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Surgery > Body Water, Osmolarity Physiology and Fluid Replacement Products > Flashcards

Body Water, Osmolarity Physiology and Fluid Replacement Products Flashcards

1
Q

Things to administer before administration?

6

A
  1. Things to consider before administration
  2. Body fluid compartments
    - ECF, ICF
  3. Fluid replacement products
    - Crystalloids, colloids
    - Isotonic, hypotonic, hypertonic
  4. Volume
  5. Electrolytes
  6. Maintenance therapy
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2
Q

Fluid and electrolyte disorders in a surgical patient

  1. Disorders of volume? 2
  2. Disorders of the electrolyte concentrations? 6
A
  1. Disorders of volume
    - Depletion
    - Excess
  2. Disorders of electrolyte concentrations
    - Sodium
    - Potassium
    - Chloride
    - Calcium
    - Magnesium
    - Phosphate
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3
Q

Sequelae of inappropriate fluid and electrolyte management

8

A
  1. Increased length of stay
  2. Increased cost
  3. Wound infection
  4. Delayed wound healing
  5. Anastomotic failure
  6. Tachyarrhythmias
  7. Cerebral edema, seizures, death
  8. Pulmonary edema, CHF, renal failure
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4
Q

What are you trying to accomplish with IV fluids?

  1. What is maintance therapy?
  2. Replacement therapy?
  3. Volume resuscitation?
A
  1. Maintenance therapy
    - If the patient is not expected to eat or drink for a period of time
  2. Replacement therapy
    - Correct abnormalities in volume and/or electrolytes
  3. Volume resuscitation
    - Hypotension, hemorrhage
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5
Q

Total body water is directly related to what?

and Inversely proportional to what?

A
  1. Directly proportional to the muscle mass
    - Muscle mass is about 70% water
  2. Inversely proportional to fat
    Fat is about 10% water
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6
Q

Total body water percentage:

  1. Neonates?
  2. Young healthy fit male?
  3. Young healthy fit female?
  4. Total body water as a % of weight decreases in who? 3
A
  1. Neonates
    - 75-80% of body weight is water
  2. Young healthy fit male
    - On average 60% of his body weight is water
  3. Young healthy fit female
    - On average 55% of her body weight is water
  4. Total body water as a % of weight decreases in:
  5. Morbidly obese,
  6. elderly, or
  7. low muscle mass due to disease or injury

May be as little as 35%

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7
Q

Total body water consists of two main compartments

  1. What are they?
  2. What part of TBW do they make up?
  3. How many liters each?
A
  1. Intracellular fluid
  2. 2/3 of TBW
  3. 28L (70kg man)
  4. Extracellular fluid
  5. 1/3 of TBW
  6. 14L (70kg man)
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8
Q
  1. What makes up the extracellular volume? 2
A
  1. Plasma and Interstitial space
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9
Q
  1. What is the main cation in plasma?
  2. Others that are there?
  3. Anions? 5
  4. What is different about interstitial space in the ECF than plasma?
A

Plasma

  1. Na+ is the main cation
  2. Other cations:
    - K+,
    - Ca++,
    - Mg++
  3. Anions:
    - Cl-,
    - HCO3-,
    - proteins,
    - sulfates,
    - organic acids
  4. Interstitial space
    - Same as plasma but lower concentration of protein
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10
Q

What are the main cations in the intracellular space? 2

Main anions are? 3

A
  1. K+ and
  2. Mg++ are the main cations

Main anions are

  1. phosphates,
  2. sulfates and
  3. proteins
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11
Q

Diffusion of proteins and ions is limited

  1. _____ diffusion is limited
  2. Sodium stays mainly on the ________ of the cell
  3. Potassium stays mainly on the _______ of the cell
  4. Water may diffuse how?
A
  1. Free
  2. outside
  3. inside
  4. freely among all compartments
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12
Q
  1. Movement of water is considered?
  2. Exchange of water between the intracellular and interstitial compartments is determined by what?
  3. ECF hypo-osmolar = water will go into cells where the osmolarity is ________ until equilibrium is reached
A
  1. Passive
  2. osmotic gradients
  3. higher
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13
Q

Osmolarity
1. Normal body fluid osmolarity about _____ osmol/L

  1. Hyperosmolarity will occur in both the ECF and ICF if what is increased?
  2. Fluid will move from the ICF to the ECF and leave the ICF more concentrated from loss of water therefore = what?
A
  1. 285
  2. extracellular osmolarity
  3. hyperosmolar
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14
Q

Summary of Body Fluid Compartments
1. What is ICF and what percentage does it make up total body fluid?

