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Pharmacology > Exam 3- IV Fluid > Flashcards

Exam 3- IV Fluid Flashcards

1
Q

Does overnight fasting have a significant reduce IV volume?

A

NO

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2
Q

Anesthesia related factors causing IV volume derangements (2)

A
  1. Anesthetics

2. Sympathetic blockade during neuralgia anesthesia

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3
Q

Surgery related factors causing IV volume derangements (6)

A
  1. Hemorrhage
  2. Coagulopathy due to hemodilution and hypothermia
  3. Decrease venous return
  4. Mechanical ventilation maneuvers
  5. Prolonged operative time, open abdominal cavity, bowel edema
  6. Reasons preventing transition from IV to oral fluid therapy within 24 hrs of surgery
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4
Q

Tissue edema effects, increase extra vascular fluid

A

Hypervolemia

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5
Q

Can hypovolemia and hypervolemia lead to tissue perfusion?

A

YES

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6
Q

3 limitations for monitoring IV volume status:

A
  1. CVP
  2. Urine output
  3. Mixed venous and oxygen saturation
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7
Q

What is tonicity:

A

Effective osmolality

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8
Q

What does serum sodium reflect?

A

Total body water status

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9
Q

What does sodium content in intravenous fluid dictate?

A

Fluid distribution

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10
Q

What can all crystalloids be viewed as?

A

Water and saline equivalents

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11
Q

More or less water as we age?

A

Less water

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12
Q

Increased ECF or ICF with malnutrition?

A

ECF

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13
Q

Water represents how much of weight?

A

50-60%

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14
Q

ICF:ECF ratio?

A

2:1

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15
Q

ECF is comprised of:

A 
Interstitial fluid (3 parts)
Plasma (IV) (1 part)
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16
Q

ISF:plasma ratio

A

3:1

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17
Q

Cellular membrane permeable to what?

A

Water but not ions

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18
Q

Principle ions of ECF:

A

Na+ Cl-

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19
Q

Principle ions of ICF:

A

K+ PO42-

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20
Q

Fluid components of blood within vessels maintained by the inward pull of…

A

Colloid osmotic pressure (oncotic pressure)

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21
Q

Fluid components of blood within vessels maintained by the outward pull of…

A

Hydrostatic pressure which pushes plasma out of vessels

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22
Q

What is endothelial glycocalyx?

A

Endothelium coated on luminal side with fragile glycocalyx layer

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23
Q

Web of membrane bound glycoproteins and proteoglycans

A

Glycocalyx layer

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24
Q

What does endothelial glycocalyx do?

A

First barrier to regulating cellular and macromolecule transport

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25
Q

What kind of pressure does endothelial glycocalyx produce?

A

Colloid oncotic pressure which is important to transcapillary flow

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26
Q

4 factors that degrade endothelium?

A
  1. Ischemia/reperfusion
  2. Hypoxia
  3. Inflammatory cytokines
  4. Atrial natriuretic peptide
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27
Q

3 protective factors of endothelium

A
  1. Sevo
  2. Hydrocortisone
  3. Antithrombin
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28
Q

Which ion is the primary determinant of osmolality?

A

Sodium

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29
Q

What governs IV fluid distribution within the body?

A

Sodium content of intravenous fluids

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30
Q

Represent particles which are confined to one side of the membrane thereby influencing distribution of fluids within the body

A

Effective osmoles

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31
Q

Does effective osmoles influence distribution of fluids within body?

A

YES

32
Q

What are the 4 effective osmoles?

A

Glucose
Sodium
Mannitol
Glycerin

33
Q

Represent particles which readily cross the membrane reaching equilibrium

A

Ineffective osmoles

34
Q

Do ineffective influence the distribution of fluids within the body?

A

NO

35
Q

3 examples of ineffective osmoles?

A

Urea
Ethanol
Methanol

36
Q

Total body osmolality equation (2)

A

(Extracellular solute+intracellular solute)/total body water
((Nax2)+(Kx2))/total body water

37
Q

Aqueous solutions of low molecular salts

A

Crystalloids

38
Q

What dictates how crystalloids distribute?

