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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
Total Osmolarity calculation
= Osmolarity of IV + Osmo of added electrolytes
26
IV infusions of hypo or hypertonic solutions
-hemolysis of RBCs -renal failure -death
27
Example
-calc osmolarity of 1L of 0.45% NaCl (154mOsm/L) with 20mEqKCl (2mOsm/mEq) -154 + (2*20) = 194 mOsm/L
28
Calc MIVF
-Holliday-Segar equation (peds or obese) -just use the clinical estimate is 30-40mL/kg/day
29
What is a patient's MIVF needs?
-30-40mL/kg/day -use actual weight
30
Example MIVF calc
-(30-40mL/kg) * 91kg = 2730-3640mL/day -divide by 24 for hourly rate
31
Maintenance IV Fluids
-MIVF -normal amt needed over 24 hours
32
Ideal Fluid
-predictable effects -inc IV volume -no accumulation -cost -stability -convenience
33
Types of Fluids
-Crystalloids -Colloids
34
Crystalloid Solutions
-give water and/or sodium -maintain osmotic gradient
35
Crystalloid Solutions
-NS -1/2 NS -D5W -LR -balanced salt solutions
36
Normal Saline (0.9% NaCl)
-used for IV fluid REPLACEMENT -RESUSCITATION -NOT FOR MAINTENANCE -Na and Cl replacement
37
1/2 NS (0.45%NaCl)
-used for MAINTENANCE FLUIDS (combo products)
38
Lacated Ringers
-REPLACE blood loss -approximates human plasma -RESUSITATION (trauma/burn) -better than normal saline
39
D5W (Dextrose 5%)
-free water replacement -NOT resuscitative -NOT and MIVF by self
40
Balanced Salt Solutions
-Crystalloid solutions w physiologic levels of chloride and buffer solutions -****
41
Examples of balanced salt solutions
-Lacated Ringers -Normosol-R -Plasma-lyte -NOT saline
42
0.9% NaCl composition
-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
0.45% NaCl composition
-half 0.9 -has 500 mL free water tho (2/3 ECF distribution)
44
Most similar to physiological electrolytes
-Normosol-R -Plasma-lyte -also have normal pH -and buffers
45
NS complications vs balanced salt solutions
-inc mortality -inc acidosis -inc blood transfusions -inc renal injury -inc hyperkalemia -inc postop infection
46
Generally only use Normal Saline
-when someone is low on sodium -prefer balance salt solutions (normosol, LR, plasma-lyte)
47
Colloid Solution MOA
-ALWAYS HYPERTONIC -inc plasma oncotic pressure -move fluid from interstitial to plasma compartment
48
Colloid solution place in therapy
-plasma expanders -inc molecular weight -corresponds to increased IV retention time compared to crystalloids
49
Colloid Solution use
-selective volume expansion or IV repletion in symptomatic pt -hemorrhagic shock w crystalloid -second line for hypovolemic shock after crystalloid
50
Colloid Tonicity
-HYPERtonic
51
Colloid examples
-Albumin -Hetastarch -Tetrastarch -Blood -Plasmanate
52
Albumin
-human derived -5% or 25% -supportive/symptomatic treatment unless hypoproteinemia
53
Albumin indications
-volume expansion -shock -burn -ARDS -cardiopulmonary bypass -Intraoperative fluid repletion
54
Albumin adverse effects
-HYPERvolemia -Azotemia -infusion related reaction/anaphylaxis
55
Albumin 5%
-250-500mL vial -50mg/mL -treat HYPOvolemia or intravascular depletion
56
Albumin 5% dosing
-0.5-1g/kg prn -2-4mL/min if normal plasma level -5-10 if hypoproteinemia
57
Albumin 25%
-50mL or 100mL vial -250mg/mL -tx fluid and/or sodium restricted patients
58
Albumin 25% dosing
-Paracentesis >5L -5-8 g/L removed (round to nearest 25g) -1mL/min for normal plasma -2-3mL/min for hypoproteinemia
59
Composition of Synthetic Colloids
-substitution ratio (SR) -Molecular Weight (MW) -not using these -black box for sepsis
60
Substitution Ratio (SR)
-number of hydroxyethyl groups per glucose
61
High substitution ratio
>0/5 -leads to prolonged IV expansion
62
high molecular weight of synthetic colloid
-alters coagulation >200kDa
63
High SR and MW
-increase mortality and toxicities
64
Synthetic colloids
-Hetastarch (Hespan) -Tetrastarch (Voluven) -use with caution
65
Synthetic Colloid safety concerns
-inc mortality at day 90 -risk renal replacement therapy -inc association with bleeding
66
Blood (Colloid)
-packed RBCs -1 unit = 230-350mL
67
Use of blood
-acute blood loss (30-40%) -inadequate resuscitation from fluids alone -preop -low hemoglobin
68
Low hemoglobin
< 7-8g/dl -1 unit RBCs increases hemoglobin by approximately 1g/dL
69
most common MIVF
-D5W + 1/2NS + 20 mEq KCl/L -inc plasma oncotic pressure -similar composition to urine
70
Monitoring Fluid Status
-daily weight -daily ins/outs -volume status (dehydration) -Urine output in mL/kg/hr -vitals
71
Monitoring volume status
-volume overload -euvolemic -dehydration
72
Monitoring vitals
-HR/BP -Central Venous Pressure (CVP) -invasive hemodynamic parameters (catheter)
73
Signs of Dehydration
-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
Low urine output
< 0.5mL/kg/hr -dehydration
75
High BUN/Scr ratio
>20 -dehydration
76
Distribution percentage of crystalloid fluids at 100% ECF
-0.9% NaCl -3% NaCl -LR -normosol -Plasma-lyte -resuscitative
77
Distribution percentage of crystalloid fluids at 2/3 and 1/3
-0.45% NaCl -0.225% NaCl -D5W -maintenance
78
Albumin 5% vs 25%
-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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