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Pharm > Fluids > Flashcards

Fluids Flashcards

1
Q

Fluid Admin goals

A
  • Maintain intravascular volume
  • Augment CO
  • Maintain tissue perfusion & O2 delivery
  • Maintain electrolyte balance
  • Enhance microcirculatory flow
  • Facilitate delivery of nutrients & clearance of waste
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2
Q

Total Body Water

A

Adult: 60% of lean body mass
Neonates: 75-85%
1 y/o: 65%

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3
Q

ICV

A

40% of body weight
2/3 of TBW
cation: K+
anion: Phos

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4
Q

ECV

A

20% of body weight
1/3 of TBW
cation: Na++
anion: Cl-

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5
Q

ECV divisions

A

plasma - 1/4

interstitial fluid in tissue spaces - 3/4

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6
Q

Starling Forces (4)

A

Interstitial hydrostatic pressure
interstitial oncotic pressure
capillary hydrostatic pressure
plasma oncotic pressure

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7
Q

Positive Net Filtration

A

= fluid into tissues
supported by:
- capillary hydrostatic pressure
- interstitial oncotic pressure

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8
Q

overall balance of filtration

A

slightly positive

~2ml/min into tissues - uptaken by lymphatics back into intravascular

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9
Q

percentage of daily losses in urine

A

60%

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10
Q

Pediatric losses considerations

A

SA:weight rate is ~ 3x that of an adult
= more insensible losses
= more heat loss
= more sodium loss

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11
Q

ECV & ICV in pediatrics

A

ECV in infants is 40% & decreases with age

ICV is 20% in premature & 30% by adolescents

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12
Q

Neurohormonal Mechanisms for Fluid Balance

A
  1. RAAS
  2. ADH
  3. ANP
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13
Q

RAAS

A

In response to hypotension & sympathetic stim:

renin from kidneys cleaves angiotensinogen from liver = ANG I + ACE (in lungs) = ANG II = water & Na ++ reabsorption

also = aldosterone release = water & Na++ reabsorption

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14
Q

ADH

A

released from posterior pituitary in response to increase serum osmolality…
= increased water & sodium reabsorption
= increased urine concentration
= arterial vasoconstriction

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15
Q

ANP

A

released due to stretch on atrial walls from increased preload or hypervolemia…
= increased sodium & water EXCRETION
= inhibitor of ADH & RAAS

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16
Q

Evaluating Volume Status

A 
BP
HR
turgor/fontanelles
UOP
perfusion 
CO
17
Q

s/s of volume loss

A

5%: poor turgor/sunken fontanelles
10%: tachycardia, oliguria, cold up to knees
15%: hypotension, sunken eyes, extremities cold
20%: unconscious

18
Q

Crystalloids

A
  • Resuscitation of dehydration
  • Lack of allergenic potential
  • ease of metabolism & clearance
    o Beneficial for restoring immediate vascular volume, preserving microcirculatory flow, reducing hormone mediated vasoconstriction & correcting plasma hyper-viscosity seen with acute hemorrhage
  • Isotonic crystalloids distribute evenly throughout the ECV
    = Limited ability to expand plasma
    = Hemodilution plasma proteins
    = Loss of capillary oncotic pressure
    filtration of 75-80% of admin volume goes into interstitial spaces
19
Q

NS

A

Na = Cl in the solution but in plasma Na > Cl
= risk for acid/base imbalances - hyperchloremic metabolic acidosis

may also impair renal function and reduce GFR

20
Q

NS compared to plasmalyte

A

associated with increased incidence of kidney failure, acidosis, blood transfusions (acidotic effect on coagulation) & post-op wound infections

21
Q

Colloids

A

suspension of high molecular weight molecules in electrolyte solutions

  • good volume expanders
  • albumin is the only naturally occurring
22
Q

Cortisol Effect

A

released from HPA axis activation

  • increased production & release of plasma proteins
  • maintains intravascular volume
  • inhibits inflammatory mediators
23
Q

Release of Cytokines

A

mediated amounts = promotes local hemostasis & migrates neutrophils

large amounts = vasodilation, endothelial damage, increased filtration, tissue edema, intravascular loss, hypotension & decreased organ perfusion

24
Q

Maintenance Fluids 4-2-1

A
  • first 10kg = 4ml/kg/hr
  • second 10kg = 2ml/kg/hr
  • additional kg = 1ml/kg/hr

ex: 54kg = 40 + 20 + 4 = 64ml/kg/hr

25
Q

NPO deficit

A

maintenance x NPO hours
hour 1: 50% + maint.
hour 2: 25% + maint.
hour 3: 25% + maint.

should be given pre-operatively

26
Q

Blood Replacement

A

3: 1 with crystalloid
1: 1 with colloid

27
Q

Third Spacing Losses due to Trauma

A

minimal: 0-2ml/kg/hg
moderate: 2-4ml/kg/hr
max: 4-12ml/kg/hr

28
Q

Allowable Blood lose

A

EBV x (HCT-25)/HCT

or

EBV x (HGBinitial - HGB acceptable)/ HGB initial

29
Q

HCT

A 
o	Premature infant: 40-45
- Transfuse: 35
o	Newborn: 45-65
- Transfuse: 30-35
o	3 Months: 30-42
- Transfuse: 25
o	1 y/o: 34-43
- Transfuse: 20-25
o	Adult: 38-46
- Transfuse: 20-30

Pharm (11 decks)

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