  1. What is ECF and what percentage does it make up total body fluid?
  2. What are the two componenets of the ECF and where are they?
A
  1. Intracellular fluid (ICF)
    - Fluid within cells
    - 2/3 of body fluid is ICF
  2. Extracellular fluid (ECF)
    - Fluid outside of cells
    - 1/3 of body fluid
  3. Two components
    - Interstitial fluid – fluid surrounding cells (26% of ECF)
    - Vascular space – fluid within blood vessels (7% plasma, blood)
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15
Q

Fluid Replacement Products
2

Then can further categorize into what? 3

A
  1. Crystalloids
  2. Colloids

Then can be further categorized as

  1. Isotonic
  2. Hypotonic
  3. Hypertonic
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16
Q

What are the categories of crystalloids? 4

A
  1. Dextrose in water
  2. Saline
  3. Combo
  4. Ringer’s lactate
17
Q

What are the categories of Colloids?

5

A
  1. Albumin
  2. Dextran
  3. Hetastarch
  4. Blood
  5. Fresh frozen plasma
18
Q

Name the following fluids in each crystalloid category:

  1. Dextrose in water? 3
  2. Saline? 3
  3. Combo? 3
  4. Ringer’s lactate (whats in it 4)?
A
  1. Dextrose in water
    - D5W
    - D10W
    - D50W
  2. Saline
    - Isotonic (0.9% or “normal”)
    - Hypotonic (0.45%, 0.225%)
    - Hypertonic (3%, 5%)
  3. Combo
    - D5 1/2NS
    - D5 NS
    - D10 NS
  4. Ringer’s lactate “physiologic”.
    (K, HCO3, Mg, Ca)
19
Q

What are the two albumin concentrations?

A
  1. 5% in NS

2. 25% (Salt Poor)

20
Q
  1. What are crystalloids?

2. How does the solution transfer?

A
  1. Solutions that contain small molecules and are able to pass through semipermeable membranes
  2. Solution transfers easily across the cell membrane of the blood vessels (small particles)
21
Q
  1. What are colloids?

2. Describe their permeability?

A
  1. Solutions that contain high molecular weight proteins (like albumin) or starch
  2. Do not cross the capillary semipermeable membrane
    - Remain in the intravascular space (pulling fluid out of the intracellular and interstitial space) for several days
22
Q
  1. When are crystalloids used most?

2. Colloids?

A
  1. Crystalloids are generally adequate for most situations needing fluid management
  2. Colloids may be indicated when more rapid hemodynamic equilibration is required
23
Q
  1. Isotonic solutions are used for?
  2. Hypotonic solutions are used for?
  3. Hypertonic?
A
  1. Isotonic solutions
    - given to expand the ECF volume
  2. Hypotonic solutions
    - given to reverse dehydration
  3. Hypertonic solutions
    - given to increase the ECF volume and decrease cellular swelling
24
Q
  1. Isotonic fluids have the same osmolality as plasma, so the fluids remain primarily in the where?
  2. Isotonic IV fluids are used to do what? 2
A
  1. ECF
    • replace ECF losses and
    • to expand vascular volume quickly
25
Q

What are the isotonic solutions?

3

A
  1. Normal saline (NS, 0.9% NaCl)
  2. Ringer’s solution
  3. Lactated Ringer’s (RS)
26
Q

What do the following conatin?

  1. Normal saline (NS, 0.9% NaCl) 2
  2. Ringer’s solution 3
  3. Lactated Ringer’s (RS) 5

What do they not have?

