Fluids And Electrolytes

Question 1

Total body water (TBW)

Answer 1

Water main component
TBW divided into intracellular water (ICW) and Extracellular water (ECW)

Question 2

TBW decreases with advancing GA

Answer 2

First trimester - 90% of body weight
32 weeks - 80%
Term - 78%
5th month - term mostly extracellular
Age 1 - 60-65% (mostly intracellular)

Question 3

Osmolality

Answer 3

Water’s relative content of solutes (electrolytes and proteins)

Question 4

Main extracellular ion

Answer 4

Sodium
Regulated by kidney

Question 5

Main intracellular ion

Answer 5

Potassium, regulated by sodium potassium cellular pump

Question 6

Sodium

Answer 6

Major extracellular ion
Makes up 90% of total solutes in extracellular compartment
Premies dump sodium so need higher levels in bag

Question 7

Potassium

Answer 7

Major intracellular cation
Initiates and maintains muscular contraction in cardiac and skeletal muscle

3.5-5.5

Question 8

Chloride

Answer 8

Extracellular, works with sodium to maintain plasma volume (holds onto water)
Normal - 96-111
Low chloride and high bicarbonate - alkalosis
High chloride and low bicarbonate - acidosis

Question 9

Calcium

Answer 9

Most abundant mineral in human body
Important for muscle contraction, neural transmission, and blood coagulation

8.8-10.3

Question 10

Phosphorus

Answer 10

85% is in skeleton
Remaining is in soft tissues and extracellular fluid
Good for bone strength, erythrocyte function, cell metabolism, and generation and storage of energy

Milk fortification

Question 11

Magnesium

Answer 11

Energy production, cell membrane function, and protein synthesis

1.6-2.4

Question 12

Trace minerals

Answer 12

Zinc and copper

Question 13

Zinc

Answer 13

Accumulated mostly in 3rd trimester
Metabolism

Question 14

Copper

Answer 14

Adequate stores in liver for both preterm and term

Question 15

Weight loss week 1 of life

Answer 15

5-10% in term
10-20% in preterms

Question 16

Potassium in 1st DOL

Answer 16

Shifts from intracellular to extracellular, can rise
As renal excretion occurs will decrease

Question 17

Glucose in first DOL

Answer 17

Decreases 60-90 minutes after birth
Once they hit low, this trigger glucogenesis ( but premies don’t have glycogen stores)

Question 18

Calcium in first DOL

Answer 18

Abrupt stop in maternal supply, plasma will drop and reach nadir 24-48 hours after birth
PTH increases which mobilizes calcium from bone (if hypocalcemic, result of sluggish PTH response)

If lower albumin and acidosis occurs, can result in lower calcium in plasma

Question 19

Highest loss of fluid

Answer 19

Urine

Question 20

Body weight

Answer 20

1 gram of weight = 1 ml of fluid

Question 21

Normal UOP

Answer 21

2-4 ml/kg/hr

Question 22

Urine specific gravity

Answer 22

Normal is 1.008-1.012
Early indication of hydration status
If high - dehydrated and need fluid
If low - too much fluid and diluted

Used in premies because kidneys are immature and can’t concentrate tribe well

Question 23

Proteinuria

Answer 23

Sign of dehydration

Question 24

Hematuria

Answer 24

Renal vein thrombosis

Question 25

BUN

Answer 25

Blood urea nitrogen 7-20 High or rapid rise indicates some degree of renal failure

Question 26

Creatinine

Answer 26

0.8-1.4 More reliable than BUN Levels mimic mom at birth 0.2-0.5 per day increase indicates renal failure

Question 27

Fractional excretion of sodium (FENa)

Answer 27

Determines kidney damage vs volume issue

Question 28

Premie body fluid composition

Answer 28

85-90% water 1/3 intracellular 2/3 extracellular

Question 29

Insensible water loss

Answer 29

Due to increased permeability of skin 70% from skin 30% from respiratory tract Average loss 10-60 ml/kg/day

Question 30

Insensible water loss results in

Answer 30

Hypernatremia, dehydration, loss of heat

Question 31

Phototherapy and water loss

Answer 31

Can increase, should increase fluids if on photo

Question 32

Dehydration can result from

Answer 32

GI losses Acute blood loss Medications (caffeine)

Question 33

Low protein (albumin) can cause

Answer 33

Overhydration/edema/third spacing

Question 34

Over hydration puts baby at risk for

Answer 34

PDA IVH BPD

Question 35

If metabolic acidosis occurs…(K)

Answer 35

Potassium shifts from intracellular to extracellular Increases potassium

Question 36

If metabolic alkalosis occurs (K)…

Answer 36

K shifts from extracellular to intracellular, lower K

Question 37

DiGeorge (chromosomal deletion at 22)…electrolytes

Answer 37

Hypocalcemia due to atresia or hypoplasia of parathyroid gland Murmur due to cardiac issues Facial anomalies

Question 38

Phenytoin (seizures) and Lasix…

Answer 38

Reduces diuretic response to Lasix

Question 39

Too much fluid can cause…Na

Answer 39

Hyponatremia, high UOP

Question 40

EKG with hypoK

Answer 40

Flattened T waves

Question 41

EKG with hyperK

Answer 41

Peaked T waves

Question 42

NEC sign (Blood gas)

Answer 42

Persistent metabolic acidosis (lower ph and bicarbonate) NEC causes lactic acidosis secondary to necrotic bowel

Question 43

Diabetes insipid is

Answer 43

High Na and high UOP

Question 44

High Na and low UOP

Answer 44

Insufficient intake

Question 45

Calcitonin

Answer 45

Decreases calcium Perinatal asphyxia and stress can cause increase in this

Question 46

High K in preterms, first line treatment

Answer 46

Insulin glucose infusion Insulin causes K to enter cells Glucose is to avoid hypoglycemia associated with giving insulin

Question 47

Intestinal ileus associated with low…

Answer 47

K