Fluid Balance

Question 1

Define Fluid Balance.

Answer 1

Fluid balance is the fluid losses that occur constantly by excretion primarily in stool, urine.

Question 2

What are the averages of fluid excreted by the average adult?

Answer 2

• 500 mL urine (average adult)
• 200 mL stool
• 400 mL respiration

Question 3

How do our bodies balance fluid loss?

Answer 3

By activating thirst and hunger

Question 4

What kind of patients will present will fluid balance issues or fluid loss?

Answer 4

1. A patient who is vomiting profusely
2. A patient with severe diarrhea
3. Cases of disease or trauma

Question 5

What are the basic fluid requirements to maintain homeostasis?

Answer 5

35mL/kg/day

Question 6

What formula is used to calculate patient fluid requirements?

Answer 6

4/2/1 rule

• 4 mL/kg/hr for first 10 kg of body weight
• 2mL/kg/hr for second 10kg of body weight
• 1 mL/kg/her for rest of body weight

Question 7

Define osmolality.

Answer 7

The concentration of an osmotic solution.

• Dehydration increases osmolality
• Overhydration decreases osmolality

Question 8

What is the expected osmolality?

Answer 8

275-295 mOsm/kgH2O

Question 9

How does Iv fluid administration affect fluid balance?

Answer 9

IV fluid administration aims to correct fluid imbalances via osmosis. The water moves from low concentration to high concentration

Question 10

What is a colloid?

Answer 10

Protein-based

-Supply proteins into ECF

Question 11

What is a crystalloid?

Answer 11

Water-based

-Supply H2O & electrolytes & solutes

Question 12

What is a Resuscitation IV?

Answer 12

Replacing defecits

Question 13

What is NPO?

Answer 13

Nothing by mouth, all fluids are given by IV

Question 14

What are the contents of normal saline?

Answer 14

Contents: 154 mEq Na+, 154 mEq Cl-

-Isotonic soultion

Question 15

Side Effects of Normal Saline?

Answer 15

• Hypokalemia

- No dextrose

Question 16

What are the contents of Lactated Ringers?

Answer 16

• 130 mEq (Na+)
• 4 mEq (K+)
• 2.7 mEq (Ca+)
• 109 mEq (Cl-)
• 28 mEq (lactate)
• Isotonic solution

Question 17

What are the Side Effects of Lactated Ringers?

Answer 17

Hyperkalemia, no dextrose, high lactate

Question 18

Define Hypertonic Fluid.

Answer 18

The movement fluid OUT of the cell

Question 19

What are the 5 types of hypertonic fluids?

Answer 19

• D5NS
• D5LR
• D10W
• D5 0.45% NaCl or D5 1/2 NS
• 3% NaCl

Question 20

When are hypertonic fluids used?

Answer 20

• Cerebral edema (lower ICP)

- Severe hyponatremia

Question 21

Define Hypotonic Fluids.

Answer 21

The movement of fluid INTO the cells

Question 22

What are the 4 types of hypotonic fluids?

Answer 22

• 0.45% NaCl
• D5W
• 3.3% dextrose, 0.3% sodium
• D5 0.2% NaCl

Question 23

When are hypotonic fluids used?

Answer 23

To treat diabetic ketoacidosis, hypernatremia and severe dehydration

Question 24

Define hyponatremia and identify the method of treatment.

Answer 24

Hyponatremia occurs when Na+ serum levels are less than 135 mEq/L
Tx: D5NS (hypertonic fluid)
-commonly caused by diuretic use

Question 25

Define hypernatremia and identify the method of treatment.

Answer 25

Occurs when Na+ serum levels are more than 145 mEq/L

Tx: reduce sodium intake, Diuretic administration

Question 26

Define Hyperkalemia and method of treatment

Answer 26

Occurs when the K+ serum level is more than 5 mEq/L

Tx: Kayaxalate (binds k+ in intestines)

Question 27

What are resuscitation fluids?

Answer 27

rescue fluids! Used to treat hypovolemic shock, dehydration, trauma, hemorrhage and severe hypotension

Question 28

What is the first route in emergency situations?

Answer 28

NS or LR bolus!

• adminsister 500mL bolus
• asses patient

Question 29

What is the second route in emergency situations?

Answer 29

• administer colloids

- Colloids will pull fluid into circulation

Question 30

What fluids are used for maintenance?

Answer 30

• LR, NS, D5NS

- children: D5.45 NS