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Therapeutics II > Fluids > Flashcards

Fluids Flashcards

1
Q

IBW calc men

A

50kg + (2.3* inches over 60”)

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2
Q

IBW calc women

A

45.5kg + (2.3* inches over 60)

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3
Q

Adjusting body weights

A

-Dosing Body Weight
-Nutrition Body Weight

-IBW is almost never the correct choice for electrolytes?

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4
Q

Dosing Body Weight (DBW)

A
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5
Q

Nutrition Body Weight (NBW)

A

IBW + 0.25(wt-IBW)
-use if ABW>130% of IBW
-use to calc fluid, electrolyte, nutrition parameters

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6
Q

Fluid Distribution

A

-intracellular (2/3)
-extracellular (1/3)
-*transcellular
-60% of body weight

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7
Q

Extracellular fluid distribution

A

-3/4 interstitial (surrounds cell)
-1/4 Intravascular (plasma)

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8
Q

Transcellular Fluid Distribution

A

-spine
-lymph
-joints
-eyes
-not subject to daily gains and losses

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9
Q

Body Water comp adults

A

-Men: 50-60%
-women: 45-55%

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10
Q

Body Water Comp and age

A

-high in infants (75-90%)
-lower in elderly
-dectrases with age
-skeletal muscle mass declines
-fat proportion may increase

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11
Q

Fluid Balance maintains:

A

-body temp
-cell shape
-transport
-nutrients
-gases
-wastes

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12
Q

Fluid balance key organs

A

-skin
-lungs
-kidneys

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13
Q

Fluid intake

A

-liquids
-solids
-meds

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14
Q

Fluid losses

A

-sensible (measurable)
-insensible (immeasurable)

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15
Q

Average Sensible Fluid Loss

A

-Urination
-Defecation
-Wounds

~1-1.5 L/day

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16
Q

Insensible Fluid Loss

A

-skin
-lungs

~1L/day

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17
Q

Additional Fluid losses

A

-NG output
-Vomit
-Diarrhea
-burns
-fistulas
-drains
-bleeding/wounds

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18
Q

Volume Regulation mediated by

A

-kidneys
-thirst
-hormone changes

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19
Q

Electrolytes lost in NG output

A

-sodium and chloride
-losss of chloride can lead to alkalosis

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20
Q

Electrolytes lost in diarrhea

A

-bicarbonate (HCO3) (bases)
-leads to acidosis

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21
Q

Isotonic

A

-275-290 mOsm/L
-prevents fluid shift
-equal concentration

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22
Q

HYPOtonic

A

<275
-less concentrated than ECF
-Fluid moves INTO cell
-hypO = swell

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23
Q

HYPERtonic

A

->290
-more concentrated than ECF
-fluid pulled out
-shrivel

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24
Q

Osmolarity

A

-measure tonicity
-depends on pH and temp

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25
Q

Total Osmolarity calculation

A

= Osmolarity of IV + Osmo of added electrolytes

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26
Q

IV infusions of hypo or hypertonic solutions

A

-hemolysis of RBCs
-renal failure
-death

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27
Q

Example

A

-calc osmolarity of 1L of 0.45% NaCl (154mOsm/L) with 20mEqKCl (2mOsm/mEq)

-154 + (2*20) = 194 mOsm/L

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28
Q

Calc MIVF

A

-Holliday-Segar equation (peds or obese)
-just use the clinical estimate is 30-40mL/kg/day

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29
Q

What is a patient’s MIVF needs?

A

-30-40mL/kg/day
-use actual weight

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30
Q

Example MIVF calc

A

-(30-40mL/kg) * 91kg = 2730-3640mL/day

-divide by 24 for hourly rate

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31
Q

Maintenance IV Fluids

A

-MIVF
-normal amt needed over 24 hours

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32
Q

Ideal Fluid

A

-predictable effects
-inc IV volume
-no accumulation
-cost
-stability
-convenience

33
Q

Types of Fluids

A

-Crystalloids
-Colloids

34
Q

Crystalloid Solutions

A

-give water and/or sodium
-maintain osmotic gradient

35
Q

Crystalloid Solutions

A

-NS
-1/2 NS
-D5W
-LR
-balanced salt solutions

36
Q

Normal Saline (0.9% NaCl)

A

-used for IV fluid REPLACEMENT
-RESUSCITATION
-NOT FOR MAINTENANCE
-Na and Cl replacement

37
Q

1/2 NS (0.45%NaCl)

A

-used for MAINTENANCE FLUIDS (combo products)

38
Q

Lacated Ringers

A

-REPLACE blood loss
-approximates human plasma
-RESUSITATION (trauma/burn)
-better than normal saline

39
Q

D5W (Dextrose 5%)

A

-free water replacement
-NOT resuscitative
-NOT and MIVF by self

40
Q

Balanced Salt Solutions

A

-Crystalloid solutions w physiologic levels of chloride and buffer solutions
-**

41
Q

Examples of balanced salt solutions

A

-Lacated Ringers
-Normosol-R
-Plasma-lyte

-NOT saline

42
Q

0.9% NaCl composition

A

-154 mEq/L Na+
-154 mEq/L Cl-
-NO water (100% ECF distribution)
-acidic pH
-10% more sodium and 50% more Cl than normal plasma

