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CLINICAL TOXICOLOGY > IV FLUIDS > Flashcards

IV FLUIDS Flashcards

(64 cards)

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1
Q

Factors that determine body water content

A

Age
Sex
Hydration level

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2
Q

Average amount of water in an adults body

A

60%

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3
Q

Proportion of water in new borns

A

80%

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4
Q

Proportions of intercellular and extracellular fluid out of total body water

A

2/3- Intracellular
1/3- extracellular

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5
Q

Percentage of water in blood and kidneys, muscles and adipose tissue

A

Blood and kidneys- 83%
Muscle- 76%
Adipose tissue- 10%

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6
Q

Two important measures of body fluid balance

A

Oral or IV fluid intake
Urine output

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7
Q

Insensible fluid input

A

300ml due to oxidation

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8
Q

Insensible fluid loss

A

500ml- Skin
400ml- Lungs
100ml- Stool

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9
Q

Examples of abnormal fluid loss

A

Diarrhea
Abnormal sweating
Burns

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10
Q

Formula for daily fluid requirement in a normal person

A

Sum of urine output and insensible loss

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11
Q

Role of the major cations

A

Sodium- Fluid balance and Osmotic pressure
Potassium - Neuromuscular excitability and Acid base balance
Calcium- bone and blood clotting
Magnesium- Enzymes

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12
Q

Role of the major anions

A

Chloride - Fluid balance and Osmotic pressure
Bicarbonate - Acid base balance
Proteins- Osmotic pressure
Phosphate - Energy storage
Sulfate- Protein metabolism

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13
Q

Major intercellular cations and anions

A

Cations- Potassium and Magnesium
Anions- Phosphate

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14
Q

Major extracellular cations and anions

A

Cations - Sodium
Anions - Chloride and Bicarbonates

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15
Q

Why determines the distribution of water Amon the different fluid compartments

A

Osmotic pressure

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16
Q

Three basic principles to know for proper fluid therapy

A

Aetiology fluid deficit and type of electrolyte imbalance present
Associated illness
Clinical status

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17
Q

Contraindications of IV fluids

A

Avoid if patient can take oral fluids
Patients with congestive heart failure or volume overload

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18
Q

Local complications of IV fluids

A

Haematoma
Infusion phlebitis
Infiltration or Extravasation

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19
Q

Systemic complications of IV fluids

A

Circulation overload

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20
Q

Patients at high risk of circulation overload with IV fluids

A

Cardiac problems
Rigors
Air embolism
Septicaemia

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21
Q

Explain the types of IV lines

A

Central lines end in a large vein close to the heart

Peripheral end in a small vein in the periphery

Peripherally inserted central catheter / PICC- An IV line threaded through a peripheral vein to end near the heart

Tunneled line- Catheter is inserted into a central vein through the chest

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22
Q

What determines the type of catheter used and site of insertion for IV fluids

A

Desired substance to be administered

Health of the veins in the desired site of insertion

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23
Q

Explain the news score

A

The National Early Warning Score (NEWS2) is a system for scoring the physiological measurements that are routinely recorded at the patient’s bedside. Its purpose is to identify acutely ill patients

