Fluids + Electrolytes

Question 1

What is the intracellular fluid distribution?

Answer 1

2/3 (40% of wt)

Question 2

What is the extracellular fluid distribution?

Answer 2

1/3 (20% of wt)

Question 3

What percent of body weight in adults is made up of fluid?

Answer 3

60%

Question 4

What 3 organ systems regulate fluid balance?

Answer 4

Skin, lungs, kidneys

Question 5

What kind of fluid loss is measurable?

Answer 5

Sensible

Question 6

What kind of fluid loss is immeasurable?

Answer 6

Insensible

Question 7

What is the role of antidiuretic hormone (ADH)?

Answer 7

-Reduces diuresis
-Increases water retention

Question 8

What is the role of the Renin-Angiotensin Aldosterone System (RAAS)?

Answer 8

-Renin secretion
-Sodium/water regulation (aldosterone)

Question 9

What is the function of Atrial Natriuretic Peptide (ANP)?

Answer 9

-Decreases ADH release
-Counteracts effects of RAAS

Question 10

What is the range of an Isotonic tonicity?

Answer 10

275-290 mOsm/L

Question 11

What is the most common colloid?

Answer 11

Albumin

Question 12

Can colloids be used as maintenance fluids?

Answer 12

NO

Question 13

When would normal saline (0.9% NaCl) be used?

Answer 13

-Used for resuscitation
-NEVER USED AS A MAINTENANCE FLUID
-Intravascular fluid replacement
-Sodium or Chloride replacement
-Patient needs something that mimics plasma

Question 14

When would 1/2 NS (0.45% NaCl) be used?

Answer 14

-Used as a maintenance fluid
-Only used in combination products!

Question 15

When would lactated ringers be used?

Answer 15

-Replacement of blood loss
-Used for resuscitation
-Replicates blood, great for blood loss
-Replicates human plasma
-Maintains BP!
-Good for large volume replacement

Question 16

When would D5W (Dextrose 5%) be used?

Answer 16

-Free water replacement
-Not a resuscitative fluid!
-NEVER USED AS A MAINTENANCE FLUID BY ITSELF
-*No sodium or chloride

Question 17

How many mEq/L of Na+ and Cl- are in normal saline (0.9% NaCl)

Answer 17

154 mEq/L

Question 18

What are the three balanced salt solutions?

Answer 18

-Lactated ringers (LR)
-Normosol-R
-Plasma-lyte

Question 19

What is the role of colloid solutions?

Answer 19

Increase plasma oncotic pressure

-Volume expansion

-Move fluid from the interstitial compartment to the intravascular (plasma) compartment

Question 20

When a patient has low blood pressure and needs fluids, what is the protocol?

Answer 20

1) Give resuscitative crystalloid first (LR)
2) Then give a colloid (albumin)

Question 21

When should albumin be used?

Answer 21

-Used selectively for volume expansion
-Second-line for hypovolemic shock
-Hypoproteinemia

Question 22

Which form of albumin is typically given for fluid replacement?

Answer 22

Albumin 5%
(less albumin and more fluid)

Question 23

What is the most common MIVF?

Answer 23

D5W +1/2NS + 20 mEq KCl/L

Question 24

When monitoring fluid status, what do we look at?

Answer 24

-Daily weight
-Daily ins/outs
-Volume status
-Urine output (UOP)
-Vitals

Question 25

What is the most common electrolyte disturbane in hospitalized patients?

Answer 25

hyponatremia

Question 26

How does hypovolemia present clinically?

Answer 26

dehydration

Question 27

How does hypervolemia present clinically?

Answer 27

Fluid overload

Question 28

What is the maximum amount that sodium should rise both per hour and per day during treatment?

Answer 28

Avoid rise in serum sodium > 0.5 mEq/L/hr
and no more than 8-12 mEq/L/day

Question 29

What is the “Rule of 8’s” when replacing sodium levels?

Answer 29

Replace half the sodium deficit in 8 hours, then replace the remaining deficit within 8-16 hours

Question 30

What are the goals of therapy in severe hyperkalemia?

Answer 30

“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”