Fluids-Paulson Flashcards

1
Q

Water balance in the human body:

-depends on water intake and ___

A

water output

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2
Q

Ex’s of water intake

A
  • Ingested water
  • Water in food
  • Water from oxidation
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3
Q

Ex’s of water output

A
  • Urine
  • Skin
  • Respiratory tract
  • Stool
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4
Q

Body water:

  • intracellular: about ___
  • extracellular and intravascular: about ____
A
  • 2/3

- 1/3

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5
Q

Intravascular compartment is called the _____

A

“first space”

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6
Q

Intracellular compartment is called _______

A

“second space”

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7
Q

____ _____ is where fluid doesn’t usually but may accumulate (pleural cavity, peritoneal cavity, edema in extracellular space)

A

“Third space”

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8
Q

We put drugs into the first space via ___

A

IV –> and expect it to evenly distribute to the second space
**Not always speedy

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9
Q

List examples of conditions that can cause third spacing

A

In surgery, major trauma, burns, inflammation & reaction can cause major third spacing, where fluids/electrolytes/meds aren’t bioavailable

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10
Q

Maintenance Therapy=

A

replaces ongoing losses of water and electrolytes under normal physiologic conditions via urine, sweat, respiration, and stool
–Tachypnea, fever, diuretics all ↑ maintenance requirements

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11
Q

Replacement therapy:

-corrects any existing water and electrolyte deficits from:

A
GI
Skin
Urinary
Bleeding
Third-space sequestration
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12
Q

IV access is often used to:

A

Deliver fluids
Deliver medications
Draw blood

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13
Q

Surgical patients are often **hypovolemic (list Ex’s)

A
  • NPO prior to surgery
  • NPO post surgery–> GI tract inhibited
  • Blood loss from surgery
  • Third spacing in surgery
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14
Q

How to Calculate Maintenance (steps)

A
  1. Calculate body weight in kg
  2. 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
  3. Divide total ml over 24 hours for a ml/hr rate

Most physiologic replacement (in normal circumstances) is D5½NS + 20 mEq K/L

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15
Q

Maintenance Fluids- Hourly Rate

A

4/2/1 rule:

  • 4 ml for kg 1-10
  • 2 ml for kg 11-20
  • 1 ml for each kg ≥21 kg
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16
Q

Dehydration: If the patients starts with a deficit, need to add more than maintenance
-Estimate deficit: Dry?

A

3% loss (5% if < 5 y/o)

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17
Q

Dehydration: If the patients starts with a deficit, need to add more than maintenance
-Estimate deficit: tachycardic?

A

6% loss (10%)

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18
Q

Dehydration: If the patients starts with a deficit, need to add more than maintenance
-Estimate deficit: shock?

A

9% loss (15%)

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19
Q

Dehydration:

-Ex: 50 kg woman who is dry

A
  • 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
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20
Q

Replacement of Losses:

-if you have HIGH output losses from a drain or NG tube, you can ____

A

measure and replace ml for ml

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21
Q

Replacement of Losses:

-NG tube losses have high ___ levels

A

Cl

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22
Q

Replacement of Losses:

