Fluids Flashcards
Total body water %
60% of the adult human body is water
3 main compartments
- Intracellular (ICF) 67%
- Interstitial fluid (ISF) 25%
- Plasma volume (PV) 8%
Bulk pressure
Balance of 2 main pressures
- Hydrostatic pressure (blood pressure)
- Colloid osmotic pressure due to plasma proteins
Crystalloids
Contains
- Electrolytes (Na, K, Cl)
- Small molecules (glucose, lactate)
- Does NOT contain proteins/large molecules
Used to:
- Treat dehydration
- Used as a replacement/maintenance fluids
- Expand plasma volume (3% NaCl)
- Mangae specific fluid and electrolyte
Saline - Normal, Hypotonic and Hypertonic
Normal saline 0.9% NaCl (154mmol). Osmolarity is 300 mOsm/L Normal saline = isotonic solution
- The only fluid used with administration of blood cell products
Hypotonic/half normal saline 0.45% NaCl
Hypertonic saline 3%
Lactated ringer has 130 Na, 109 Cl, and 4 K
D5W, Plasmalyte
Crystalloids - Indications
Acute liver failure Acute nephrosis Burns Hypovolemic shock Renal dialysis Many other conditions
Crystalloids - Adverse Effects
Edema - peripheral or pulmonary (fluid overload)
May dilute plasma prtoeins
Effects may be short-lived
Many other effects
Colloids - Function
- Increase colloid osmotic pressure
- Move fluid from interstitial compartment to plasma compartment
- “Plasma volume expanders” to restore BP
- Dextran 40 or 70 (big glucose polymers), draws water into blood vessels
- Hetastarch and hydroxyethyl startch (HES) are synthetic and derived from cornstarch
- Modified gelatin
- 5% or 25% albumin (from human donors)
Colloids - Indication
Fluid resuscitation due to
- Trauma
- Burns
- Sepsis
- Hypovolemic shock
Colloids vs. Crystolloids
- Colloids are more expensive, harder to use
- Maybe combination would be best
- No answer to which one is better, depends on the situation
Colloids - Indication
Superior to crystalloids in PV expansion
- But more expensive
Colloids - Adverse effects
Usually safe, but concerns in renal failure
Disadvantages
- may cause altered coagulation - excess bleeding
- no oxygen-carrying capacity
Blood Products
Most expensive and least available fluid because they require human donors
Increased COP and PV
- Pull fluid from interstitial space into vessels
- Plasma expanders
RBC products carry oxygen
- Increase supply of various products eg clotting factors
Blood Products - Indications
Cryoprecipitate and plasma protein factors (PPF)
- Management of acute bleeding (>50% slow blood loss or 20% acutely)
Fresh frozen plasma ( FFP)
- Increase clotting factor levels in clients with demonstrated deficiency = coagulation disorder
Pack RBC’s and whole blood
- To increase oxygen-carrying capacity
- Anemia
- Substantial hemoglobin deficits
- Blood loss >25% of total blood volume
Blood Products - Adverse effects
Transfusion reactions
- Blood type and cross-match
Transmission of pathogen to recipient (hepatitis, HIV)
Client Care
- Administer colloids slowly
- Monitor for fluid overload and possible heart failure
- For blood products, follow administration procedures closely
- Monitor closely for signs of transfusion reactions