43
Q

0.45% NaCl composition

A

-half 0.9
-has 500 mL free water tho (2/3 ECF distribution)

44
Q

Most similar to physiological electrolytes

A

-Normosol-R
-Plasma-lyte
-also have normal pH
-and buffers

45
Q

NS complications vs balanced salt solutions

A

-inc mortality
-inc acidosis
-inc blood transfusions
-inc renal injury
-inc hyperkalemia
-inc postop infection

46
Q

Generally only use Normal Saline

A

-when someone is low on sodium
-prefer balance salt solutions (normosol, LR, plasma-lyte)

47
Q

Colloid Solution MOA

A

-ALWAYS HYPERTONIC
-inc plasma oncotic pressure
-move fluid from interstitial to plasma compartment

48
Q

Colloid solution place in therapy

A

-plasma expanders
-inc molecular weight
-corresponds to increased IV retention time compared to crystalloids

49
Q

Colloid Solution use

A

-selective volume expansion or IV repletion in symptomatic pt
-hemorrhagic shock w crystalloid
-second line for hypovolemic shock after crystalloid

50
Q

Colloid Tonicity

A

-HYPERtonic

51
Q

Colloid examples

A

-Albumin
-Hetastarch
-Tetrastarch
-Blood
-Plasmanate

52
Q

Albumin

A

-human derived
-5% or 25%
-supportive/symptomatic treatment unless hypoproteinemia

53
Q

Albumin indications

A

-volume expansion
-shock
-burn
-ARDS
-cardiopulmonary bypass
-Intraoperative fluid repletion

54
Q

Albumin adverse effects

A

-HYPERvolemia
-Azotemia
-infusion related reaction/anaphylaxis

55
Q

Albumin 5%

A

-250-500mL vial
-50mg/mL
-treat HYPOvolemia or intravascular depletion

56
Q

Albumin 5% dosing

A

-0.5-1g/kg prn
-2-4mL/min if normal plasma level
-5-10 if hypoproteinemia

57
Q

Albumin 25%

A

-50mL or 100mL vial
-250mg/mL
-tx fluid and/or sodium restricted patients

58
Q

Albumin 25% dosing

A

-Paracentesis >5L
-5-8 g/L removed (round to nearest 25g)
-1mL/min for normal plasma
-2-3mL/min for hypoproteinemia

59
Q

Composition of Synthetic Colloids

A

-substitution ratio (SR)
-Molecular Weight (MW)

-not using these
-black box for sepsis

60
Q

Substitution Ratio (SR)

A

-number of hydroxyethyl groups per glucose

61
Q

High substitution ratio

A

> 0/5
-leads to prolonged IV expansion

62
Q

high molecular weight of synthetic colloid

A

-alters coagulation
>200kDa

63
Q

High SR and MW

A

-increase mortality and toxicities

64
Q

Synthetic colloids

A

-Hetastarch (Hespan)
-Tetrastarch (Voluven)
-use with caution

65
Q

Synthetic Colloid safety concerns

A

-inc mortality at day 90
-risk renal replacement therapy
-inc association with bleeding

66
Q

Blood (Colloid)

A

-packed RBCs
-1 unit = 230-350mL

67
Q

Use of blood

A

-acute blood loss (30-40%)
-inadequate resuscitation from fluids alone
-preop
-low hemoglobin

68
Q

Low hemoglobin

A

< 7-8g/dl
-1 unit RBCs increases hemoglobin by approximately 1g/dL

69
Q

most common MIVF

A

-D5W + 1/2NS + 20 mEq KCl/L

-inc plasma oncotic pressure
-similar composition to urine

70
Q

Monitoring Fluid Status

A

-daily weight
-daily ins/outs
-volume status (dehydration)
-Urine output in mL/kg/hr
-vitals

71
Q

Monitoring volume status

A

-volume overload
-euvolemic
-dehydration

72
Q

Monitoring vitals

A

-HR/BP
-Central Venous Pressure (CVP)
-invasive hemodynamic parameters (catheter)

73
Q

Signs of Dehydration

A

-decreased skin turgor
-dry membranes
-delayed capillary refill
-maybe TACHYCARDIA and HYPOtension
-peripheral pulses weak
-deacreased urine output/dark urine
-high BUN/SCr ratio
-vary on age, disease, meds, cause of fluid depletion

74
Q

Low urine output

A

< 0.5mL/kg/hr
-dehydration

75
Q

High BUN/Scr ratio

A

> 20
-dehydration

76
Q

Distribution percentage of crystalloid fluids at 100% ECF

A

-0.9% NaCl
-3% NaCl
-LR
-normosol
-Plasma-lyte

-resuscitative

77
Q

Distribution percentage of crystalloid fluids at 2/3 and 1/3

A

-0.45% NaCl
-0.225% NaCl
-D5W

-maintenance

78
Q

Albumin 5% vs 25%

A

-5% for people that need more fluid
-25% for people that don’t need/cant have more sodium

Therapeutics II (55 decks)

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