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APA Fundamentals > Fluid Management > Flashcards

Fluid Management Flashcards

1
Q

What % of body weight is total body water?

A

60% average.
55% Man
45% Woman
80% Infant

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2
Q

What percent of total body water is intracellular volume?

Extracellular volume?

A

Intracellular 40%.

Extracellular 20%.

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3
Q

The extracellular volume (ECV) is broken into two fluid compartments, what are they are how are they distributed?

A

Interstitial fluid volume 75% of ECV.

Plasma Volume 25% of ECV.

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4
Q

What separates the two extracellular fluid compartments?

A

Vascular endothelium.

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5
Q

Do obese individuals have more or Total Body Water (TBW) than non-obese individuals?

A

Less TBW

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6
Q

What separates the intracellular space from the extracellular space?

A

Cell membrane

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7
Q

Which three electrolytes does the intracellular fluid compartment contain in high concentration?

A

Potassium.
Phosphate.
Magnesium.

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8
Q

What is responsible for maintaining the high concentration of K+ in ICF?

A

Na+K+ATPase.

Sodium potassium pump.

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9
Q

What two electrolytes are in high concentration in the EFC?

A

Sodium and Chloride.

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10
Q

Is there a larger concentration of proteins (particularly Albumin) in the blood vessels or in the interstitial space?

A

Inside the capillary.

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11
Q

What is the formula for serum osmolality?

A

2 (Na+) + (BUN/2.8) + (Glucose/18)= Serum osmolality.

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12
Q

What is a normal serum osmolality?

A

285-295

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13
Q

Fluid movement across a fluid compartment is affected by what two things?

A
  1. Properties of membranes separating compartments.

2. Concentration of osmotically active substances within a compartment.

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14
Q

Hydrostatic pressure in capillary (Pc). Pushing/pulling/where?

A

Pushing pressure out.

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15
Q

Hydrostatic pressure in the interstitium (Pi). Pushing/pulling/where?

A

Low pressure, typically negative d/t lymphatics

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16
Q

Oncotic pressure in the capillary (pc).

Pushing/pulling/where

A

Pulling into the capillary.

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17
Q

Oncotic pressure in the interstitium (pi).

Pushing/pulling/where?

A

Pulling out of the capillary.

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18
Q

A net driving force that is positive moves fluid into the capillary- T/F?

A

False.

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19
Q

How a solution affects cell volume is a measurement of its _____?

A

Tonicity:

i.e. hypotonic, hypertonic, isotonic.

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20
Q

What does a hypotonic solution do to a sell?

A

Causes cell engorgement, it fills with fluid.

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21
Q

What does a hypertonic solution do to a cell?

A

Causes cell shrinkage, it pulls fluid out of the cell.

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22
Q

Difference between hypovolemia and dehydration?

A

Hypovolemia is loss of extracellular fluid/reduced circulating volume.

Dehydration is a concentration disorder/osmolality issue/insufficient water present in relation to sodium levels (can be caused by too much Na+ or too little water).

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23
Q

What is the most abundant electrolyte in the ECF?

A

Na+

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24
Q

Which two electrolytes are responsible for normal osmotic activity of the ECF?

A

Na+ and Cl-

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25
Q

Unlike the rest of the body/organs, the blood-brain barrier lacks premeability and instead of protein being the major determinant of water movement, what is?

A

Sodium

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26
Q

What is a normal ECV Sodium?

ICV?

A

ECV 140

ICV 25

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27
Q

Hyponatremia can be caused by what?

A 
Vomiting.
Diarrhea.
Diuretics.
Adrenal insufficiency.
SIADH.
Renal failure.
Water intoxication.
CHF.
Liver failure.
Nephrotic Syndrome.
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28
Q

Major clinical manifestations of hyponatremia:

A

Cerebral edema is most significant factor for us.
Coma. Confusion. Headache.
Malaise. Agitation. Anorexia. N/V. Cramps. Weakness.

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29
Q

What three methods of treatment can be used for hyponatremia?

A
  1. Fluid restriction.
  2. Hypertonic saline.
  3. Osmotic/loop diuretic.
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30
Q

What is important to consider when correcting hyponatremia?

A

Needs to be corrected slowly.

No more than 1-2mEq/hr and no more than 10-15mEg change in 24 hrs.

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31
Q

What problem can be caused by too fast of a sodium increase?

A

Myelinolysis=demylenation.

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32
Q

What is the most common cause of hypernatremia?

