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PDAT3 > 2 - Fluid Disorders > Flashcards

2 - Fluid Disorders Flashcards

1
Q

TBW
Total Body Weight
for Male & Female

A 
**Male = 60%
Female = 50%**

% of body weight

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2
Q

TBW
Total Body Weight
for
Pediatrics

A

Pediatrics = 60-70%

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3
Q

TBW
Total Body Weight
for
Elderly Male & Female

A

Elderly Male = 50%

Elderly FEMALE = 45%

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4
Q

TBW
Total Body Weight​
for
OBESE

A

Decrease by 5%
if >130% over the IBW (ideal body weight)

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5
Q
  • *Split of Total Body Water**
  • *ECF / ICF / ISF / IVF**
A

2/3 ICF (intracellular Fluid)

1/3 ECF (Extracellular Fluid)
broken down to:
3/4 ISF (Interstitial Fluid)
&
1/4 IVF (Intravascular fluid)

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6
Q

Body Fluid Composition

A

TBW = ICF + ECF (ISF + IVF)

for a Male, 60% of weight is TBW

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7
Q

Tonicity

A

Fluid Tension between ECF & ICF
Extracellular Fluid - Intracellular Fluid (2/3 of TBW)

Weight of particles in a compartment that can Attract fluid
depend on relative solute permeability

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8
Q

OsmaLALity

Definition and Range

A

Total Solute concentration
given a weight of water in a given compartment

  • *Collected or Measured** Plasma OsmoLALity:
  • *280-295** mOsm/kg h2o
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9
Q

OsMOLARity

A

Osmolarity (mOsm/L H2O) =
​2x[Na+] + glucose/18 + BUN/2.8

  • *CALCULATED**
  • compared to OsmoLALity, which is collected/measured*

Qualitative measure of TBW
↓ pOsm implies EXCESS water
↑ pOsm implies LACK of water

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10
Q

Regulation of Water Metabolism

A

Water Intake
THIRST is the mechanism to increase water intake
↑pOsm (lack of water)
↓ECF or BP

WATER EXCRETION
AVP = Arginine Vasopressin
major determinant of water loss

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11
Q

Water Balance

A

Water Gain
Sensible = Drinking Fluids / Eating Solids
Insensible = 250mL
From Metabolism / not measurable, but need to be taken account for

Water LOSS
Sensible = Urine / Intestinal / Sweat
Insensible = 600
from lungs / skin

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12
Q

AVP
Arginine Vasopressin

A

an ADH hormone synthesized in the Hypothalmus
stored in the posterior pituitary

Major Determinant of WATER LOSS
Water Excretion

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13
Q

Vasopressin Receptors
AVP

A

V2: Renal COLLECTING DUCT
<–Resorption of water via aquaporin-2 channel
decreases water excretion

V1A: Vascular Smooth Muscle
vasoconstriction / cardiac hypertrophy

V1B: Stress Reactive
release ACTH & Endorphin

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14
Q

What stimulates the RELEASE of AVP?

A

↑pOsm or ↓BP

NAUSEA**

Pain / Anxiety

  • *Medications**:
  • *Nicotine** / carbamezapine / TCA’s
  • *SSRI’s** / opiates / haloperidol
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15
Q

Labs / Vitals / Symptoms
for HypoVolemia

A
  • *Vitals**
  • *↑HR** , orthostatics , ↓BP (severe), ↓Urine output

Labs
conc. urine , ↑BUN,
↑SCr // ↑Na+ (severe)

  • *Symptoms**
  • *weakness / syncope** / confusion / THIRST
  • *↓ skin turgor / dry mouth**
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16
Q

Causes of dehydration which can lead to hypoVolemia

A

Increasing Age / Medications

INSENSIBLE Losses
Sweat / burn / HYPERVentilation

GI Losses
Vomiting / Diarrhea / biliary

  • *Diabetes Insipidus** = AVP issues
  • *Central** (neurogenic) - ↓ AVP secretion
  • *Nephrogenic** = RESISTANCE to AVP effect
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17
Q

What type of VOLUME THERAPY?

Goal is to maintain ORGAN PERFUSION
by treating the intravascular hypovolemia

A

RESUSCITATION

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18
Q

What type of VOLUME THERAPY?

Goal is to Replace Volume Lost

A

REPLACEMENT

19
Q

What type of VOLUME THERAPY?

Goal is to PREVENT Dehydration
consider BOTH sensible & insensible losses

A

MAINTENANCE

20
Q

CRYSTALLOID
Volume Therapy

A

FLUID + ELECTROLYTES
replaces water & electrolytes

readily available / better tolerated / 1st line

Ex:
0.45% / 0.9% NaCl // LR // D5W

21
Q

COLLOID
Volume Therapy

A

PRBC / Albumin 5% / 25% hetastarch
HUMAN PRODUCTS

used for I_ntravascular Volume (IVF) EXPANSION_

large molecules stay in the VASCULAR space

22
Q

ISOTONIC
Replacement Fluid Tonicity

A

SImilar to Plasma, no fluid shifts

0.9% NaCl & LR’s

23
Q

HYPERtonic
​Replacement Fluid Tonicity

A

GREATER than PLASMA

IC –> EC fluid shifts
intracellular to extracellular

3% NaCl

24
Q

HypoTonic
​Replacement Fluid Tonicity

A

< 150 mOsm/L
flows BACK <– into Intracellular Space
EC –> IC

0.2% NaCl

25
Q

Crystalloid Characteristics

A

Dextrose 5% is isotonic
hypotonic solution
BUT it causes increases in ICF / ISF / IVF

