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Pathophys- Fluid and Electrolytes > Fluid and Electrolyte Management > Flashcards

Fluid and Electrolyte Management Flashcards

1
Q

acute tx in patients with very high levels of Potassium?

A

insuling and glucose, or calcium gluconate- MOA- raises the threshold of nerves and muscles. Kayexalate can also be given if you have time- binds to Potassium, excrete out in feces

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2
Q

Good dietary sources of potassium (recommend to patients on Lasix)

A

banana, watermelon, OJ, broccoli, uncooked potatoes

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3
Q

calculated osmolarity

A

2(Na + K) + (BUN/2.8) + glucose/16

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4
Q

insensible fluid loss in adults per hour (for maintenance fluid)

A

1.5 ml/kg/hr or 135 ml/hour

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5
Q

Maintenance requirements for fluid replacement

A

4-2-1 rule (per hour) or 100-50-20 rule (for 24 hours)

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6
Q

daily electrolyte requirements for sodium and potassium

A

Sodium is 2-3 mmol/kg/day or 1-2 mmol/kg/day. potassium is 0.5-1 mmol/kg/day

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7
Q

how much sodium and potassium in 1 L 0.45% NaCl?

A

77 mmol Na, and 20 mmol K

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8
Q

how much sodium in 1 L 0.9% NaCl?

A

154 mmol sodium

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9
Q

resuscitation replacement

A

NPO deficit, bowel prep, and measurable fluid losses like NG suctioning, vomitting, ostomy output

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10
Q

how much fluid loss in bowel prep?

A

1 L

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11
Q

Replacement during surgery includes…

A

3rd space losses and blood losses

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12
Q

fluid loss in superficial surgical trauma

A

1-2 ml/kg/hr

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13
Q

fluid loss in moderate surgical trauma (hysterectomy, chest surgery, hemicolectomy)

A

5-6 ml/kg/hr

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14
Q

fluid loss in AAA repair, nephrectomy (severe surgical trauma)

A

8-10 ml/kg/hr

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15
Q

minimal surgical trauma (head and neck sx, hernia, knee surgery- not arthroscopic)

A

2-3 ml/kg/hr

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16
Q

replacement for blood loss in surgery

A

replace 3 ml of crystalloid solution for every ml of blood loss

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17
Q

what kind of fluid for maintenance, resuscitatin, replacement?

A

for maintenance- hypotonic 0.45% NaCl used. For replacement- isotonic 0.9% NaCl used. resuscitation- not sure which is better, LR or NS

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18
Q

types of crystalloid fluid given

A

LR, plasmylate, normosol, hypotonic soln, hypertonic soln

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19
Q

LR components

A

Na, Cl, K, calcium, lactate (monitor potassium and calcium)

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20
Q

plasmylate and normosol components

A

NS, K, and Mg (good for preventing arrhythmias in some heart patients)

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21
Q

types of colloid IV fluid given

A

hetastarch, albumin, dextran

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22
Q

when do you want to avoid hetastarch IV fluid replacement?

A

in patients with renal disease- is nephrotoxic. and can cause anaphylaxis

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23
Q

when is dextran (colloid) given IV?

A

used for thromboembolic prophylaxis (to prevent clots) by diluting out coag factors and platelets

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24
Q

if deficits in plasma volume-

A

reduced tissue perfusion, so capillary refill abnormal and coloring of skin pale

25
Q

if deficits in interstitial fluid-

A

decrease turgor, dry skin, fissuring tongue, and sunken eyes

26
Q

What to look at when determining if fluid replacement is working?

A

Physical assessment does not show turgor, dry skin, sunken eyes. HR is going down, BP is going up. Urine output greater than 1.0 ml/kg/hr

27
Q

Invasive monitoring in patients with fluid replacement

A

CVP, PAP, PWP

28
Q

Lab tests in patient that is getting replaced with fluids

A

Hgb, Hct

29
Q

Rule of thumb for hct rise in patient that has lost fluid

A

If Hct rises 1%, that indicates that patient has lost 500 ml ECF if RBC loss is NIL

30
Q

daily weigh gains or losses greater than ___ represent changes in body fluid content

A

0.5 pounds

31
Q

Surgical patient that has gained 15 pounds during surgical course. Wants to know when he will go back to his normal weight.

