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RD Polytechnic Year 2 Semester 2 > 252 Pharmacology Fluids and Electrolytes > Flashcards

252 Pharmacology Fluids and Electrolytes Flashcards

1
Q

What is the composition of total body water?

A
  • Intracellular fluid: 67%
  • Interstitial fluid: 25%
  • Plasma volume: 8%
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2
Q

What percentage of the adult human body is water?

A

60%

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3
Q

What is the value of normal colloid oncotic pressure?

A

24 mm Hg

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4
Q

Where is intravascular fluid found?

A

inside the blood vessel

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5
Q

Where is extravascular fluid located?

A

outside the blood vessel (lymph, cerebrospinal fluid)

interstitial fluid

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6
Q

What is there more of in the body, ECF or ICF?

A

ICF. ⅔ ICF to ⅓ ECF.

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7
Q

What kind of pressure does interstitial fluid exert?

A

hydrostatic pressure, 17 mm Hg

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8
Q

Which electrolyte is the principal extracellular electrolyte, playing a major role in maintaining water concentration?

A

Sodium

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9
Q

Define dehydration.

A

When the quantity of water lost exceeds that gained. When 20-25% of TBW is lost, death can occur.

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10
Q

List 7 crystalloids.

A
  • Normal saline (0.9% sodium chloride) - isotonic
  • 0.45% normal saline (hypotonic)
  • 3.3% dextrose and 0.3% NS (two thirds one third - isotonic)
  • Hypertonic saline (3% sodium chloride)
  • Lactated ringer’s solution (isotonic)
  • Dextrose 5% in water (D5W)(isotonic)
  • D5W and 0.45% normal saline (hypertonic)
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11
Q

What are characteristics of crystalloids?

A
  • Solutions containing fluids and electrolytes that are normally found in the body
  • Do not contain proteins (colloids)
  • No risk for viral transmission, anaphylaxis, or alteration in coagulation profile
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12
Q

What are crystalloids best used for?

A
  • Better for treating dehydration rather than expanding plasma volume
  • Used as maintenance fluids to:
    • Compensate for insensible fluid losses
    • Replace fluids
    • Manage specific fluid and electrolyte disturbances
    • Promote urinary flow
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13
Q

What indications are there for crystalloids?

A
  • Acute liver failure
  • Acute nephrosis
  • Adult respiratory distress syndrome
  • Burns
  • Cardiopulmonary bypass
  • Hypoproteinemia
  • Hemodialysis
  • Deep vein thrombosis (reduction of risk)
  • Shock
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14
Q

What are the adverse effects of crystalloids?

A
  • May cause edema, especially peripheral or pulmonary
  • May dilute plasma proteins, reducing colloid oncotic pressure
  • Effects may be short-lived
  • Prolonged infusions may worsen alkalosis or acidosis
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15
Q

What are the three types of dehydration?

A

Hypertonic, hypotonic, and isotonic

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16
Q

What is hypertonic dehydration?

A

When water loss is greater than sodium loss, which results in higher concentration of solutes outside the cells and causes the fluid inside the cells to move to the extracellular space, thus dehydrating the cells.

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17
Q

What is hypotonic dehydration.

A

Occurs when sodium loss is greater than water loss, which results in higher concentrations of solute inside the cells and causes fluid to be pulled from outside the cells (plasma and interstitial spaces) into the cell. (e.g. kidney insufficiency and inadequate aldosterone secretion).

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18
Q

What is isotonic dehydration?

A

Caused by a loss of sodium and water from the body, which results in a decrease in the volume of extracellular fluid. (e.g. diarrhea and vomiting).

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19
Q

What are characteristics of colloids?

A
  • Protein substances
  • Increase colloid oncotic pressure
  • Move fluid from interstitial compartment to plasma compartment (when plasma protein levels are low)
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20
Q

List 3 colloid products.

A
  • Albumin 5% and 25% (from human donors)
  • Dextran 40 or 70 (available in sodium chloride and 5% dextrose)
  • Hetastarch (synthetic)
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21
Q

What are the adverse effects of colloids?

A
  • Usually safe
  • May cause altered coagulation, resulting in bleeding
  • Have no clotting factors or oxygen-carrying capacity
  • Rarely, dextran therapy causes anaphylaxis or kidney failure.
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22
Q

What are the characteristics of albumin?

A
  • Natural protein that is normally produced by the liver
  • Responsible for generating approximately 80% of colloid oncotic pressure
  • Sterile solution of serum albumin that is prepared from pooled blood, plasma, serum, or placentas obtained from healthy human donors
  • Pasteurized to destroy any contaminants
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23
Q

What are characteristics of blood products?

