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Therapeutics 2 - Exam 1 > Fluids > Flashcards

Fluids Flashcards

Walworth lectures 2,3,4

1
Q

intracellular fluid percentage of weight

A

40%

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2
Q

extracellular fluid percentage of weight

A

20%

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3
Q

interstitial percentage of extracellular

A

75%

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4
Q

intravascular percentage of extracellular

A

25%

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5
Q

as age increases, water weight ?

A

decreases

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6
Q

do males or females have a higher water weight percentage?

A

males

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7
Q

three major organs of fluid balance

A

skin
kidney
lungs

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8
Q

what type of fluid loss can be measured?

A

sensible

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9
Q

what type of fluid loss cannot be measured?

A

insensible

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10
Q

sensible fluid loss amount per day

A

1 to 1.5L

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11
Q

insensible fluid loss amount per day

A

1 L

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12
Q

what of fluid is not subjected to daily gains or losses?

A

transcellular

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13
Q

isotonic solution mOsm/L

A

between 275 to 290

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14
Q

hypotonic solution mOsm/L

A

less than 275

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15
Q

hypertonic solution mOsm/L

A

greater than 290

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16
Q

what type of hypotonic solutions should not be dispensed?

A

less than 154 mOsms

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17
Q

what type of hypertonic solutions should be given in small amounts and through a central line?

A

greater than 600 mOsms

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18
Q

when should NBW be used?

A

when ABW is 130% of IBW

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18
Q

MIVF requirements

A

30 to 40 mL per kg per day

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19
Q

what type of solutions are crystalloids and colloids?

A

crystalloids – all
colloids – always hypertonic

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20
Q

examples of crystalloids

A

NS
1/2 NS
D5W
LR
Balanced salt solutions

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21
Q

examples of colloids

A

albuminb (5% or 25%)
Hetastarch
tetrastarch
blood
plasmanate

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22
Q

what do crystalloids provide?

A

water and/or sodium

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23
Q

what type of fluid is NS?

A

resuscitation

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24
Q

what type of fluid is 1/2 NS?

A

maintenance

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25
Q

what type of fluid is lactated ringers?

A

resuscitation

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26
Q

what does LR approximate?

A

human plasma

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27
Q

what type of solution is dextrose 5%?

A

maintenance

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28
Q

is D5w a MIVF by itself?

A

NO

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29
Q

examples of balanced salt solutions (BSS)

A

lactated ringers (LR)
normosol-R
plasma-lyte

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30
Q

BSS definition

A

solutions that contain physiologic levels of chloride and buffer solutions

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31
Q

colloid definition

A

fluids used to increase plasma oncotic pressure (volume expansion)

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32
Q

albumin

A

human derived blood product
AE - hypervolemia and azotemia
strengths - 5 and 25%

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33
Q

when should 5% albumin be used?

A

when the patient needs volume/fluid

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34
Q

when should 25% albumin be used?

A

when the patient is fluid and/or sodium restricted

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35
Q

SR

A

number of hydroxyethyl groups per glucose molecule in synthetic colloids
high is greater than 0.5

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36
Q

coagulation

A

altered at a higher molecular weight in synthetic colloids

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37
Q

high molecular weight

A

over 200kDa

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38
Q

is high SR and MW good or bad?

A

Bad

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39
Q

what does the prefix indicate in synthetic colloids, hetastarch, and tetrastarch?

A

number of hydroxyethyl groups (SR)

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40
Q

1 unit of RBC is equal to how many mL?

A

230 to 350 mL

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41
Q

low hemoglobin

A

equal to or greater than 7 to 8 g/dL

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42
Q

how many g/dL is hemoglobin increased by with 1 unit of RBCs?

A

1 g/dL

43
Q

what is the most common MIVF?

A

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

44
Q

indications of dehydration and compensate for each other

A

tachycardia and hypotension

45
Q

BUN/SCr ratio of dehydration

A

greater than 20

46
Q

primarily location of Na+ and K+

A

Na+ extra cellular
K+ intra cellular

47
Q

normal Na+ range

A

135 to 145 mEq/L

48
Q

what is the most common electrolyte disturbance?

A

hyponatremia

49
Q

what can rapid sodium correction cause?

A

seizure
demyelination

50
Q

isotonic hyponatremia

A

hyponatremia with normal osmserum
also called pseudo hyponatremia
caused by increased lipids and proteins, which increases volume and dilutes sodium
calculated Osm is low

51
Q

hypertonic hyponatremia cause

A

increased blood glucose

52
Q

what does high Osmserum but normal calculated osmolality indicate?

A

presence of other substances in the blood

53
Q

serum sodiums falls by ____mEq/L for each ___mg/dL increase in BG greater than ___ mg/dL

A

1.6
100
100

54
Q

hypovolemic hypotonic hyponatremia

A

low TBW
very low sodium

55
Q

isovolemic hypotonic hyponatremia

A

high TBW
unchanged Na+

56
Q

hypervolemic hypotonic hyponattremia

A

very high TBW
high sodium

57
Q

what is the most type of hyponatremia?

