW

11

UO is not reliable in the OR because

Stress response causes the release of ADH, so pt is euvolemic but not peeing.

OR

insufflation of abdomen can decrease uo

12

crystalloid solutions are preferable for

conditions of dehydration.

TBW loss leading to plasma hypertonicity

13

administration of isotonic crystalloids leads to the hydration of

the entire ECV restoring water and electrolyte homeostasis to both intravascular and interstitial spaces for normal cellular processes.

14

IMMEDIATE restoration of circulating volume =

crystalloids

15

crystalloids are preferred for

immediate restoration of circulating volume

- preservation of microcirculatory flow

decrease in hormone mediated vasoconstriction

correction of plasma hyper viscosity

lack of allergenic potential

ease of metabolism and renal clearance

16

because of their low molecules weight, crystalloids

crystalloid solutions contribute to the hemodilution of plasma proteins and loss of capillary oncotic pressure

17

intravascular repletion with crystalloids is

immediate BUT transient, bc crystalloids will hydrate all of the. ECV meaning 75-80% of administered volumes will go to interstitial space

18

osmolality of 0.45% NaCl

154 mOsm/ L

19

osmolality of D5W

253 mOsm/L in bag, less in body r/t metabolism of dextrose

20

osmolality of NaCl 0.9%

308 mOsm/L

21

osmolality of LR

273 mOsm/L in bag,

less in body because body metabolizes lactate

22

Osmolality of Plasmalyte A

294 mOsm/L

23

Osmolality of NaCl 3%

1026 mOsm/L

24

Osmolality of D5 NaCl 0.9%

560 mOsm/L

25

Osmolality of D5 NaCl 0.45%

405 mOsm/L, probably less in body

26

Osmolality of D5LR

525 mOsm/L probably less in body

27

Isotonic Colloids

Albumin 5%
Voluven 6%
Hespan 6%

28

Osmolality of albumin 5%

300 mOsm/L

29

Osmolality of Voluven 6%

296 mOsm/L

30

Osmolality of Hespan 6%

309 mOsm/L

31

Osmolality of Dextran 10%

350 mOsm/L

only hypertonic colloid?

32

Composition of LR
sodium/potassium/chloride/lactate

LR
sodium: 130
Potassium: 4
Chloride: 110
Lactate: 28

calcium: 3

osmolality: 273! - slightly hypotonic, more so because the body will metabolize lactate

33

Composition of 0.9% NaCl

Composition of 0.9% NaCl
Sodium = 154
Potassium = 0
Chloride = 154
Mag = 0

osmolality ; 308

34

Composition of Plasmalyte A

Sodium = 140-141
Potassium = 5
Chloride = 98
Phosphate = 1
Magnesium = 3

35

D5W is given in

patients receiving insulin,

sometimes neonates

even then typically D51/2NS

36

D5W provides

170-300 calories / 1000 mL for energy

37

Typical use of 3% or 5% NaCl is in

treatment of hyponatremia

USED FOR LOW VOLUME RESUSCITATION

38

Risks associated with hypertonic 3%/5% NaCl

Hyperchloremia, hypernatremia, cellular dehydration,

potential for osmotic demyelination syndrome

39

DEXTRAN

synthetic colloid. Made with sugars.

Use is largely abandoned.

Black box warning: acute renal failure

r/f noncardiac pulmonary edema
interference with crossmatching
anaphylaxis

40

evaporative loss for superficial trauma (orofacial)

1-2 mL/kg per hr

41

evaporative loss for minimal trauma

2-4 mL/kg per hr

42

evaporative loss for moderate trauma (major non abdominal)

4-6 mL/kg per hr

43

evaporative loss for severe trauma

6-8 mL/kg per hr

44

things that cause an intracellular shift that lead to HYPOKALEMIA (3)

alkalosis, insulin, beta 2 agonist

45

Presentation of hypokalemia (4) <3.5

skeletal muscle cramps
weakness
paralysis
worsens Digoxin toxicity

46

iatrogenic hyperkalemia >5.5

succhs

47

Presentation of hyperkalemia >5.5

cardiac dysthymias

48

EKG changes with hyperkalemia >5.5

Early: PR long, T wave peaked, QT short
Middle: P flat, QRS wide
Late: QRS becomes sine wave -> VF.

49

Presentation Hyponatremia <135

N/V
skeletal muscle weakness
mental status changes -> seizures, coma
cerebral swelling

50

must avoid rapid correction of sodium to prevent

osmotic demyelination syndrome

51

Presentations of hypernatremia >145

thirst, mental status changes -> seizures, coma
cerebral dehydration

52

treatment for hypermagnesemia

calcium chloride

53

levels of hypermagnesemia

Loss of DTR : 4 - 6.5 meq/L or 10-12 mg/dL
Respiratory Depression: 6.5 - 7.5 mEq/L or >18mg/dL
cardiac arrest: >10 mEq/L or >25 mg/dL

54

decreased coronary blood flow is associated with

alkalosis

55

decreased contractility is associated with

acidosis

56

Increased pulmonary vascular resistance is associated with

acidosis

57

solutions that contain calcium are incompatible with

blood products

58

colloids act by producing

intravascular volume expansion by directly increasing plasma oncotic pressure AND interacting with the endothelial glycocalyx to decrease trans capillary filtration

59

dextran has a half life of roughly

6 to 12 hours.

much longer than crystalloids

60

dextran causes nephrotoxicity by

1. indirect hyperosmotic renal injury
2. direct renal tubular damage as a result of accumulation

61

dextran was popular in vascular surgery because

it has coagulopathic effects, antithrombin effects , platelet inhibition

62

stress activates

hypothalamus-pituitary axis-release of cortisol

63

release of catchecholaimes

increased HR, increased SVR, increased microcirculatory vasoconstriction, release of aDH, reabsorption of water, potassium excretion

64

prophylactic volume administration in euvolemic patients

is an antiquated practice with substantial risk of disrupting the endothelial glycocalyx and contributing to pathological fluid overload

65

If a patient is receiving maintenance fluid

there is no NPO deficit but consider other losses

66

adult estimated blood volume

70 mL / kg
75 - 85 mL/ kg

67

MAP, CVP, andUO do not

have good predictive value at measuring fluid responsiveness

68

ERAS aim:

Utilize individualized hemodynamic end points to support oxygen transport balance by minimizing oxygen demand and optimizing CO, tissue oxygenation, capillary and macrovascualr flow, oxygen and nutrient delivery and end organ perfusion.

69

failure to recognize preload independence in hypotensive patients is often the mechanism for

inappropriate fluid administration

70

CDPA preservative

citrate - binds with calcium
dextrose for glycolysis
phosphate buffer acidosis
adenosine helps RBC synethesize ATP

71

Citrate toxicity occurs with

multiple units, leads to hypocalcemia, monitor ionized calcium

72

most common infectious complication

cytomegalovirus

73

most common cause of transfusion related death

TRALI transfusion related acute lung injury

platelets and FFP have the highest risk *