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24
Q

Parameters in the NEWS score

A

AB
Respiratory rate
O2 saturation
Any supplemental oxygen

C
Systolic BP
Pulse

D
AVPU score

E
Température

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25
Classes in the NEWS score
Low 1-4 Medium 5-6 High 7 and above
26
Types of IV fluids
Hypertonic : more than 375mOsm/L Isotonic: 250- 375 Hypotonic: less than 250
27
Examples of isotonic solutions
0.9% Normal saline Ringers Lactate Blood component 5% Dextrose Water D5W
28
Indications of isotonic solutions
Direct fluid replacement in Diarrhea Bleeding
29
Examples of hypotonic solutions
Half or 45% Normal Saline 0.33% NaCl
30
Examples of hypertonic solutions
D5W in Normal Saline D5W in Half Normal Saline 10% Dextrose in Water (D10W)
31
Classify IV fluids
Two types 1. Blood and Products 2. Non blood IV fluids 2.a Colloids 2. a.i. Proteinious 2.a.ii. Non proteinous 2.b Crystalloids
32
Examples of crystalloids
Glucose containing Electrolyte Solutions Mixed solutions
33
Types of proteinous colloids and examples
1. Gelatins Heamacel Gelofusin 2. Albumin 20% and 5%
34
Types of non proteinous colloids and examples
1. Starch HES Pentastarch Tatrastarch 2.Dextrans
35
Factors that drive fluid movement
Diffusion Active Transport Osmosis Capillary filtration
36
What is the driving force for capillary filtration
Hydrostatic pressure
37
What balances out hydrostatic pressure
Colloid osmotic pressure from albumin
38
Components of the juxtaglomerular apparatus
Macula densa of the thick ascending limb Juxtaglomerular or Granular cells of the afferent arteriole Extraglomerular mesangial cell
39
Functions of the cells in the juxtaglomerular apparatus
Juxtaglomerular cells secrete renin Macula sends cells osmoreceptors Mesanglial cells regulate GFR
40
Functions of ANP
Suppresses release of renin, aldosterone and ADH Increases glomerular filtration Causes vasodilation
41
Why are older people more prone to dehydration
Thirst mechanism is less effective in older people
42
Three phases of rehydration
1. Fluid resuscitation or emergency phase 2. First 8 hours of Maintenance phase 3. Next 16 hours of Maintenance phase
43
How to calculate degree of dehydration
Difference in pre-illness and illness weights divided by pre-illness weight multiplied by 100
44
Various degrees of dehydration based on body weight
Mild (less than 3% change in body weight), Moderate (3%–9% change in body weight) Severe (greater than 9% change in body weight).
45
Types of dehydration
Isotonic dehydration Hypotonic dehydration Hypertonic dehydration
46
Treatments for mild and moderate dehydration
Oral fluid therapy Mild 50ml/kg over 4 hours Moderate 100ml/kg over 4 hours
47
Content of oral rehydration solutions
140mmol/L of carbohydrate 45mmol/l of sodium 20mmol/l of potassium
48
IV fluid delivery systems
Infusion pump Gravity
49
Initial approach for children with moderate to severe dehydration
Isotonic fluid blouses (NS) in 20ml/kg max of 1L given over 20mins in moderate dehydration and given as fast as possible in severe dehydration Blouses should be repeated until the child has restoration of intravascular volume
50
Maintenance phase for children with moderate to severe dehydration
Phase 2- 1/2 remaining deficit + 1/3 daily maintenance Phase 3- 1/2 remaining deficit + 2/3 daily maintenance
51
When are maintenance fluids used
When patient is NPO (nil per oral)
52
Components of maintenance fluids
Water Glucose Sodium Potassium
53
Role of glucose in maintenance fluids
Prevents starvation, ketoacidosis and hypoglycemia
54
Types of body sizes that can be used
Ideal body weight or dry body weight Body surface area Actual body weight
55
Preferred fluid for maintenance fluids
Isotonic fluids ( N/S OR LR)
56
Contraindications to isotonic fluids
Volume overload Hypernatremia
57
Standard dextrose composition of maintenance fluids
D5W
58
Strategy for fluid replacement in oliguria
Provide maintenance fluids at a rate that replaces insensible loss
59
Maintenance fluid therapy for 0-10kg
100ml/oh at a rate of 4ml/kg/hour
60
Maintenance fluid therapy for 11-20kg
Volume/24 hours 1000ml + 50ml/kg for each kg over 10kg Rate/hour 40ml + 2ml/kg for each kg over 10kg
61
Maintenance fluid therapy for more than 20kg body weight
Volume/24hours 1500ml + 20ml/kg for each kg over 20kg Rate/hour 60ml +1ml/kg for each kg over 20kg
62
Maximum volume and rate for maintenance fluids
Volume/24 hours 2.4-3L Rate/hour 100-120ml
63
Examples of elctrolyte solutions
Normal saline Ringers solution (Na, K, Cl and Ça) Lactated ringers ( Na, K, Cl, Ça and Lactate)
64
Ph and osmolarity of D5W
Ph- 3.2-6.5 Osmolarity - 252mosml/l

CLINICAL TOXICOLOGY (14 decks)

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