Fluids-Paulson Flashcards
Water balance in the human body:
-depends on water intake and ___
water output
Ex’s of water intake
- Ingested water
- Water in food
- Water from oxidation
Ex’s of water output
- Urine
- Skin
- Respiratory tract
- Stool
Body water:
- intracellular: about ___
- extracellular and intravascular: about ____
- 2/3
- 1/3
Intravascular compartment is called the _____
“first space”
Intracellular compartment is called _______
“second space”
____ _____ is where fluid doesn’t usually but may accumulate (pleural cavity, peritoneal cavity, edema in extracellular space)
“Third space”
We put drugs into the first space via ___
IV –> and expect it to evenly distribute to the second space
**Not always speedy
List examples of conditions that can cause third spacing
In surgery, major trauma, burns, inflammation & reaction can cause major third spacing, where fluids/electrolytes/meds aren’t bioavailable
Maintenance Therapy=
replaces ongoing losses of water and electrolytes under normal physiologic conditions via urine, sweat, respiration, and stool
–Tachypnea, fever, diuretics all ↑ maintenance requirements
Replacement therapy:
-corrects any existing water and electrolyte deficits from:
GI Skin Urinary Bleeding Third-space sequestration
IV access is often used to:
Deliver fluids
Deliver medications
Draw blood
Surgical patients are often **hypovolemic (list Ex’s)
- NPO prior to surgery
- NPO post surgery–> GI tract inhibited
- Blood loss from surgery
- Third spacing in surgery
How to Calculate Maintenance (steps)
- Calculate body weight in kg
- Calculate fluid needed over 24 hours
- 100 ml/kg for first 10 kg
- 50 ml/kg for second 10 kg
- 20 mg/kg for each kg over 20 - Divide total ml over 24 hours for a ml/hr rate
Most physiologic replacement (in normal circumstances) is D5½NS + 20 mEq K/L
Maintenance Fluids- Hourly Rate
4/2/1 rule:
- 4 ml for kg 1-10
- 2 ml for kg 11-20
- 1 ml for each kg ≥21 kg
Dehydration: If the patients starts with a deficit, need to add more than maintenance
-Estimate deficit: Dry?
3% loss (5% if < 5 y/o)
Dehydration: If the patients starts with a deficit, need to add more than maintenance
-Estimate deficit: tachycardic?
6% loss (10%)
Dehydration: If the patients starts with a deficit, need to add more than maintenance
-Estimate deficit: shock?
9% loss (15%)
Dehydration:
-Ex: 50 kg woman who is dry
- Calculate real weight (weight + 3% deficit): 51.5 kg
- Calculate maintenance: 2190 ml/day
- Add deficit: 1.5 kg = 1.5 L
- Total IVF rate: 3690/24 hours = 154 ml/hr
Replacement of Losses:
-if you have HIGH output losses from a drain or NG tube, you can ____
measure and replace ml for ml
Replacement of Losses:
-NG tube losses have high ___ levels
Cl
Replacement of Losses:
-use _______ fluid type for type of loss
appropriate
Volume Overload can happen with too vigorous resuscitation OR with _____
mobilization of third space fluids
Sx of Volume Overload
May have jugular venous distention, lung crackles, edema, dyspnea
Volume Overload: tx
fluid restriction, diuretics, or lower the rate
