Fluids Flashcards
Fluids containing larger molecular weight particles with plasma oncotic pressures similar to normal plasma proteins
colloids
Examples of colloids
albumin, FFP, hetastarch, dextran
noting or pertaining to a solution containing the same salt concentration as blood
isotonic fluids
Examples of isotonic solutions
0.9% NS or lactated ringers
a solution of lower osmotic pressure than blood
hypotonic fluids
examples of hypotonic fluids
0.45% NaCl and D5 0.45% in NaCl
most osmotically active electrolyte in the body
sodium
easiest way to monitor net gain/loss of fluids
daily weights
tells you the patient has adequate water balance
normal serum sodium
obligate fluid loss of normal adults
1600 ml/day
Ideal fluid to use for maintenance therapy since the kidneys will regulate Na, K, and H20 retention
0.45% NaCl + 20 mEq KCl
Estimate of daily fluid requirements (from ALL sources) in adults without fever/sweats
1500ml + 20ml/kg for each kg >20
How much does water requirement increase for each degree of fever > 37C?
100-150 ml/day for each degree above 37C
Earliest sign of hypovolemia due to the kidneys conserving sodium and water
decreased urine Na (<25 mEq/L)
What is the BUN/Cr ratio with hypovolemia?
> 20:1
Treatment for hypovolemia due to decreased intake or excess excretion while waiting for labs
0.45% NaCl
Treatment for hypovolemia due to decreased intake or excess excretion if serum Na > 145
0.25% NaCl
Treatment for hypovolemia due to decreased intake of excess excretion if serum Na < 138
0.9% NaCl (NS)
Minimum amount of urine that should be made per hr
30cc
Treatment for hypovolemia due to vomiting or diarrhea until labs are back
0.9% NaCl (NS)
Treatment for hypovolemia due to vomiting or diarrhea if serum Na > 145
0.45% NaCl
handled like free water…will diffuse thru body water
1L 5% dextrose
isotonic…distributed in ECF since cell membrane not permeable to sodium
1L 0.9% NS
remains in intravascular space…shock
1L 5% albumin
Acute sequestration in a body compartment that is not in equilibrium with ECF (Isotonic). Examples include: intestinal obstruction, severe pancreatitis, peritonitis, major venous obstruction, burns. Will need IV fluids to preven extracellular volume depletion
third spacing
What is the fluid therapy of choice for acute hypernatremia?
5% dextrose
What is the fluid therapy of choice for chronic (> 48 hrs) of hypernatremia?
5% dextrose in water
What is the fluid therapy of choice for emergent hyponatremia?
100ml bolus of hypertonic saline given over 10 to 15 minutes
What is the fluid therapy of choice for nonemergent hyponatremia?
Hypertonic saline (50ml bolus or slow continuous infusion)
What is the fluid therapy of choice for chronic severe hyponatremia?
Hypertonic saline as a slow infusion at 15 to 30ml/hour. 50ml bolus can be used
