Fluids (exam 3)

Question 1

what is the total amount of fluids in a male?

female?

Answer 1

60%

55%

Question 2

total body fluid distribution

Answer 2

2/3 ICF
1/3 ECF

Question 3

extracellular fluid distribution

Answer 3

75% interstitial fluid
25% blood/plasma

Question 4

third space

Answer 4

abnormal fluid collections can occur
common spaces are peritoneal cavity and pleural cavity
pleural fluid

Question 5

osmolality

Answer 5

measure of the total number of particles dissolved in a kilogram of solution

Question 6

osmolality of ICF compared to ECF

Answer 6

equal!

Question 7

components of ICF

Answer 7

potassium
other anions

Question 8

component of ECF

Answer 8

sodium
chloride
bicarbonate
glucose
BUN

Question 9

concentrations are maintained by

Answer 9

fluid shifts and NaKATPase pump

Question 10

how to estimate osmolality based on components of a BMP

Answer 10

Osm = (2 x Na) + (Glu/18) + (BUN/2.8)

Question 11

Tonicity

Answer 11

measure of the effective osmotic gradients between 2 solutions separated by permeable membrane

Question 12

tonicity is dependent on

Answer 12

concentration of effective osmoses inside and outside the cell

Question 13

effective osmoles

Answer 13

solutes that cannot freely cross cell membranes

Question 14

isotonic = _______ leakage

Answer 14

75%

Question 15

Isotonic crystalloids

Answer 15

0.9% NaCl
Ringer’s Lactate
Plasma-Lyte
Dextrose 5% in water

Question 16

Hypotonic crystalloids

Answer 16

0.2% NaCl
0.3% NaCl
0.45% NaCl
Dextrose 5% in water

Question 17

hypertonic crystalloids

Answer 17

3% NaCl
23.4% NaCl

Question 18

what fluids to use for volume resuscitation

Answer 18

LR
0.9% NaCl
Plasma-Lyte

Question 19

what fluids to use for dehydration/free water deficit

Answer 19

D5W
0.45% NaCl

Question 20

what fluids to use for maintenance

Answer 20

D5W/0.45% NaCl
0.45% NaCl

Question 21

what fluids to use for elevated ICP, severe hyponatremia

Answer 21

3% NaCl
23.4% NaCl

Question 22

considerations for 0.9% NS

Answer 22

may cause hypernatremia
hyperchloremic acidosis
may cause acute kidney injury
hyperkalemia

Question 23

considerations for LR, Plasma-Lyte

Answer 23

more physiologic
less hyperchloremia than NS

Question 24

avoid LR in patients with

Answer 24

elevated lactic acid

Question 25

avoid LR and plasma-lyte with

Answer 25

cirrhosis patients or traumatic brain injury

Question 26

considerations for D5W/0.45% NS

Answer 26

distributes to both ICF/ECF less hyponatremia than D5W most used maintenance fluid

Question 27

considerations for D5W

Answer 27

distributes to both ICF/ECF hyponatremia/hyperglycemia

Question 28

D5W is virtually _____________ because only 8% is retained in ________ this means its a poor options for _____________

Answer 28

free water vasculature resuscitation

Question 29

avoid albumin in

Answer 29

trauma, particularly traumatic brain injury

Question 30

albumin is not a

Answer 30

first line agent

Question 31

albumin considerations

Answer 31

isotonic, but provides oncotic pressure pulls fluid into vasculature

Question 32

what to use to assess fluid status

Answer 32

vital signs urine output physical exam labs perfusion

Question 33

vital signs to assess for fluid status

Answer 33

low blood pressure tachycardia

Question 34

urine output to assess for fluid status

Answer 34

abnormal urine output Ins and Outs are uneven

Question 35

physical exam to assess for fluid status

Answer 35

poor skin turgor dry mucous membranes

Question 36

labs to assess for fluid status

Answer 36

inc/dec Na inc Hct inc BUN dilutional CBC lactate is present

Question 37

perfusion to assess for fluid status

Answer 37

poor capillary refill cool extremities mottling is present

Question 38

how much fluids do we give to adults

Answer 38

500-1000ml over an hour repeat until perfusion is restored

Question 39

how much fluids do we give to children

Answer 39

10-20ml/kg as rapidly as possible repeat until perfusion restored

Question 40

how much fluids do we give when there is sepsis

Answer 40

initiating 30ml/kg within the first hour of presentation

Question 41

when do we stop giving fluids?

Answer 41

improvement in symptoms no changes in symptoms or worsening

Question 42

when there is no changes in symptoms or worsening, there may be

Answer 42

overloaded not be fluid responsive

Question 43

when fluids are too aggressive what can be seen?

Answer 43

pulmonary edema heart failure cerebral edema acidosis

Question 44

how to assess the extravascular compartment

Answer 44

anasarca third spacing

Question 45

how to assess the intravascular compartment

Answer 45

central venous pressure stroke volume variation fluid challenge passive leg raise

Question 46

when CVP is less than 8 mm Hg

Answer 46

does not have enough volume

Question 47

when SVV is less than 12%

Answer 47

no longer volume responsive

Question 48

when doing the fluid challenge and the cardiac output is over 10%

Answer 48

still fluid responsive

Question 49

when doing the PLR and the cardiac output is over 10%

Answer 49

still fluid responsive

Question 50

maintenance fluid

Answer 50

replaces ongoing losses of water and electrolytes under normal physiologic conditions

Question 51

replacement fluids

Answer 51

corrects deficits outside of normal loss

Question 52

ways to calculate maintenance fluids

Answer 52

30-35 ml/kg/day (adults) Holliday-segar method (children) 4-2-1 method

Question 53

4-2-1 method

Answer 53

first 10kg x 4 second 10 kg x 2 remaining weight x1 add all together

Question 54

4-2-1 method units

Answer 54

ml/kg/hour

Question 55

de-escalation is done more so to

Answer 55

mitigate fluid therapy and promote fluid removal