A
  • The only class of fluids that are able to carry oxygen
  • Increase tissue oxygenation
  • Increase plasma volume
  • Most expensive and least available fluid because they require human donors
  • Increase colloid osmotic pressure and plasma volume
    • Pull fluid from extravascular space into intravascular space (plasma expanders)
    • Red blood cell products also carry oxygen.
  • Derived from human donors and thus have all the benefits (and hazards) of human blood products
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24
Q

What are cryoprecipitate and plasma protein factors?

A

Management of acute bleeding (greater than 50% slow blood loss or 20% acutely)

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25
Q

What is fresh frozen plasma indicated for?

A

Increase clotting factor levels in patients with demonstrated deficiency

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26
Q

What are packed red blood cells indicated for?

A

To increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume

27
Q

What are indications for whole blood?

A
  • Same as for packed red blood cells except that whole blood is more beneficial in cases of extreme (greater than 25%) loss of blood volume, because whole blood also contains plasma
  • Contains plasma proteins, which help draw fluid back into blood vessels from surrounding tissues
28
Q

What are some of the adverse effects of blood products?

A
  • Incompatibility with recipient’s immune system
  • Cross-match testing
  • Transfusion reaction
  • Anaphylaxis
  • Transmission of pathogens to recipient (hepatitis, human immunodeficiency virus)
29
Q

What contraindications are there for sodium chloride?

A

Safe in pregnancy; naturally occurring in the body, so no hypersensitivity; not to be used where hypernatremia or hyperchloremia are present.

30
Q

When is hypertonic saline injection (3%) contraindicated?

A
  • Not be used in presence of increase, normal, or slightly decreased serum electrolyte concentrations
  • Correcting too quickly can lead to demyelination syndrome
31
Q

Why is infusing hypotonic saline not recommended?

A

It can cause hemolysis of the red blood cells.

32
Q

What are the principle ECF electrolytes?

A
  • sodium cations and chloride anions
33
Q

What are the principle intracellular electrolyte?

A
  • Potassium
34
Q

What are the characteristics of potassium?

A
  • Most abundant positively charged (cationic) electrolyte inside cells
  • 95% of body’s potassium is intracellular.
  • Potassium content outside of cells ranges from 3.5 to 5 mmol/L.
  • Potassium levels are critical to normal body function.
35
Q

Which foods are high in potassium?

A
  • Bananas
  • oranges
  • apricots,
  • dates
  • raisins
  • broccoli
  • green beans
  • potatoes
  • tomatoes
  • meats
  • fish
  • wheat bread
  • legumes.
36
Q

How is excess potassium excreted?

A

Via kidneys. Impaired kidney function leads to higher serum levels, possibly toxicity.

37
Q

What contraindications are there for albumin?

A

Known hypersensitivity, those with heart failure, severe anemia, or kidney insufficiency

38
Q

What is the mechanism of action of dextran?

A

Derivative of sugar; expands the plasma volume by drawing fluid from the interstitial space to the intravascular space.

39
Q

When is dextran contraindicated?

A

heart failure, kidney insufficiency, and extreme dehydration

40
Q

What are the advantages of packed red blood cells?

A
  • Oxygen carrying capacity in better than that of other blood products
  • Less likely to cause cardiac fluid overload
41
Q

What are the disadvantages of packed red blood cells?

A
  • high cost
  • limited shelf life
  • fluctuating availability
  • can transmit viruses
  • trigger allergic reactions
  • Can cause bleeding abnormalities
42
Q

What is the fluid of choice for blood loss of 20% or less (slow loss)?

A

crystalloids

43
Q

What is the fluid of choice for blood loss of 20-50% (slow loss)?

A

Nonprotein plasma expanders (dextran, pentastarch, hydroxyethyl starch, and hetastarch)

44
Q

What is the fluid of choice for blood loss of over 50% (slow loss) or 20% (acutely)?

A

Whole blood or packed red blood cells or plasma protein fraction and fresh frozen plasma

45
Q

What causes hyperkalemia: excessive serum potassium; serum potassium level over 5.5 mmol/L?

A
  • Potassium supplements
  • Angiotensin-converting enzyme inhibitors
  • Kidney failure
  • Excessive loss from cells
  • Potassium-sparing diuretics
  • Burns
  • Trauma
  • Metabolic acidosis
  • Infections
46
Q

What causes hypokalemia: deficiency of potassium; serum potassium level less than 3.5 mmol/L?

