Fluids Flashcards
What is found intracellular?
potassium
phosphate
protein
What is found extracellular
sodium
chloride
bicarb
What is the total body water vol distribution?
intracellular: 40%
extracellular: 60% = interstitial fluid 80% + plasma vol 20%)
What does normal saline have?
Na and Cl
What is the downside of normal and isotonic saline?
it can increase interstitial fluid vol but only SOME will stay in intravascaulr space
What is good about blood transfusion?
goes STRAIGHT into vascular space and STAYS there
How does colloid work?
leaks in interstitla space
What fluid should be use dot resusicate?
isontonic
NEVER dextrose/hypotonic
How to replace dec ECF?
saline
What should be used to increase vascular fluid?
blood
When should dextrose be used?
rehydrate
What are sx that BOTH hypo and hypervol have?
tachycardia
organ failure
What are sx for dec vol?
hypotension NO JVP YES turgor DRY mucosa LOW urine output
What are sx for inc vol?
HYPERtension YES JVP edema pleura effusion ascties INCR urine output
What is the fluid rule/formula?
4cc, 2cc, 1cc
4cc for 1st 10kg
2cc for next 10 kg
1cc for each kg after
How to rehydrate 70kg adult?
40cc + 20cc + 50cc = 110cc
What is hypokalemia? Life threatening? Tx?
less than 3.5
life threatening less than 2.5
tx: IV 20-30mml/h if sx
GI 20-40mml/h if no sx
What if pt has K >2.5 but less than 3.5?
GI 40-60mmol q 4-6h
Pt has peaked T waves?
hyperkalemia
Pt has short QT?
hypercalcemia
Pt has long QT?
hypocalcemia
How to tx hyperkalemia?
C-a for cardiac toxicity
B-ig: push K into cells to off balance; use insulin and glucose, sodium bicarbonate, inhaled B2 agonist
Di-alysis: remove K via loop diuretic, kayexalate, dialysis
What is considered hyponatremia?
less than 135
What are the types of hyponatremia?
euvolemia
hypovolemia
hypervolemia
What is cx if pt is euvolemia with urine output of Na >30 and urine osm is less than 100?
urine is dilute but high output of Na
cx: polydipsia, too much H20 in children
What is cx if pt is euvolemia with urine output of Na >30 and >100 urine osmolality?
urine is very concentrated - not much water is excreted but high concentration of na
cx: SIADH, hypothyroidism (water retention is sx), adrenal insufficiency (when you’re nervous, high cortisol = you pee! but in insufficiency, you lack cortisol = no pee, water retention)
What is cx if pt is hypovolemic with high urine osmolality but little urine Na output? What should be FENa?
vomiting, diarrhea, third space fluid loss
FENa less than 1
What is cx if pt is hypovolemic w/ high urine osmolality but with high Na output? What should be FENa?
kidney probs: diuretics, aldosterone def, renatl tubular dysfxn FENa bigger than 1
What is cx if pt is hypervolemic ? What should urine osmolality, urine Na and FENa?
CHF, cirrhosis, renal failure
urine osmolality: greater than 300
urine Na: less than 10-20
FENa less than 1
How to tx hypernatremia?
hypotonic fluid SLOWLY
How to tx hyperglycemia? What to check first before tx?
fluids: crystalloids + insulin; add glucose to fluids when 250-300 mg/dL
K levels; if less than 3.3 hold insulin and replace K
add K to fliuds if K is 3.3-5
Who should have normal saline?
hypernatremia and hemodynamic unstable