A

Water deficiency d/t:

  • Excessive loss.
  • Inadequate intake.
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33
Q

What are some other causes of hypernatremia?

A

Exogenous Na+ load.
Primary hyperaldosteronism.
Diabetes Insipidus.
Renal dysfunction.

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34
Q

Clinical manifestations of hypernatremia?

A

Weakness, seizure, hallucinations, irritability, disorientation, coma, intracranial bleed, hypervolemia, polyuria or oliguria, renal insufficiency.

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35
Q

How is hypernatremia treated?

A

Estimate water deficit and correct hypernatremia by replacing the water deficit.
Correction should take place over 24hr period.

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36
Q

What electrolyte is in highest concentration within ICV?

A

Potassium

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37
Q

What is intracellular K+?

Extracellular K+?

A 
Intracellular= 150-160mEq/L.
Extracellular= 3.5-5.0mEq/L
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38
Q

What is the most common electrolyte abnormality we will see in clinical practice?

A

Hypokalemia.

39
Q

What are causes of hypokalemia?

A 
Gastrointestinal losses.
Systemic alkalosis.
Diabetic ketoacidosis.
Diuretic therapy.
Sympathetic nervous system stimulation.
Poor dietary intake.
40
Q

What are cardiovascular related clinical manifestations of hypokalemia?

A
  1. ST-Segment depression.
  2. Presence of U-wave.
  3. Flattened or inverted T waves.
  4. Ventricular ectopy.
41
Q

What is typically the max replacement speed for potassium?

A

40mEq/hr

42
Q

Why would you avoid dextrose containing solutions in hypokalemia?

A

Stimulates insulin production which will drive K+ into cells.

43
Q

What are causes of hyperkalemia?

A 
Two major categories
1.Increased total body potassium:
Renal failure.
Potassium-sparring diuretics.
Excessive IV K+ supplements.
Excessive use of Salt substitutes.
2. Altered distribution of potassium:
Metabolic or respiratory acidosis.
Digitalis toxicity.
Insulin deficiency.
Hemolysis.
Tissue and muscle damage after burns.
Administration of succinylcholine.
44
Q

Cardiovascular related clinical manifestations of hyperkalemia?

A
  1. Tall, peaked a elevated T waves.
  2. Widened QRS complex.
  3. Prolonged PR Interval.
  4. Flattened or absent P wave.
  5. ST Segment depression.
  6. Cardiac arrest.
45
Q

What is treatment of hyperkalemia?

A 
Insulin/glucose.
IV Calcium.
Hyperventilate.
Beta 2 agonist.
Bicarb
46
Q

What are the limits of Potassium levels for doing a case?

A

3.0-5.5

47
Q

What are causes for hypomagnesemia?

A

Inadequate dietary intake.
TPN w/o mag.
Vomitting/diarrhea, NGT suctioning.
Chronic alcoholism.

48
Q

Cardiovascular related clinical manifestations of hypomagnesemia?

A
  1. Flat T waves.
  2. U Waves.
  3. Prolonged QT interval.
  4. Widened QRS.
  5. Atrial/ventricular PVCs.
49
Q

Ultimately, low magnesium has inhibitory effects in what cellular function?

A

Na-K- ATPase pump.

50
Q

What is treatment for hypomagnesemia?

A

1-2g IV mag over 5 mins.

Followed by 1-2g/hr

51
Q

Name three causes of hypermagnesemia?

A
  1. Iatrogenic admin: preeclamptic, antacids
  2. Renal failure.
  3. Adrenal insufficiency
52
Q

At what level of hypermagnesemia do we normally see CV effects begin?

A

5-10mEq/L

53
Q

What other electrolyte can be used in treatment of hypermagnesemia?

A

Calcium as an antagonist to CV effects

54
Q

What drug will magnesium potentiate?

A

NMBA

55
Q

Where is calcium found in the body?

A

99% Bones

1% Blood cells/plasma

56
Q

What is calcium’s main role outside of bone integrity?

A

Second messenger that couples cell membrane receptors to cellular responses.

57
Q

Why does massive blood transfusion decrease serum Ca++ levels?

A

Because the blood has citrate in it for storage. The citrate binds to Ca++.

58
Q

What are causes of hypocalcemia?

A

Hypoparathyroidism.
Malignancy.
Chronic renal insufficiency

59
Q

Which ones moves calcium into the bones and which moves it out- Calcitonin and parathyroid hormone?