A

Diuresis and associated weight loss is expected 3 or more days postup. This is when 3rd space fluid accummulations in interstitial space move into the intravascular or the intracellular space, from there pee it out. lose weight. takes time!

32
Q

what are signs that you see clinically that indicate patient is losing fluid/blood?

A

patient tachycardic, narrow pulse pressure, reduced BP. Urine output less than 0.5 ml/kg/hr. PE- dry skin, decrease turgor, fissuring tongue, sunken eyes. abnormal cap refill and coloring. Labs: BUN:Cr ratio> 20:1, Increased hct, and Urine Na is less than 20 mEg/L

33
Q

indications for replacement of blood components

A

If Hb less than 7 gm/dL.

34
Q

If compromised patient, what level do you want to see their Hb?

A

may require levels above 10 gm/dL

35
Q

1 unit of packed RBC contains how many ml?

A

250 ml

36
Q

Packed RBC’s Hct

A

70-80%

37
Q

1 unit packed RBC’s effect on Hgb

A

raises Hgb by 1 gm/dL

38
Q

how many units of packed RBC’s would you give female patient with Hgb of 7?

A

Want to see patients with Hgb level at 12-14. So 5 units (1 unit inc Hgb by 1 gm/dL)

39
Q

indications to give platelet concentrate?

A

thrombocytopenia and intraoperative platelet count less than 50,000

40
Q

Platelets get consumed in surgery. For this reason, what do you want plt count to be pre-operatively?

A

greater than 90,000

41
Q

FFP composition

A

coag factors, no platelets

42
Q

method of increasing platelet count

A

1 unit RDP inc platelet count by 5-10,000/ul. 1 unit RDP for every 10 kg increases platelet count by 50,000.

43
Q

1 unit SDP

A

=6-7 RDP

44
Q

indication for how much FFP to give?

A

15 ml/kg (about 1 L)

45
Q

in which situations would you choose to give patient FFP?

A

factor deficiencies, reversal of coumadin effect (coumadin patient hits head- FFP helps to get clotting factors up), TTP, and intraoperatively when PT and PTT are greater than 1.5x normal value

46
Q

cryoprecipitate components

A

FIBRINOGEN, vWF, Factor VIII, and Factor XIII

47
Q

how much fibrinogen/bag in cryoprecipitate?

A

200 mg/bag

48
Q

Benefits to cryoprecipitate

A

stores longer than FFP, and less fluid required to give a high concentration of factors (nice option in CHF patients who can’t take on too much more fluid)

49
Q

most common transfusion reaction

A

Febrile non-hemolytic transfusion reaction (FNHTR)

50
Q

FNHTR d/t

A

cytokines IL-2, IL-6, IL-8, and TNF

51
Q

why is temp taken every 10-15 minutes after blood is given?

A

to check for reaction (fever)- febrile non hemolytic transfusion reaction

52
Q

name complications of transfusion reactions

A

Febrile non-hemolytic transfusion reaction, allergy, hemolytic anemia, viral transmission, hypothermia, coag disorders, citrate

53
Q

classic signs of hemolytic anemia

A

fever, flank pain, red or brown urine

54
Q

tx in hemolytic anemia

A

stop transfusion, and give fluids to perfuse kidneys (NS)

55
Q

why do you get flank pain and red or brown urine in hemolytic anemia?

A

flank pain d/t intravascular hemolysis. Hb released into the bloodstream, gets trapped in kidney and can cause kidney damage- flank pain. Red/brown urine results d/t oxidation of hemoglobin as it goes through the kidneys

56
Q

viral complications from transfusion reactions

A

Hep C (1:30,000), Hep B (1:200,000), HIV (1:500,000), CMV

57
Q

to prevent hypothermia in transfusion complications,

A

use warmers

58
Q

why would coag disorders result as transfusion complication?

A

massive transfusion more than 10 units may dilute platelets and factor V and VIII

Pathophys- Fluid and Electrolytes (2 decks)

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