-use _______ fluid type for type of loss

A

appropriate

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23
Q

Volume Overload can happen with too vigorous resuscitation OR with _____

A

mobilization of third space fluids

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24
Q

Sx of Volume Overload

A

May have jugular venous distention, lung crackles, edema, dyspnea

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25
Volume Overload: tx
fluid restriction, diuretics, or lower the rate
26
Ex: 70 kg Pt | -Calculate maintenance fluids hourly rate
70 kg Pt 4 x 10= 40 mL 2x 10= 20 mL 1x 50= 50 Total= 110 cc(mL) per hour
27
Ex: dehydration | -calculate maintenance for a 50 kg woman who is dry
-Take 3% of her normal body weight and add that into her body weight 3% of 50= 1.5--> 50 + 1.5= 51.5 kg - 1L= 1kg - She has 3% deficit--> so she is down by 1.5 L - -add maintence to the deficit= total of 3690 over the course of a day/24= 154 mL/hr
28
Colloids: | Solute= large proteins like albumin or other molecules that remain ________
intravascular
29
Solute: fx?
draw water from the cells to intravascular space--> can significantly ↑ intravascular volume but also dehydrate cells
30
The use of colloids is _______
* *limited - Expensive - Specific storage requirements - Short shelf life
31
Which Pt group should receive colloids?
Pt just recently had a large volume paracentesis (lots of albumin was removed), or a Pt with hemorrhagic shock (prior to blood arriving for transfusion), OR burn Pt Risks: dehydration of cells, and overload of protein (ppl w renal failure/dz cant handle large protein loads, same w/ liver impairment
32
Crystalloids: | -contain?
electrolytes (sodium, potassium, calcium, chloride) as the solutes
33
Crystalloids are classified according to ______
tonicity (=concentration of electrolytes)
34
Compared to the body plasma, isotonic solution contains_____
the same amount of electrolytes as normal plasma
35
Compared to the body plasma, Hypertonic solution contains _____
more electrolytes than body plasma
36
Compared to the body plasma, Hypotonic solution contains _____
less electrolytes than body plasma
37
3% normal saline=
has 3% more electrolytes than normal saline
38
Lactated Ringer’s (LR)= isotonic crystalloid that has _____
sodium chloride, potassium chloride, calcium chloride, and sodium lactate in sterile water
39
What is Lactated Ringer's (LR) designed for?
Designed as a ml for ml replacement for blood lost from trauma, surgery, burns
40
Lactate is converted to _______ in the liver
bicarbonate -->often used for this property **Counteracts acidosis (this is why Lactated Ringer's is used)
41
When is Lactated Ringer's preferred?
Often preferred if large volumes are needed for fluid resuscitation
42
Normal Saline (NS)= an isotonic crystalloid that contains ___% sodium chloride in sterile water
0.9% | normal saline= sodium and chloride
43
Normal Saline (NS) approximates _____
plasma
44
When can NS cause problems?
LARGE volumes cause problems --> hyperchloremic metabolic acidosis
45
NS is also used to ____
flush wounds
46
What is NS administered with?
**blood products
47
½ NS=
- **0.45% NaCl in water | - Hypotonic
48
When in ½ NS helpful?
Helpful in hypernatremic patients who do not need extra glucose (ie: diabetics)
49
D5W=
aka 5% Dextrose in Water | -Hypotonic
50
D5W is isotonic in the bag, but glucose metabolized almost immediately leaving _____
free water (**once metabolized it’s hypotonic)
51
Clinical uses for D5W
Helpful for rehydrating those who are hypernatremic
52
Which Pt population should NOT receive D5W?
Dextrose solutions NOT for uncontrolled diabetics or those who are hypokalemic (explanation: glucose (ie dextrose) will cause insulin to be released--> insulin brings potassium into cells--> and the Pt will become MORE hypokalemic)
53
D5W provides ___ calories/L
170-200
54
D5½NS: | -helpful for ?
- Helpful for daily maintenance of body fluids, for rehydration (hypotonic solution) - **Most common postoperative fluid
55
D5NS= - what kind of solution? - Replaces ____
- Hypertonic | - Replaces fluid, sodium, chloride
56
For Pts who have been administered D5NS, what should you watch out for?
**Watch for volume overload
57
3% Saline: | -what kind of solution?
hypertonic
58
3% saline: | -Used cautiously in those with _____
* *severe hyponatremia | - Remember, hyponatremia is often from an excess of fluid
59
3% saline: - typically give ___-___ ml bolus - how much does it raise the serum Na by?
50-100 ml bolus of 3% saline (raises serum Na by 2-3 mEq) | --May repeat 1-2 times
60
May add a slow IV infusion of 3% saline at ___ ml/hour
15-30 ml/hour | -Remember parameters for raising serum sodium
61
Rate of infusion: | -depends on many factors (list 3)
- Severity of volume depletion - Condition of the patient - Other diseases (ie: CHF)
62
How to determine if you were successful? (w/ fluid administration) hint: urine output=
- Urine output--> **Ideally want 30-50 ml/hr - BP, HR normalizing - Mental status - Capillary refill (1-2 seconds) - NEED TO FREQUENTLY MONITOR THE PATIENT AND ADJUST ACCORDINGLY
63
How can a provider monitor the Pt and adjust fluids accordingly? (3 things)
- Physically look at them - Frequent lab monitoring - Vitals