  • Dextrose is slowly distributed
26
Q

Colloid Characteristics

NO Intracelular Movement

A
27
Q

Lactated Ringers & 0.9% NaCl
USES

LR contains K+, not good for patients with RENAL failure

A

Useful for hypotensive patients

IVF EXPANSION
(intravascular)

Since they are ISOTONIC, there is no fluid shift
does NOT enter any cells

commonly used in general surgery / neurosurgical poulations
since there is a LOSS of a lot of blood –> need to expand volume

28
Q

D5W
Uses

A
  • *ISOTONIC**
  • BUT it* INCREASES ICF / ISF / IVF

The Dextrose provides OSMOTIC Activity to prevent hemolysis

Effective admin of a hypotonic solution“free water”

Watch out for:
HYPERglycemia &hypoNatremia

29
Q

0.45% NaCl or 0.45% NaCl/D5W

USES

A

Able to REPLACE MORE Free water vs NS

Useful in:
HYPERNatremic Patients
&
Replacing INSENSIBLE water loss
dextrose can add calories

30
Q
  • *RESUSCITATION**
  • *Management of HypoVolemia**
A

*ONLY if S/Sx of SHOCK
Bolus Dosing with 250-1000mL of
0.9% NaCl or LR
goal is to EXPAND IVF volume, need blood purfusion –> vital organs FIRST

Monitor:
BP / HR / Urine Output / CNS symptoms

MAY REPEAT if still SYMPTOMATIC

31
Q

REPLACEMENT
Management of HypoVolemia

A
  • *Calculate:**
  • *FREE WATER DEFICIT**
  • based on SODIUM concentrations*
32
Q

MAINTENANCE
Management of HypoVolemia

A

Goal is to:
Prevent Dehydration
while administering daily water requirements

check comorbidities
revie patient’s electrolytes
&
nutritional status

33
Q

Daily Fluid Requirements
(Maintenance)
Based on Volume Status
Dehydration / Post-OP / Euvolemia / Elderly or CHF

A
  • *Dehydation**
  • *45** mL/kg/day
  • *Post-Operative**
  • *40** mL/kg/day
  • *Euvolemia**
  • *35** mL/kg/day
  • *Elderly or CHF**
  • *30** mL/kg/day
34
Q

Daily Fluid Requirement
(Maintenance)
Alternative Method - PEDIATRICS

A
  • *for the 1st 10kg**
  • *100** mL/kg/day
  • *for the 2ND 10kg**
  • *50**​ mL/kg/day
  • *for WEIGHT > 20kg**
  • *20** mL/kg/day
35
Q

What Fluid & how much for this patient?

Post-OP patient with EBL of 500ml
(estimated blood loss)

A

FIRST
LR or 0.9% NaCl @ 40 mL/kg/day
useful in surgery - loss of a lot of blood // post-op pt

after 24 hours, THEN
D5W/0.45% NaCl @ 35 mL/kg/day
??? // euvolemic (normal volume)

36
Q

What Fluid & how much for this patient?

HypoTensive Patient

A

LR or 0.9% NaCl @ 45 mL/kg/day

useful in HypoTensive Patients
&
low BP will lead to AVP release –> WATER excretion
dehydration is 45 mL/kg/day

37
Q

What Fluid & how much for this patient?

NPO Cardiac patient w/ K+ level 3.4 mEq/L

A

D5W/0.45% NaCl + KCl 20 mEq @ 30 mL/kg/day

Normal K+ levels are 3.5-5.0​ mEq/L, patient is hypoKalemic
to correct the hypokalemia along with the KCL tabs

30 mL/kg/day –> CARDIAC PATIENT (CHF)

38
Q

What Fluid & how much for this patient?

NPO Patient for an elective procedure

A

D5W/0.45% NaCl @ 35 mL/kg/day

not an EMERGENCY / sudden surgery, likely no blood loss
need to add calories?
replace free water &insensible water losses

35 because euvolemic (normal volume)

39
Q

Assessment of TOXICITY

A
  • *FLUIDs = DRUGS**
  • *volume overload is a COMMON PROBLEM**
  • if not MONITORED properly*:

Monitor:
Daily weight / Labs / Physical Exam

S/Sx:
Pulmonary + Peripheral Edema // Heart Failure
↓serum Osm // ↓Na+
reduction of pOsm, means EXCESS water

40
Q

↓ pOsm
IMPLIES WHAT?
(osmolarity, qualitative measure of TBW)

A

EXCESS OF WATER

can be HYPERvolemic

41
Q

­­↑ pOsm
IMPLIES WHAT?

(osmolarity, qualitative measure of TBW)

A

LACK OF WATER

HypoVolemic

42
Q

Use for COLLOID Solutions
5% Albumin // 25 % Albumin
no intracellular movement

A

for INTRAVASCULAR VOLUME EXPANSION
4x GREATER
IVF expansion vs equal volume of crystaloid

BLOOD TRANSFUSIONS
packed RBC’s = PRBC

43
Q
  • *Colloid Solutions**
  • *Albumin Uses**
A

5% is adminstered in 250mL doses

25% is admin in 50-100mL doses
25% is DIFFERENT because
fluid flows from ISF (negative) –> IVF
interstitial –> intravascular

PDAT3 (23 decks)

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