Fluids

Question 1

What is found intracellular?

Answer 1

potassium
phosphate
protein

Question 2

What is found extracellular

Answer 2

sodium
chloride
bicarb

Question 3

What is the total body water vol distribution?

Answer 3

intracellular: 40%
extracellular: 60% = interstitial fluid 80% + plasma vol 20%)

Question 4

What does normal saline have?

Answer 4

Na and Cl

Question 5

What is the downside of normal and isotonic saline?

Answer 5

it can increase interstitial fluid vol but only SOME will stay in intravascaulr space

Question 6

What is good about blood transfusion?

Answer 6

goes STRAIGHT into vascular space and STAYS there

Question 7

How does colloid work?

Answer 7

leaks in interstitla space

Question 8

What fluid should be use dot resusicate?

Answer 8

isontonic

NEVER dextrose/hypotonic

Question 9

How to replace dec ECF?

Answer 9

saline

Question 10

What should be used to increase vascular fluid?

Answer 10

blood

Question 11

When should dextrose be used?

Answer 11

rehydrate

Question 12

What are sx that BOTH hypo and hypervol have?

Answer 12

tachycardia

organ failure

Question 13

What are sx for dec vol?

Answer 13

hypotension
NO JVP
YES turgor
DRY mucosa
LOW urine output

Question 14

What are sx for inc vol?

Answer 14

HYPERtension
YES JVP
edema
pleura effusion
ascties
INCR urine output

Question 15

What is the fluid rule/formula?

Answer 15

4cc, 2cc, 1cc
4cc for 1st 10kg
2cc for next 10 kg
1cc for each kg after

Question 16

How to rehydrate 70kg adult?

Answer 16

40cc + 20cc + 50cc = 110cc

Question 17

What is hypokalemia? Life threatening? Tx?

Answer 17

less than 3.5
life threatening less than 2.5
tx: IV 20-30mml/h if sx
GI 20-40mml/h if no sx

Question 18

What if pt has K >2.5 but less than 3.5?

Answer 18

GI 40-60mmol q 4-6h

Question 19

Pt has peaked T waves?

Answer 19

hyperkalemia

Question 20

Pt has short QT?

Answer 20

hypercalcemia

Question 21

Pt has long QT?

Answer 21

hypocalcemia

Question 22

How to tx hyperkalemia?

Answer 22

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

Question 23

What is considered hyponatremia?

Answer 23

less than 135

Question 24

What are the types of hyponatremia?

Answer 24

euvolemia
hypovolemia
hypervolemia

Question 25

What is cx if pt is euvolemia with urine output of Na >30 and urine osm is less than 100?

Answer 25

urine is dilute but high output of Na

cx: polydipsia, too much H20 in children

Question 26

What is cx if pt is euvolemia with urine output of Na >30 and >100 urine osmolality?

Answer 26

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)

Question 27

What is cx if pt is hypovolemic with high urine osmolality but little urine Na output? What should be FENa?

Answer 27

vomiting, diarrhea, third space fluid loss

FENa less than 1

Question 28

What is cx if pt is hypovolemic w/ high urine osmolality but with high Na output? What should be FENa?

Answer 28

kidney probs: diuretics, aldosterone def, renatl tubular dysfxn FENa bigger than 1

Question 29

What is cx if pt is hypervolemic ? What should urine osmolality, urine Na and FENa?

Answer 29

CHF, cirrhosis, renal failure
urine osmolality: greater than 300
urine Na: less than 10-20
FENa less than 1

Question 30

How to tx hypernatremia?

Answer 30

hypotonic fluid SLOWLY

Question 31

How to tx hyperglycemia? What to check first before tx?

Answer 31

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

Question 32

Who should have normal saline?

Answer 32

hypernatremia and hemodynamic unstable