  1. Normal saline (NS, 0.9% NaCl) 2
  2. Ringer’s solution 5
  3. Lactated Ringer’s (RS) 3
A

Normal Saline (NS, 0.9% NaCl) 1. provides

  • sodium and
  • chloride in water with same osmolality as serum;
    2. Ringer’s solution – contains
  • sodium,
  • potassium,
  • calcium in similar concentrations to plasma
    3. Lactated Ringer’s (LR) – contains
  • sodium,
  • chloride,
  • potassium,
  • calcium, and
  • lactate in concentrations similar to normal plasma
  1. Normal Saline (NS, 0.9% NaCl)
    - no calories or
    - free water (water without solute)
  2. Ringer’s solution
    - no dextrose,
    - magnesium or
    - bicarbonate;
    - no calories or
    - free water
  3. Lactated Ringer’s (LR) –
    - no dextrose,
    - magnesium or
    - free water
27
Q

Hypotonic solutions
1. _______ osmolality than normal plasma

  1. MOA?
  2. What does this result in? 2
  3. Used for? How?
  4. Contraindicated in? Why?
A
  1. Lower
  2. Increases cell water by pulling water out of the vessels into the cells
  3. Results in
    - decreased vascular volume and
    - increased cell water
  4. Used to prevent and treat cellular dehydration by providing free water to the cells
  5. CONTRAINDICATED in acute brain injuries because cerebral cells are very sensitive to free water, absorbing it rapidly and leading to cerebral cellular edema
28
Q

What are our hypotonic solutions?

3

A
  1. 5% Dextrose in water (D5W)
  2. 0.45% normal saline (1/2 NS)
  3. 0.225% normal saline (1/4 NS)
29
Q

5% dextrose in water (D5W) –

  1. Describe the difference between D5W in a bag and then when it gets into the body?
  2. What can it prevent?
  3. 45% saline (1/2 NS) and 0.225 saline (1/4 NS) –
  4. What do they provide the cells and what are they often used as?
A

5% dextrose in water (D5W) –
1. although isotonic in IV bag, it has a hypotonic effect in the body as the dextrose is quickly metabolized…leaving free water that shifts osmosis from vessels into cells;

  1. the dextrose content does not meet daily nutritional caloric requirements but it does prevent starvation
  2. 45% saline (1/2 NS) and 0.225 saline (1/4 NS) –
  3. these fluids provide free water to the cells as well as small amounts of sodium and chloride…
  4. often used as maintenance fluids
30
Q

Hypertonic Fluids:
1. ________ osmolality than normal plasma

  1. Causes water to be pulled from the cells into the ________?
  2. resulting in what? 2
A
  1. Higher
  2. vessels
    • increased vascular volume
    • decreased cell water
31
Q

Hypertonic Solutions
Used to treat very specific problems
-Administered in carefully controlled, limited doses to avoid what?
2

A
  1. vascular volume overload

2. and cell dehydration…pulls excess fluid from cells and to promote osmotic diuresis

32
Q

Hypertonic Fluids

What is the one?

A

Saline solutions > 0.9%

Used infrequently

33
Q

Describe movement in the following solutions:

  1. Isotonic?
  2. Hypotonic?
  3. Hypertonic?
A
  1. Stays inside the bloodstream or intravascular compartment
  2. Will shift and flow into a more concentrated solution
    (draws fluid from vessels and moves fluid into cells)
  3. Will pull a less concentrated solution into itself
    (draws fluid out of the cells and into the blood) ex: tx severe low Na levels
34
Q
  1. D5W is handled like free water since dextrose is what?

2. with high volumes infusion there is a risk for which electrolyte disturbance?

A
  1. metabolized

2. Hyponatremia

35
Q
  1. 0.9% saline (isotonic) does not diffuse thru all compartments since what?
  2. ½ NS…1/2 behaves as what and ½ as what?
A
  1. the cell membrane is impermeable to sodium

2. free water, saline

36
Q

1 Liter 0.9% saline (isotonic…distributed in _____ since cell membrane not permeable to sodium)

A

ECF

-does not go into ICF

37
Q

1 liter 5% Albumin and PRBCs (remains in where?)

A

intravascular space

38
Q

Adverse affects of the following are:

  1. Normal saline? 3
  2. Lactated ringers? 3
  3. D5W? 1
A
  1. Normal saline
    - Fluid overload
    - Metabolic acidosis (hyperchloremic)
    - Hypernatremia
  2. Lactated Ringers
    - Fluid overload
    - Hyponatremia
    - Hyperkalemia
  3. D5W
    - Hyponatremia

Surgery (20 decks)

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