A

Sodium content

39
Q

Plasma sodium?

A

140

40
Q

0.9% NaCl is?

A

154 mEq/L

41
Q

What is normal saline?

A

.9% NaCl

42
Q

What does each liter of .45% NaCl provide?

A

500ml of .9% NaCl

500ml free water

43
Q

Hypertonic saline solution

A

3% and 5%

44
Q

Provides significant salt load in a small water volume

A

Hypertonic saline solution

45
Q

Decrease cell volume

A

Hypertonic saline

46
Q

What does LR contain?

A

Sodium; isotonic

47
Q

3 main types of colloids:

A
  1. Albumin
  2. Hetastarch
  3. Dextrans
48
Q

What are colloids prepared in?

A

.9% NaCl

49
Q

Albumin is an important source of what pressure?

A

Capillary oncotic pressure

50
Q

Effectively draws interstitial fluid, if available, into vascular space

A

Hyperoncotic albumin

51
Q

Not a protein so contribution to capillary oncotic pressure is difficult to measure and derived from amylopectin and is a synthetic glycogen like compound

A

Hydroxyethyl starches (HES)

52
Q

What are products with high ratios expected to be?

A

Degraded more slowly

53
Q

Does osmotic effectiveness depend on number of particles or molecular size?

A

Number of particles, NOT SIZE

54
Q

4 adverse effects with HES:

A
  1. Increased amylase
  2. ESR
  3. Renal function
  4. Prolonged PT, aPTT
55
Q

Moderate platelet function and are anti-thrombotic

A

Rheological properties

56
Q

What has rheological properties?

A

Dextrans

57
Q

How does water distribute?

A

From vascular compartment into interstitial space and then across cell membrane

58
Q

How does sodium distribute?

A

Readily across capillary membrane into interstitial fluid, but it is pumped out of the cell

59
Q

How do colloids distribute?

A

Don’t readily cross the capillary membrane. Normally confined to vascular compartment early on

60
Q

3 reasons for crystalloids:

A
  1. Provide maintenance requirements
  2. Replacement of losses (water, blood, secretions, suction)
  3. Treatment of excess or deficit of fluid or electrolytes
61
Q

2 things about colloids:

A
  1. Add to oncotic pressure

2. Rheological properties

62
Q

Body is able to maintain water and electrolyte balance through where?

A

Kidneys and GI tract

63
Q

What is sensible water losses?

A

Measurable

-kidney, GI

64
Q

What are insensible water losses?

A

Not measurable

-respiration, fever, evaporation

65
Q

Maintenance for adult?

A

2-2.5 L/day

66
Q

Maintenance fluid rule?

A

4-2-1

Add 40ml to their weight (kg) if above 20kg

67
Q

5 situations for increases loss:

A
  1. Fever
  2. Sweat
  3. Gastric losses (NG tube)
  4. Small intestine, biliary, pancreatic
  5. Colon (diarrhea)
68
Q

Intra-op IV electrolyte crystalloid solution management and administration rate?

A

LR

1.5:1 volume basis until transfusion threshold met

69
Q

What to avoid in intra-op IV volume management:

A

Dextrose

Large amount of NS .9%NaCl

70
Q

What are large amounts of NS .9%NaCl associated with:

A
  1. Hyperchloremic acidosis

2. Risk of acute kidney injury

71
Q

Minimal evaporative fluid losses:

A

0-2 ml/kg

72
Q

Moderate evaporative fluid losses:

A

2-4 ml/kg

73
Q

Severe evaporative fluid losses:

A

4-8 ml/kg

74
Q

When is zero balance approach used?

A

Only fluid lost is replaced

75
Q

What is recommended in major invasive surgeries?

A

Restrictive, zero balance approach

76
Q

5 restrictive favored outcome:

A
  1. Pneumonia
  2. Pulmonary edema
  3. First bowel activity
  4. LOS
  5. Morality
77
Q

3 goal directed tools:

A
  1. Pulmonary artery catheter
  2. Esophageal Doppler
  3. Preload responsiveness

Pharmacology (14 decks)

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