A

hypotonic

58
Q

renal causes of hypovolemic hypotonic hyponatremia

A

diuretics
adrenal insufficiency
salt losing nephropathy
cerebral salt wasting

59
Q

non-renal causes of hypotonic hyponatremia

A

blood loss
skin loss
GI loss

60
Q

what is the urine sodium level from renal causes of hypo-hypo-hypo?

A

greater than 20 mEq/L

61
Q

what is the urine sodium level from non-renal causes of hypo-hypo-hypo?

A

under 20mEq/L

62
Q

what is the 1 cause of iso-hypo-hypo

A

SIADH

63
Q

SIADH

A

syndrome of inappropriate antidiuretic hormone secretion
water intake exceeds capacity of kidneys to excrete water
#1 cause – drugs

64
Q

drugs that cause SIADH

A

antipsychotics
carbamazepine
SSRIs

65
Q

SIADH treatment

A

stop taking the medication that is causing it
reduce fluid intake
if reducing water doesn’t work, use vaptan diuretics

66
Q

symptoms of hypo-hypo-hypo

A

dehydration

67
Q

symptom of iso-hypo-hypo

A

CNS

68
Q

symptom of hyper-hypo-hypo

A

edema

69
Q

max limit of rise in serum sodium

A

0.5 mEq/L/hr

70
Q

max limit of rise in sodium

A

8 to 12 mEq/L/day

71
Q

treatment of hypo-hypo-hypo

A

symptomatic - 3% NaCl
asymptomatic - 0.9% NaCl

72
Q

treatment of iso-hypo-hypo

A

symptomatic - furosemide or 3% NaCl
asymptomatic - 0.95% NaCl or water restriction

73
Q

treatment of hyper-hypo-hypo

A

symptomatic - furosemide, judicious 3% NaCl
asymptomatic - 3% NaCl

74
Q

symptoms of acute hyponatremia

A

seizures
brain swelling

75
Q

how quickly should serum sodium levels be increased?

A

1 to 2 mEq/L/hr

76
Q

demyelination

A

occurs when sodium is added too quickly

77
Q

reasonable short term Na goal for hyponatremia patients

A

120 mEq/L

78
Q

normal K+ range

A

3.5 to 5 mEq/L

79
Q

K+

A

primary intracellular cation
mainly affects the heart
Mg2+ depletion affects reabsorption

80
Q

symptoms of hypokalemia

A

weakness
changes in cardiac function
cramping

81
Q

treatment of hypokalemia

A

when levels are 3.5 to 4 – none
when levels are 3 to 3.4 – oral potassium for patients with cardiac conditions
when levels are less than 3 – oral potassium in asymptomatic, IV potassium in symptomatic

82
Q

goal of hypokalemia treatment

A

correcting Mg depletion

83
Q

IV K+

A

should only be used in severe cases of hypokalemia due to the chance of arrhythmia or cardiac arrest if added too quickly

84
Q

K+ infusion rates

A

without cardiac monitoring –10mEq/hr
with cardiac monitoring – 20 mEq/hr
with cardiac monitoring EMERGENT – 40 to 60 mEq/hr

85
Q

normal Mg2+ range

A

1.5 to 2.5 mEq/L
related to Ca2+ and K+ metabolism

86
Q

hypomagnesemia

A

main cause is loop or thiazide diuretics
can be identified by looking for signs of hypocalcemia and hypokalemia
treatment should include treating these disturbances

87
Q

treatment of asymptomatic hypomagnesemia

A

Milk of Magnesia 5 to 10ml by mouth QID
Mag-OX 800mg by mouth QD or 400mg by mouth TID with meals

88
Q

treatment of symptomatic hypomagnesemia with 1 to 2mg/dL level

A

0.5 mEq/kg via IV

89
Q

treatment of symptomatic hypomagnesemia with under 1mg/dL level

A

1 mEq/kg via IV

90
Q

8 mEq is equal to how many grams?

A

1 gm

91
Q

how much magnesium should be infused per hour?

A

1 gm

92
Q

normal total calcium levels

A

8.5 to 10.5 mg/dL

93
Q

hypocalcemia causes

A

magnesium deficiency
large volume of blood products
hypoalbuminemia

94
Q

acute treatment of hypocalcemia

A

100 to 300mg elemental Ca2+ over 5 to 10 minutes

95
Q

how would you assess Ca2+ properly?

A

by using corrected Ca2+ levels

96
Q

rate of calcium chloride to calcium gluconate to elemental calcium

A

1 gram to 3 grams to 270 mg

97
Q

administration rate of calcium

A

1 gm per hour

98
Q

normal phosphorus levels

A

2.5 to 4.5 mg/dL

99
Q

mild to moderate hypophosphatemia levels

A

1 to 2 mg/dL

100
Q

severe hypophosphatemia levels

A

under 1 mg/dL

101
Q

treatment of mild to moderate hypophosphatemia

A

oral PO4

102
Q

treatment of severe hypophosphatemia

A

IV PO4

103
Q

when to use KPhos?

A

when K+ levels are under 4 mEq/L

104
Q

when to use NaPhos?

A

when K+ levels are greater than or equal to 4 mEq/L

Therapeutics 2 - Exam 1 (6 decks)

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