Fluid Balance

Question 1

GI bleed Tx

Answer 1

Stop antiplatelets/coagulants, thrombolytics, NSAIDS

• give fluids, blood transfusion
• PPIs
• find cause with endo or colonoscopy

Question 2

Osmolality

Answer 2

is a measure of how much one substance has dissolved in another substance.

expected is 275-295 mOsm/kgH20

Question 3

What increases osmolality?

Answer 3

dehydration

Question 4

what decreases osmolality?

Answer 4

Overhydration

Question 5

Isotonic

Answer 5

same osmolality as plasma

Question 6

hypertonic

Answer 6

higher osmolality than plasma

Question 7

Hypotonic

Answer 7

lower osmolality than plasma

Question 8

Side effects of albumin saline and dextrose saline

Answer 8

body vs bag tonicity differs once infused

Question 9

Routine fluid maintenance requires

Answer 9

• 35ml/kg/day of water for an adult.
• potassium, sodium and chloride
• 50-100 g/day of glucose
• 4ml/kg/hr for 1st 10 kg of body weight
• 2ml/kg/hr for 1st 10 kg of body weight
• 1ml/kg/hr for 1st 10 kg of body weight

Question 10

Colloid vs crystalloid IV fluid

Answer 10

colloid is protein based ans stays in the circulation aka plasma expanders.

crystalloid is water based, can move between ECF and ICF easily.

Question 11

Maintenance vs resuscitation

Answer 11

maintenance is meeting body requirements, resus is replacing deficits.

Question 12

Isotonic Fluids

Answer 12

Lactated Ringers
0.9 NS

5% albumin (colloid)
Dextran 40 (colloid)
(these are isotonic however hypertonic in the body)

Question 13

Colloid IV Fluids Treat?

Answer 13

• hypovolemic shock
• Particles too large to pass through membranes so stay in the intravascular spaces longer than crystalloids

ex. plasbumin, alburex

Question 14

NS (0.9%)

Answer 14

Contents:
154 mEq Na
154 mEq Cl

Isotonic, best for resuscitation fluid.

Question 15

LR Fluid

Answer 15

Contents: 
Na 130 mEq
Potassium 4 mEq
Calcium 2.7 mEq
Chloride 109 mEq
Lactate 28 mEq

isotonic, SE hyperkalemia, no dextrose, high lactate.

Question 16

Hypertonic Fluids

Answer 16

High glucose or high sodium 
D5NS
D5LR
D10W
D5 .45 NaCl (mild) aka D5 1/2 NS
3% NaCl (tx for head injury to lower ICP)
25% Albumin (resus)

Question 17

D5.45 NS

Answer 17

77 mEq Na
77 mEq Cl
50 mEq Dextrose

hypertonic, SE cellular dehydration, hyponatremia
1st choice for meds maintenance fluids, check K+

Question 18

25% Albumin (colloid)

Answer 18

25% albumin
up to 160 mEq Na
hypertonic

Caution: intravenous volume expander, 3.5x the volume of additional fluid into the circulation within 15 minutes

Question 19

Hypotonic Fluids

Answer 19

Low NaCl
.45% NaCl 
D5W
3.3% dextrose, .3% sodium (2/3, 1/3)
D5 0.2% NaCl (mild)

for hypernatremic dehydration

Question 20

Hyponatremia

Answer 20

less than 135 mEq/L

common cause: diuretics, dehydration, hyponatremia

tx. D5NS

Question 21

Hypernatremia

Answer 21

more than 145 mEq/L

common cause: kidney failure, high Na intake, dehydration, hypernatremia.

tx: low sodium, diuretics.

Question 22

Hyperkalemia

Answer 22

Potassium more than 5mEq/L

cause: potassium sparing diuretics, renal disease
tx: keyexalate (PO, NG) binds K+ in intestines

Question 23

Hypokalemia

Answer 23

potassium less than 3.5

cause: potassium wasting diuretics (furosemide), N/V
tx: KCL (IV or PO)