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Flashcards in IV fluids Deck (32)
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1

On average what % of body weight is water in neonates, young healthy fit male and female?

What two main compartments does your body water comprise?

Neonate: 75-80%

Male: 60%

Female: 55%

Intracellular 2/3
Extracellular 1/3 (interstitial and vascular space)

2

What are the components of your extracellular and intracellular fluid?

Extracellular:
-plasma;
--Na+********, K+, Ca++, Mg++
--anions: cl-, HCO3-, proteins, sulfates, organic acids
-interstitial space

Intracellular Fluid:
-K+ and Mg++ ******
-anions; phosphates, sulfates, and proteins.


***= main cations

3

What is normal body fluid osmolarity?

What are the two types of fluid replacement products?

Normal: 285osmol/L

Fluid replacement products: crystalloids and colloids

4

Examples of crystalloids and colloids

Crystalloids:
-dextrose in water: D5W, D10W, D50W

-Saline:
--isotonic (0.9%)
--hypotonic (0.45%)
--hypertonic (3%, 5%)

-Combo:
--D5 1/2NS
--D5 NS
--D10 NA

-Ringers lactate (K, HCO3, Mg, Ca)

Colloids:
-Albumin (5% NS, 25% salt poor)
-Dextran
-Hetastarch
-Blood
-FFP

5

T/F, crystalloids transfers easily across cell membrane of blood vessels?

T/F, colloids transfers easily across cell membrane of blood vessels?

True. Crystalloid solutions contain small molecules and are able to pass through semipermeable membranes.

FALSE! colloid solutions contain high molecular weight proteins or starch and cannot cross the capillary semipermeable membrane and remain in the intravascular space.

6

Why fluid type is indicated when more rapid hemodynamic equilibration is required?


Which type of solution (iso/hypo/hyper) is indicated in each of the following:
-given to expand ECF volume
-reverse dehydration
-increase ECF volume and decrease cellular swelling.

Colloids.

CRYSTALLOIDS:
expand ECF: isotonic solution.

reverse dehydration: hypotonic

increase ECF volume/decrease cellular swelling: Hypertonic

7

Which crystalloids are considered isotonic?

Which solution is CI in acute brain injuries? why?

Isotonic:
-NS
-Ringers solution
-Lactated Ringers

Hypotonic solutions are CI in acute brain injuries b/c cerebral cells are very sensitive to free water, absorbing it rapidly leading to cerebral cellular edema.

8

Which crystalloids are conisdered hypotonic?

Crystalloids:
-D5W (isotonic in bag, hypotonic effect in body)
-1/2 NS (0.45)
-1/4 NS (0.225)

9

Which solutions are considered hypertonic?

What are the types of volume deficits?

Hypertonic: saline solutions greater than 0.9%

Volume deficits:
-total body water: water loss (diabetes insipidus)

-extracellular:salt and water, GI tract losses, Third spacing

-intravascular: acute hemorrhage

10

What is third space? examples? causes?

Third space: areas of the body where fluid does not normally collect in larger amounts.

Examples: spaces in eye, CNS, peritoneal/pleural cavities, and joint capsules.

Causes:
-intestinal obstruction
-severe pancreatitis
-peritonitis
-major venous obstruction
-capillary leak syndrome
-burns

11

What are ways to assess extracellular space volume loss?

Weight loss

BP

JVP

Urine Na conc

Urine output

HCT

12

What are some increased states of fluid loss?

Signs of extracellular fluid depletion? Lab findings?

Fever, burns, sepsis, gastric fistulas, surgical drains

Signs of Extracellular fluid depletion:
-thirst
-decreased urine output
-weight loss
-drowsiness to coma
-decreased skin turgor
-dry mucous membranes
-sunken eyes
-tachycardia
-orthostatic hypotension progressing to hypotension

Labs:
-increased HCT
-Elevated BUN/Creat
-Elevated Urine Na
-Urine Specific Gravity greater than 1.020?

13

What needs to be monitored frequently in pts with extracellular fluid loss?

hemodynamic parameters

Urine output

Daily weights

Daily labs: HCT, BMP

14

Compare the signs of hypovolemia to hypervolemia?

