Perioperative Fluid and Electrolytes Flashcards Preview

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Flashcards in Perioperative Fluid and Electrolytes Deck (81)
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1

what is Total Body Water (TBW)?

60% of total body weight

2

TBW is broken down into IntraCellular Volume ___ and ExtraCellular Volume (ECV)____.

40%
20 %

3

Blood volume is ___ % of TBW

7%

4

Extracellular contains primarily what?

Na
Cl
HCO3

5

intracellular fluid is mainly waht?

K
PO4
SO4

6

most important osmotically active colloid in ECV and is normally 4g/L in serum vs. only 1g/L in interstitial fluid.

Albumin

7

normal level of Na

140

8

Normal level of Cl

100

9

Normal level of K

4.0 mg/dl

10

normal level of albumin

4.0 g/L

11

what is the normal water loss per day

2.5-3 L / day

12

what is the breakdown of water losses per day

urine 1-1.5 L
150 cc GI
1 L insensible losses (sweat, respiration)

13

We generally required how many mEq/Kg/day of Na and Cl?

1-2 mEq/Kg/day

14

we generally require less than __ mEq/Kg/day of K

1 mEq/Kg/day

15

what is the 4-2-1 rule?

Appropriate maintenance fluids
4 ccs per hour for the first 10 kg of weight
2 cc's per hour for the next 10 kgs
1 cc per hour for every kg beyond that

16

what is in normal saline?

created the right concentration of salt in water at the same concentration as their blood (330 mEq/L)

17

why does D5 1/2 NS not lyse the cells?

added 50 grams of sugar is enough to bring it up to same osmolarity as the blood

18

what does lactated ringer's contain.

4 K
2 Ca
28 lactate
(much closer analog of normal body's makeup)

19

for high volumes should you use LR or NS?

LR

20

what fluids do you use for life saving measures?

NS
LR

21

what are some scenarios where you lose more fluids?

fever
vomiting
diarrhea
NGT
fistulas
bleedings
drains
long open abd cases
third spacing

22

where is albumin found

4 mg/dl in blood
1 in extracellular fluids

23

what is the problem with giving albumin

a lot of it is in the interstitial space and is higher there
when the inflammation stops, the albumin is trapped in that space, so it is hard to unload the water in the third space

24

what are the goals with fluid resucitation

normal BP
HR in double digits
urine out put of 1/2 cc/kg/hr
for child low end of normal is 1 cc/kg/hr

25

He says that pt X is diabetic but has been placed on D5 NS and his sugars are high...would you change it to just NS please?

No, need some sort of glucose so they don't undergo gluconeogenesis. giving dextrose allows them to avoid this (only 600 calories a day) keeps them from breaking down muscle.

26

Nurse says that pt Y has a BMP with a glucose of 488. What would you like him to do?

Ask if patient is awake (need to know if in DKA)
have them recheck their glucose on other arm (often did a draw above the IV site

27

a drop a D5NS would read what on a glucometer?

5000

28

a high K is associated with what?

arrhythmias and cardiac death

29

what is a common reason for a high K reading?

hemolysis of blood during draw

30

what is hypernatremia usually due to?

typically from loss of water without salts e.g. burns, fever, hyperventilation.