Final - Fluid Mgmt Flashcards
What percentage of total body weight is water?
- 60%
Elderly and Obese patients will have lower percent of water in the body.
Pediatrics will have HIGHER percent of water in the body (Table 47.1)
What are the two main compartments fluid compartments?
How much does each compartment make up of TBW?
- Intracellular Fluid (ICF) makes up two-thirds of total body water
- Extracellular Fluid (ECF) makes up one-third of total body water
What are the 3 different compartments of the ECF?
A. intracellular
B. interstitial
C. extravascular
D. intravascular
E. transcellular
F. intrastitial
B. Interstitial: lymphatics and protein-poor fluid around the cell.
D. Intravascular: plasma volume
E. Transcellular: GI Tract, Urin, CSF, Joint fluid, aqueous humor.
Diffusion involves solute particles filling the solvent by moving from ___ to ___ concentrations.
A. low to high
B. high to low
C. different to same
B.. High to Low concentration
* occur across permeable membranes
* relate to electrical gradients
What are types of solutes found in our body? Select 2.
A. norepinephrine
B. glucose
C. proteins
D. ADH
B. Glucose
C. Proteins (Albumin, globulins, fibrinogen)
and Electrolytes!
What is the primary extracellular cation?
primary intracellular cation?
extra: Sodium (Na+)
intra: Potassium (K+)
Osmosis is the movement of water through a semipermeable membrane from ___ solute concentration.
A. low to high
B. high to low
C. similar
movement of WATER which diffuses from low to high solute concentration
Semipermeable membrane is what separates pure water from water with solute!
What is osmotic pressure?
A. pressure that has less pull on water
B. pressure that proteins place on walls of container
C. pressure that resists the movement of water thru osmosis
D. pressure that allows water to move freely thru membranes
C. Pressure that resists the movement of water through osmosis
more oncotic pressure = more pull
What is osmolarity?
A. number of osmotically active particles per L of solvent
B. number of osmotically inactive particles per L of solvent
C. number of osmotically active particles per kg of solvent
D. number of osmotically inactive particles per kg of solvent
A. Number of osmotically active particles per L of solvent
Higher osmolarity, higher “pulling power”
Patient A has serum glucose of 600mg/dl
Patient B has serum glucose of 250mg/dl
Who has higher osmolarity?
Patient A
What is osmolality?
A. number of osmotically active particles per L of solvent
B. number of osmotically inactive particles per L of solvent
C. number of osmotically active particles per kg of solvent
D. number of osmotically inactive particles per kg of solvent
C. Number of osmotically active particles per Kg of solvent
unit is usually mOsm
What is normal osmolality?
A. 200-210 mOsm
B. 250-260 mOsm
C. 280-290 mOsm
D. 300-310 mOsm
C. 280-290 mOsm
Oncotic pressure is the component of total osmotic pressure due to ___?
A. electrolytes
B. colloids
C. crystalloids
D. glucose
B. component of total osmotic pressure due to colloids
aka albumin, globulins, fibrinogen
What percentage of oncotic pressure is due to albumin?
65-75%
What makes up our daily average intake?
Solids:
Metabolism:
Liquids:
Solids - 750 mL
Metabolism - 350 mL
Liquids - 1400 mL
What makes up our daily output?
Insensible loss:
GI loss:
UOP:
Insensible Loss - 1000 mL
GI loss - 100 mL
Urine output - 0.5-1 mL/kg/hr
Urine secretion accounts for ____-% of daily water loss.
- 60%
What 3 hormones regulate urine output?
- ADH
- ANP
- Aldosterone
How does ADH regulate urine output?
Renal H2O excretion/retention in response to plasma tonicity
How does ANP regulate urine output?
- ANP is activated by ↑ fluid volume
- ↑ Atrial Stretch = ↑ Renal Excretion
How does Aldosterone regulate urine output?
- Regulates sodium and potassium levels
- Aldosterone is released if sodium and fluid volume decreases, causing sodium and water conservation.
What are the sensors for fluid balance?
- Hypothalamic osmoreceptors
- Low-pressure baroreceptors (large veins and RA)
- High-pressure baroreceptors (carotid sinus and aortic arch)
What is the trigger for fluid balance?
- Increased thirst or increase ADH
What are the compensatory mechanisms for acute disturbances in circulating volume?
- Venoconstriction
- Mobilization of venous reservoir
- Autotransfusion from ISF to plasma
- Reduced urine production
- Maintenance of CO…tachycardia, increased inotropy
Where is Renin released?
What does Renin do to angiotensinogen?
- Released from juxtaglomerular cells
- Cleaves angiotensinogen to make angiotensin I
When ANG I → ANG II, what will this cause?
A. vasodilation and aldosterone release
B. vasodilation and ADH release
C. vasoconstriction and ADH release
D. vasoconstriction and aldosterone release
D. Vasoconstriction and aldosterone release
Where is aldosterone released from?
- Aldosterone is released from the adrenal cortex and causes salt and water retention
In the absence of ongoing fluid loss, loss volume should be restored within ______- hours (range).
- 12-72 hours
In the absence of ongoing fluid loss, RBC should be restored through erythropoiesis in ______ weeks (range).
- 4-8 weeks.
What are the Electrolytes (Na+ and Cl-) and Osmolarity of Normal Saline (0.9%)?
Na+: 154 mEq/L
Chloride: 154 mEq/L
Osmolarity: 308 mOsm/L
What are the Electrolytes and Osmolarity of LR?
Na+: 130 mEq/L
K+: 4 mEq/L
Chloride: 109 mEq/L
Lactate: 28 mEq/L
Osmolarity: 274 mOsm/L
What are the Electrolytes and Osmolarity of Plasmalyte?
Na+: 140 mEq/L
K+: 5 mEq/L
Cl-: 98 mEq/L
Acetate: 27 mEq/L
Osmolarity: 295 mOsm/L
What are the Electrolytes and Osmolarity of Albumin 5%?
Na+: 145 +/- 15 mEq/L
K+: <2.5 mEq/L
Cl-: 100 mEq/L
Osmolarity: 330 mOsm/L
What are the Electrolytes and Osmolarity of Hetastarch 6%?
Na+: 154 mEq/L
Cl-: 154 mEq/L
Osmolarity: 310 mOsm/L
What are crystalloids?
A. Balanced solution of sodium and chloride in saline
B. Solutions of electrolytes in water
C. Balanced solution of sodium and chloride in water
D. Solutions of electrolytes in saline
B. Solutions of electrolytes in water
they are called balanced solutions (but not really balanced; misnomer)
LR is probably considered the most “balanced” crystalloid
What are indications of using crystalloids?
- Replacement of free water and electrolytes
- Volume expansion