Hypovolemia sx:
-orthostatic hypotension
-tachycardia
-flat neck veins
-decreased skin turgor
-dry mucosa
-supine hypotension
-oliguria
-organ failure

Hypervolemia:
-hypertension
-tachycardia
-increased JVP
-Gallop
-Edema
-Pleural effusion
-pulmonary edema
-ascites
-organ failure

15

Severe hypovolemia and hypovolemic shock is treated with which fluids?

1-2L of isotonic saline.
-if bleeding use blood

OR

colloids(more rapid volume expansion)

Crystalloids are equally effective in expanding the plasma volume as colloids but need to use 1.5-3x as much because of the extravascular distribution

16

T/F, large volume resuscitation with isotonic saline may be associated with development of hyperchloremic metabolic acidosis.

true. if acidotic add sodium bicarboniate to the transfusate.

17

Tx of mild-moderate hypovolemia?

rapid fluid resuscitation is not necessary.

The rate of fluid administration must be greater than the rate of fluid losses. Consider administration of fluid at a rate that is 50-100ml/hr greater than estimated fluid losses.

18

What type of replacement fluids for each of the following situations:
-hypernatremia
-hyponatremia
-blood loss
-hypokalemia or metabolic acidosis

Hypernatremia: hypotonic solution

Hyponatremia: hypertonic or isotonic

Blood loses: isotonic or blood

Hypokalemia: potassium

Metabolic acidosis: bicarbonate.

19

How do we lose electrolytes?

A disruption in water balance is manifested as an abnormality in ______.

all electrolytes are lost in the urine. NO significant amount of electrolytes are lost in sweat or exhaled water vapor.

A disruption in water balance is manifested as an abnormality in serum sodium.

20

What is the consequence of correcting hyper/hyponatremia too quickly?

Which calculation is used to determine rate of infusion of solution in hypernatremia?

Cerebral edema or central pontine myelinosis

Madias formula.

21

Who needs maintenance fluid/electrolyte therapy?

What are some baseline tests needed before starting maintenance fluid therapy?

Unable to eat or drink normally for a prolonged period of time

perioperative period

ventilated patients

Tests:
-serum Na
-baseline weight

22

Which fluid is MC used for maintenance therapy?

0.45% NS D5 + 20mEq K+.

*if eating may not need D5.

23

What needs to be monitored frequently in pts with extracellular fluid loss?

hemodynamic parameters

Urine output

Daily weights

Daily labs: HCT, BMP

24

Compare the signs of hypovolemia to hypervolemia?

Hypovolemia sx:
-orthostatic hypotension
-tachycardia
-flat neck veins
-decreased skin turgor
-dry mucosa
-supine hypotension
-oliguria
-organ failure

Hypervolemia:
-hypertension
-tachycardia
-increased JVP
-Gallop
-Edema
-Pleural effusion
-pulmonary edema
-ascites
-organ failure

25

Severe hypovolemia and hypovolemic shock is treated with which fluids?

1-2L of isotonic saline.
-if bleeding use blood

OR

colloids(more rapid volume expansion)

Crystalloids are equally effective in expanding the plasma volume as colloids but need to use 1.5-3x as much because of the extravascular distribution

26

T/F, large volume resuscitation with isotonic saline may be associated with development of hyperchloremic metabolic acidosis.

true. if acidotic add sodium bicarboniate to the transfusate.

27

Tx of mild-moderate hypovolemia?

rapid fluid resuscitation is not necessary.

The rate of fluid administration must be greater than the rate of fluid losses. Consider administration of fluid at a rate that is 50-100ml/hr greater than estimated fluid losses.

28

What type of replacement fluids for each of the following situations:
-hypernatremia
-hyponatremia
-blood loss
-hypokalemia or metabolic acidosis

Hypernatremia: hypotonic solution

Hyponatremia: hypertonic or isotonic

Blood loses: isotonic or blood

Hypokalemia: potassium

Metabolic acidosis: bicarbonate.

29

How do we lose electrolytes?

A disruption in water balance is manifested as an abnormality in ______.

all electrolytes are lost in the urine. NO significant amount of electrolytes are lost in sweat or exhaled water vapor.

A disruption in water balance is manifested as an abnormality in serum sodium.

30

What is the consequence of correcting hyper/hyponatremia too quickly?

Which calculation is used to determine rate of infusion of solution in hypernatremia?

Cerebral edema or central pontine myelinosis

Madias formula.