Fluids + Electrolytes Flashcards
What is the intracellular fluid distribution?
2/3 (40% of wt)
What is the extracellular fluid distribution?
1/3 (20% of wt)
What percent of body weight in adults is made up of fluid?
60%
What 3 organ systems regulate fluid balance?
Skin, lungs, kidneys
What kind of fluid loss is measurable?
Sensible
What kind of fluid loss is immeasurable?
Insensible
What is the role of antidiuretic hormone (ADH)?
-Reduces diuresis
-Increases water retention
What is the role of the Renin-Angiotensin Aldosterone System (RAAS)?
-Renin secretion
-Sodium/water regulation (aldosterone)
What is the function of Atrial Natriuretic Peptide (ANP)?
-Decreases ADH release
-Counteracts effects of RAAS
What is the range of an Isotonic tonicity?
275-290 mOsm/L
What is the most common colloid?
Albumin
Can colloids be used as maintenance fluids?
NO
When would normal saline (0.9% NaCl) be used?
-Used for resuscitation
-NEVER USED AS A MAINTENANCE FLUID
-Intravascular fluid replacement
-Sodium or Chloride replacement
-Patient needs something that mimics plasma
When would 1/2 NS (0.45% NaCl) be used?
-Used as a maintenance fluid
-Only used in combination products!
When would lactated ringers be used?
-Replacement of blood loss
-Used for resuscitation
-Replicates blood, great for blood loss
-Replicates human plasma
-Maintains BP!
-Good for large volume replacement
When would D5W (Dextrose 5%) be used?
-Free water replacement
-Not a resuscitative fluid!
-NEVER USED AS A MAINTENANCE FLUID BY ITSELF
-*No sodium or chloride
How many mEq/L of Na+ and Cl- are in normal saline (0.9% NaCl)
154 mEq/L
What are the three balanced salt solutions?
-Lactated ringers (LR)
-Normosol-R
-Plasma-lyte
What is the role of colloid solutions?
Increase plasma oncotic pressure
-Volume expansion
-Move fluid from the interstitial compartment to the intravascular (plasma) compartment
When a patient has low blood pressure and needs fluids, what is the protocol?
1) Give resuscitative crystalloid first (LR)
2) Then give a colloid (albumin)
When should albumin be used?
-Used selectively for volume expansion
-Second-line for hypovolemic shock
-Hypoproteinemia
Which form of albumin is typically given for fluid replacement?
Albumin 5%
(less albumin and more fluid)
What is the most common MIVF?
D5W +1/2NS + 20 mEq KCl/L
When monitoring fluid status, what do we look at?
-Daily weight
-Daily ins/outs
-Volume status
-Urine output (UOP)
-Vitals
What is the most common electrolyte disturbane in hospitalized patients?
hyponatremia
How does hypovolemia present clinically?
dehydration
How does hypervolemia present clinically?
Fluid overload
What is the maximum amount that sodium should rise both per hour and per day during treatment?
Avoid rise in serum sodium > 0.5 mEq/L/hr
and no more than 8-12 mEq/L/day
What is the “Rule of 8’s” when replacing sodium levels?
Replace half the sodium deficit in 8 hours, then replace the remaining deficit within 8-16 hours
What are the goals of therapy in severe hyperkalemia?
“C A BIG K DROP”
1) Antagonize the membrane actions
“Calcium”
2) Decrease extracellular K+ concentrations
“Albuterol, Bicarb, Insulin, Glucose”
3) Remove K+ from the body
“Kayexalate/Lokelma, Diuretics, Renal unit for dialysis Of Patient”
