Fluid and Electrolytes Flashcards by Tumi Oluwadele

What is the composition of total body water?

ICF: 67%
Interstitial Fluid: 25%
Plasma Volume: 8%

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_________ of the adult human body is water

60%

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Interstitial fluid + Plasma (Intravascular fluid) =

ECF

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What is ICF

Cytosol inside cells

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Plasma proteins exert constant ________ pressure
What is the pressure normally?

Osmotic
24mmHg

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Interstitial fluid exerts _________ pressure
What is the pressure normally?

Hydrostatic
17mmHg

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What is a hypotonic solution?
What is a way to describe its action?

Solute concentration outside the cell is lower than the concentration inside the cell
Water moves from H to L concentration (Out to in)
Water enter cells via osmosis
Cell swells and eventually bursts
AKA bursting balloon

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What is a hypertonic solution?
What is a way to describe its action?

Solute concentration outside the cell is higher than the concentration inside the cell
Water moves from H to L concentration (In to out)
Cell loses water, gets smaller and eventually shrinks
AKA Crenates

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What is a crystalloid?

Solutions containing fluids and electrolytes that are normally found in the body
They do not contain proteins (colloids)

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What are crystalloids used as maintenance fluids for?

Compensation for insensible fluid losses
Replacing fluids
Managing specific and electrolyte disturbances
Promoting urinary flow

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Name six types of crystalloids

Normal saline (NS): 0.9% NaCl isotonic; 0.45% hypotonic
3.3% dextrose and 0.3% NS (isotonic)
Hypertonic saline (3% NaCl)
Lactated ringer’s solution (isotonic)
Dextrose 5% in water(D5W) (isotonic)
D5W and 0.45% NS (hypertonic)

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What are the indications for crystalloids?

Acute liver failure
Acute nephrosis
Adult respiratory distress syndrome
Burns
Cardiopulmonary bypass
Hypoproteinemia
Hemodialysis
DVT
Shock

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What are the adverse effects of crystalloids?

Edema (Peripherally and Pulmonary)
Dilution of plasma proteins which would reduce colloid oncotic pressure
Effects are short-lived
Prolonged infusions may worsen alkalosis or acidosis

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What is a contraindication of crystalloids?

Fluid Overload

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What are colloids and what do they do?

Protein substances that increase colloid osmotic pressure
They move fluid from interstitial compartment to plasma compartment

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Name 3 types of colloids

Albumin 5% (Children) and 25% (Adults)
Dextran 40 or 70
Hetastarch

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What are the adverse effects of colloids?

Altered coagulation
No clotting factors or oxygen-carrying capacity
Dextran Therapy may cause anaphylaxis or kidney failure

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What is albumin prepared from?

Pooled blood, plasma, serum or placentas obtained from healthy donors

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Blood products increase ___________ and _____________

Tissue oxygenation and Plasma volume

What is the only class of fluids that are able to carry O2

Blood products

What are the indications of cryoprecipitate and plasma protein factors?

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

What are the indications of fresh frozen plasma?

Increase clotting factor levels in patients with demonstrated deficiency

What are the indications of packed red blood cells?

Increase o2-carrying capacity in patients with anemia, substantial HB deficits and patients that have lost up to 25% of the total blood volume

What are the indications for whole blood?

Same as packed RBC except its more beneficial in cases of extreme blood loss (>25%) because it contains plasma

What are the adverse effects of blood products?

Incompatibility with recipients immune system Cross-match testing Transfusion reaction Anaphylaxis Transmission of pathogens to recipient

Name an example of a principal ECF electrolyte and a principal ICF electrolyte

Sodium cation Potassium cation

What is the normal potassium range outside of cells?

3.5 to 5 mmol/L

What excretes excess dietary K+?

The kidneys Impaired kidney function can lead to toxicity

What are the causes of hyperkalemia?

K supplements ACE inhibitors Renal failure Excessive loss from cells K-sparing diuretics Burns Trauma Metabolic acidosis Infections

What are the causes of hypokalemia?

Alkalosis Corticosteroids Diarrhea Ketoacidosis Hyperaldosteronism Increased secretion of mineralocorticoids Burns Thiazide and loop diuretics Vomiting and malabsorption

What can happen if hypokalemia occurs while a patient is on digoxin therapy?

Digoxin toxicity resulting in serious ventricular dysrhythmias

What is K responsible for?

Muscle contraction Transmission of nerve impulses Regulation of heartbeat Maintenance of acid-base balance Isotonicity Electrodynamic characteristics of cells

What is the main indication of potassium?

Treatment or prevention of K depletion when dietary solutions are inadequate

What are other therapeutic uses of Potassium?

Stopping irregular heartbeats Management of tachydysrhythmias that can occur after cardiac surgery

What are the adverse effects of oral , IV and excessive administration of potassium?

Oral: Diarrhea, nausea, vomiting, GI bleed, ulceration IV: Pain at site, Phlebitis Excessive: Hyperkalemia, Toxic effects, Cardiac arrest

What are the manifestations of hyperkalemia?

Muscle weakness, paresthesia, paralysis, cardiac rhythm irregularities

What is the treatment of severe hyperkalemia?

IV sodium bicarbonate Sodium polystyrene sulphonate or hemodialysis to remove excess K.

What is the normal concentration range of sodium outside cells?

135 to 145 mmol/L

What are the symptoms and causes of hyponatremia?

Symptoms: Lethargy, Stomach Cramps, Hypotension, Vomiting, diarrhea and seizures Causes: Some of the same conditions that cause hypokalemia and excessive perspiration, prolonged diarrhea or vomiting, kidney disorders, and adrenocortical impairment

What are the symptoms and causes of hypernatremia?

Symptoms: Edema, HTN, red flushed skin, dry, sticky mucous membranes, increased thirst, elevated temp, decreased urinary output Causes: Poor kidney excretion stemming from kidney malfunction; inadequate water consumption and dehydration

What is sodium responsible for?

Control of water distribution Fluid and electrolyte balance Osmotic pressure of body fluids Participation in acid-base balance

What is the main indication of sodium

Sodium depletion when dietary options are inadequate. Mild: Treated with Oral NaCl or fluid restriction Severe: Treated with IV NS or lactated ringer's solution

What are the adverse effects of oral and IV sodium admin?

Oral: Nausea, vomiting, cramps IV: Venous phlebitis

IV potassium must not be given at a rate faster than 10 mmol/hr to patients who are not on cardiac monitors. What is the rate of for patients on cardiac monitors?

For critically ill patients on cardiac monitors, rates of 20 mmol/hr may be used.

Potassium must never be given as an ___________ or ___________

IV bolus or undiluted

Oral forms of K must be diluted with how many mL of water or fruit juice?

100 to 250mL