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APEX: Flashcards > Fluids > Flashcards

Fluids Flashcards

1
Q

Body water distribution

A

TBW
(60% / 42 L)

     ICF                                     ECF     (40% / 28 L)                       (20% / 14 L)

                             Interstitial fluid       Plasma 
                                (15% / 11 L)        (5% / 3 L)
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2
Q

Major ECF ions

A
  1. Na
  2. Ca
  3. Cl
  4. HCO3
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3
Q

Major ICF ions

A
  1. K
  2. Mg
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4
Q

Neonates TBW%

A

higher

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5
Q

Females, obese, elderly TBW%

A

lower

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6
Q

Starling forces

A

dictate passive exchange of H2O b/t capillaries & interstitial fluid

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7
Q

Forces that move fluid from capillary to interstitial space

A
  1. Pc = capillary hydrostatic pressure (push)
  2. Interstitial oncotic pressure (pull)
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8
Q

Forces that move fluid from interstitial space into capillary

A
  1. Pif = interstitial hydrostatic pressure (push)
  2. capillary oncotic pressure (pull)
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9
Q

endothelial glycolayx

A
  • protective layer on interior wall of vessel
  • gatekeeps what can pass from vessel to interstitial space
  • disruption contributes to capillary leark
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10
Q

What factors disrupt glyocalyx?

A
  1. sepsis
  2. ischemia
  3. DM
  4. vascular surgery
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11
Q

Hematocrit

A

fraction of BV occupied by erythrocytes

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12
Q

Hct is increased by:

A
  1. increased # RBCs (polycythemia)
  2. decreased plasma volume (hypovolemia)
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13
Q

Hct is decreased by:

A
  1. decreased # RBCs (anemia)
  2. increased plasma volume (hemodilution)
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14
Q

Lymphatic system

A
  • removes fluid protein, bacteria, & debris in interstitium
  • propels lymph through vessel network via one way valves
  • creates negative pressure
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15
Q

Return of lymph for systemic circulation

A
  • returned via thoracic duct at juncture of IVC & subclavian vein
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16
Q

osmosis

A

net movement of H2O across semipermeable membrane

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17
Q

diffusion

A

net movement of substance from area of high concentration to area of lower concentration across fully permeable membrane

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18
Q

osmotic pressure

A

pressure of a solution against a semipermeable membrane that prevents H2O from diffusion across

19
Q

osmolarity

A
  • measures concentration of particles in a solution
  • unit of measurement = osmoles per L of solution (mOsm/L)
20
Q

osmolality

A
  • measures concentration of particles in a solution
  • unit of measurement = osmoles per kg of solvent (mOsm/kg of H2O)
21
Q

plasma osmolarity formula

A

2 [Na+] + Glucose/18 + BUN/2.8

22
Q

normal plasma osmolarity

A

280-290 mOsm/L

23
Q

most important determinant plasma osmolarity

A

Na+

24
Q

What 2 things can increase plasma osmolarity?

A
  1. hyperglycemia
  2. uremia
25
Q

Hypotonic solutions

A
  • solution hypotonic to cell
  • H2O enters & cell swells
  • lower osmolarity than plasma
  • increases ECF & ICF volume
  • decreases plasma osmolarity
26
Q

isotonic solutions

A
  • solution isotonic to cell
  • no H2O transfer & cell remains same size
  • osmolarity approximates plasma
  • expand plasma volume & ECF
  • increases ECF
  • ICF & plasma osmolarity stay same
27
Q

hypertonic solutions

A
  • solution hypertonic to cell
  • H2O exits cell & cell shrinks
  • osmolarity exceeds plasma
  • expands IV volume
  • ECF & plasma osmolarity increase
  • ICF decreases
28
Q

Hypotonic solution examples

A

Crystalloids
- NaCl 0.45%
- D5W

29
Q

Isotonic solution examples

A

Crystalloids
- NaCl 0.9%
- LR
- Plasmalyte A

Colloids
- albumin 5%
- volvuven 6%
- hespan 6%

30
Q

Hypertonic solution examples

A

Crystalloids
- NaCl 3%
- D5 NaCl 0.9%
- D5 NaCl 0.45%
- D5 LR

Colloids
- Dextran 10%

31
Q

What complication can result from large amounts of NaCl?

A

hyperchloremic metabolic acidosis

32
Q

How long do crystalloids remain in the IV space?

A

~ 30 minutes

33
Q

What complication can result when hypertonic saline is administered too quickly?

A

central pontine myelinolysis

34
Q

Crystalloid advantages

A
  • 3:1 replacement
  • expands ECF
  • restores 3rd space loss
35
Q

Colloid advantages

A
  • 1:1 replacement
  • increases plasma vol (3-6 hr)
  • smaller vol needed
  • less peripheral edema
  • albumin has anti-inflammatory properties
  • dextran 40 reduces blood viscosity
35
Q

Crystalloid disadvantages

A
  • limited ability to expand plasma volume
    ~ increases for ~ 20-30 min
    ~ higher potential for peripheral edema
  • large vol NaCl –> hyperchloremic met acidosis
  • dilutional effect on albumin
  • dilutional effect on coagulation factors
36
Q

Colloid disadvantages

A
  • albumin binds Ca+ –> hypocalcemia
  • black box warning on synthetic colloids- renal injury
  • coagulopathy
    Dextran > Hetastarch > Hextend (no >20 ml/kg)
  • anaphylactic potential- highest = dextran
37
Q

What is the black box warning on synthetic colloids?

A

risk of renal injury

38
Q

Which colloid has highest incidence of coagulopathy?

A

dextran > hetastarch

39
Q

How does albumin affect serum calcium?

A

hypocalcemia

40
Q

Fluid Calculation (Historical)

A

1: Fluid Hourly Maintenance (4:2:1)
- 4 ml/kg/hr = 1st 10 kg
- 2 ml/kg/hr = 2nd 10 kg
- 1 lm/kg/hr remaining kg

  1. Calculate fluid deficit
    - # fasting hours x hourly maintenance
  2. Calculate “third space” loss
    - very minimal surgical trauma = 1-2 ml/kg/hr
    ex: orofacial surgery
  • minimal surgical trauma = 2-4 ml/kg/hr
    ex: inguinal hernia repair
  • moderate surgical trauma = 4-6 ml/kg/hr
    ex: major nonabdominal surgery
  • severe surgical trauma: 6-8 ml/kg/hr
    ex: major abdominal surgery
  1. Calculate blood loss replacement
  • crystalloid = 3:1 (3 ml for q 1 ml blood loss)
  • colloid or blood = 1:1
41
Q

Goal-directed fluid therapy

A
  • attempts to optimize pt’s position on Starling curve
  • administration of small quantities of fluid (200-250 ml) to determine difference b/t preload dependence & preload independence
42
Q

Enhanced Recovery After Surgery

A
43
Q

5 objectives to enhance postsurgical outcomes w/ ERAS

A
  1. Attenuate physiologic changes that accompany surgical trauma
  2. Minimize impact of fluid shifts
  3. Maximize nutritional impact of healing
  4. Improve postop pain
  5. Improve patient education & compliance

APEX: Flashcards (13 decks)

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