A
  • Excessive potassium loss (rather than poor dietary intake)
    • Alkalosis
    • Corticosteroids
    • Diarrhea
    • Ketoacidosis
    • Hyperaldosteronism
    • Increased secretion of mineralocorticoids
    • Burns
    • Thiazide, thiazide-like, and loop diuretics
    • Vomiting
    • Malabsorption
47
Q

True or false. Hypokalemia, in the presence of digoxin therapy, can cause digoxin toxicity, resulting in serious ventricular dysrhythmias.

A

True

48
Q

What is potassium responsible for?

A
  • Muscle contraction
  • Transmission of nerve impulses
  • Regulation of heartbeat
  • Maintenance of acid–base balance
  • Isotonicity
  • Electrodynamic characteristics of the cell
49
Q

What are some of the other therapeutic uses of potassium?

A
  • Stop irregular heartbeats
  • Management of tachydysrhythmias that can occur after cardiac surgery
50
Q

What are some of the adverse effects of potassium?

A
  • Oral preparations
    • Diarrhea, nausea, vomiting, gastrointestinal bleeding, ulceration
  • IV administration
    • Pain at injection site
    • Phlebitis
  • Excessive administration
    • Hyperkalemia
    • Toxic effects
    • Cardiac arrest
51
Q

What are manifestations of hyperkalemia?

A
  • Muscle weakness
  • paresthesia
  • paralysis
  • cardiac rhythm irregularities (leading to possible ventricular fibrillation and cardiac arrest)
  • Think ‘tight and contracted’
52
Q

What is the treatment for severe hyperkalemia?

A
  • IV sodium bicarbonate, calcium gluconate or calcium chloride, dextrose with insulin
  • Sodium polystyrene sulphonate (Kayexalate®) or hemodialysis to remove excess potassium
53
Q

What are some of the characteristics of sodium?

A
  • Most abundant positively charged electrolyte outside cells
  • Normal concentration outside cells is 135 to 145 mmol/L
  • Maintained through dietary intake of sodium chloride
    • Salt, fish, meats, foods flavoured or preserved with salt
54
Q

What are symptoms of hyponatremia?

A
  • Lethargy
  • stomach cramps
  • hypotension
  • vomiting
  • diarrhea
  • seizures
  • Think ‘depressed and deflated’
55
Q

What are the causes of hyponatremia?

A
  • Some of the same conditions that cause hypokalemia
  • Also, excessive perspiration (during hot weather or physical work), prolonged diarrhea or vomiting, kidney disorders, and adrenocortical impairment
56
Q

What are symptoms of hypernatremia?

A
  • Water retention (edema), hypertension
  • Red, flushed skin; dry, sticky mucous membranes; increased thirst; elevated temperature; decreased or absent urinary output
  • Think ‘big and bloated’
57
Q

What is sodium responsible for?

A
  • Control of water distribution
  • Fluid and electrolyte balance
  • Osmotic pressure of body fluids
  • Participation in acid–base balance
58
Q

What are the indications for sodium?

A
  • Main indication
    • Sodium depletion when dietary measures are inadequate (treatment or prevention)
    • Mild: Treated with oral sodium chloride or fluid restriction or both
    • Severe: Treated with IV NS or lactated Ringer’s solution
59
Q

What are the adverse effects of sodium?

A
  • Oral administration
    • Nausea, vomiting, cramps
  • IV administration
    • Venous phlebitis
60
Q

What should you do before giving potassium?

A

Before giving potassium, assess electrocardiogram

61
Q

What are some key considerations when monitoring a potassium infusion and what should you never do with potassium?

A
  • IV potassium must not be given at a rate faster than 10 mmol/hr to patients who are not on cardiac monitors. For critically ill patients on cardiac monitors, rates of 20 mmol/hr may be used.
  • Never give as an IV bolus or undiluted
62
Q

How do you administer oral forms of potassium?

A
  • Must be diluted in either water or fruit juice (100 to 250 mL) and taken with food or immediately after meals to minimize gastrointestinal distress or irritation and to prevent too rapid absorption
  • Monitor reports of nausea, vomiting, gastrointestinal pain, and gastrointestinal bleeding.
63
Q

When is extreme caution taken with potassium supplementation?

A
  • ACE inhibitors
  • potassium sparing diuretics (like spironolactone)
64
Q

True or false: oral potassium supplements are irritants and may be ulcerogenic.

A

True.

RD Polytechnic Year 2 Semester 2 (25 decks)

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