A

Calcitonin moves it into the bones.

Parathyroid hormone moves it out of the bones.

60
Q

What is best treatment for hypocalcemia?

A

Calcium Chloride

61
Q

Why is calcium chloride a better treatment for hypocalcemia than calcium gluconate?

A

More bioavailable and more rapid correction.

62
Q

What is the conversion factor for CaCl and CaGluc infusions?

A

CaGluc 3gm=CaCl 1gm

63
Q

What is most common cause of hypercalcemia?

A

Hyperparathyroidism.

because parathyroid hormones moves Ca++ out of the bones.

64
Q

What cardiac effects may be seen with hypercalcemia?

A

Hypertension.
Heart block.
Dysrhythmias.
Shorted QT interval

65
Q

What is typical treatment of hypercalcemia?

A

Volume expansion with NS 0.9% and possibly loop diuretic

66
Q

What patients do we consider “malnourished”?

A

Elderly, alcoholics, dialysis patients, major blood loss, anorexic/bullemic, liver disease, GI patients d/t bowel prep, bariatric from liquid diet

67
Q

What are the three main ways there is intra-operative fluid loss?

A
  1. Insensible loss.
  2. Third space loss.
  3. Blood loss
68
Q

How do we historically replace typical insensible losses?

A

2ml/kg/hr Crystalloid

69
Q

How do we historically replace 3rd space loss?

A

Minimal trauma: 3-4ml/kg/hr
Moderate trauma: 5-6ml/kg/hr
Severe trauma: 7-8ml/kg/hr

70
Q

What day post-op do 3rd spaced fluids typically become mobilized?

A

3rd day post-op.

71
Q

What is the new way of intra-op fluid therapy?

A

Perioperative Goal-Directed Fluid Therapy (PGDT).

72
Q

What are some ways of determining fluid status on a patient when doing PGDT?

A
  1. *Pulse contour:
    plethsmography
  2. Echo
  3. Dilution technique with PAC.
73
Q

How do we assess the baseline for target hemodynamic measurements?

A

Give small fluid bolus and assess Frank-Starling curve

74
Q

What is ERAS?

A

Enhanced Recovery After Surgery

75
Q

How long do crystalloids stay intravascularly before moving extravascularly?

A

20 minutes

76
Q

Which crystalloid can lead to hyperchloremic metabolic acidosis?

A

0.9% Sodium Chloride (NS)

77
Q

Which crystalloid is used in trauma/head injuries?

A

3% Sodium Chloride.

78
Q

Which crystalloid helps maintains neutral pH?

A

Lactated ringers

79
Q

Which crystalloid promotes intravascular expansion?

A

3% Sodium Chloride

80
Q

Why can LR never be hung with blood?

A

Calcium content in LR binds with Citrate in blood.

81
Q

Which crystalloid should high doses be avoided in DM- NS, LR, 3%?

A

LR.

Lactate metabolite is gluconeogenic and causes high blood sugar over time.

82
Q

What is the tonicity of LR?

A

Slightly hypotonic

83
Q

What is the most isotonic balanced crystalloid?

A

Plasmalyte-A, Normosol-R, and Isolyte-S

84
Q

If EBL is 350, how much crystalloid should be used to replace it?

A

3x EBL(350)=1050ml

85
Q

Does surgical stress response cause hypo or hyper glycemia?

A

Hyperglycemia

86
Q

How much Na+ and Cl- are in NS?

A

154mEq of each

87
Q

How much Na+ and Cl- are in LR?

A

Na+=130mEq

Cl-=110mEq

88
Q

What is blood loss replacement ratio of colloids?

A

1:1

89
Q

Compared to blood, what are advantages and disadvantages of colloids?

A 
Advantages:
-Lack of risk of disease transmission.
Disadvantages:
-Lack of oxygen carrying capacity.
-Lack of coagulation factors
90
Q

What are issues with Dextran and Hetastarch administration in large volumes?

A

Dilutional coagulopathy and decrease platelet adhesiveness

91
Q

T/F: Albumin can cause anaphylaxis?

A

True

92
Q

What is the Donnon Effect?

A

Albumin binds to ions with increase plasma osmolality (and increases oncotic pulling pressure).

93
Q

What is the primary indication of 5% albumin administration?

A

Rapid expansion of intravascular fluid volume.

94
Q

What is the primary indication of 25% albumin administration?

A

Hypoalbuminemia

APA Fundamentals (10 decks)

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