Fluids - Paulson Flashcards
Body water is _/3 intracellular, and _/3 extracellular & intravascular.
2/3 intracellular 1/3 extracellular and intravascular.
Intravascular compartment is called the _____ space
intravascular = first space.
Intracellular compartment is called the ____ space
Second space
The pleural cavity, periotneal cavity, and extracellular space is called?
The third space - where fluid doesn’t usually but may accumulate.
People put drugs into the _____ space by IV, and expect it to evenly distribute to the _______ space
We put drugs in the first space and expect it to distribute to the second space. - Not always fast.
In surgery, major trauma, burns, inflammation & reaction can cause major ______ spacing.
Third spacing - fluids/meds/electrolytes aren’t bioavailable.
What kind of therapy replaces ongoing losses of water and electrolytes under normal psysiologic conditions via urine, sweat, respiration, and stool?
Maintenance therapy
Tachypnea, fever, diuretics all increase maintenance requirements.
What therapy corrects any existing water or electrolyte deficits from GI, skin, urinary, bleeding, or third spacing?
Replacement therapy.
For maintenance replacement the first 10kg requires how much ml/kg? Second 10kg? Each Kg over 20?
First 10 = 100 ml/kg
Second 10 kg = 50ml/kg
Every kg over 20 = 20mg/kg
For 70 kg patient
10x 100 = 1000 +
50 x 10 = 500 +
50 x 20 = 1000
2500 in total over 24 hours. 2500/24 = 104 mL/hr
4/2/1 rule for maintenance fluids?
4 ml for kg 1-10
2 ml for kg 11-20
1 ml for each kg >21 kg.
70 kg
10 x 4 = 40
10 x 2 = 20
50 x 1 = 50
50+40+20 = 110 cc/hr
If you had to estimate when someone becomes dry what would their fluid loss be?
3%
People become tachycardic what % loss
6%
An NG tube losses have high levels of what?
Cl
What fluid contains large proteins like albumin or other molecules that remain intravascular. They draw water from cells to the intravascular space and can signfiicantly increase volume but also dehydrate cells?
Colloids
Used after hemorrhage, shock, ascites drainage.
What solution contains electrolytes (sodium, potassium, calcium, chloride) as the solutes? These are then classified by tonicity
Crystalloids.
What is a isotonic crystalloid that has sodium chloride, potassium chloride, calcium chloride, and sodium lactate in sterile water?
Lactated ringers.
Lactate is converted into bicarbonate in the liver. What fluid contains lactate and is used for renal failure and sepsis for this property?
Lactated ringers.
What is an isotonic crystalloid that contains 0.9% sodium chloride in sterile water?
Normal saline
Hypercholeremic metabolic acidosis can be caused if given too much of what fluid?
Normal saline.
In hypernatremic patients what kind of fluid could you give them if they do not need extra glucose?
1/2 NS
What kind of fluids could you give your patient with hypernatremia and contains glucose?
D5W (5% dextrose in water)
When should you not use D5W or dextrose solutions?
In uncontrolled diabetics, or those who are hypokalemic
What kind of fluid is helpful for daily maintenance of body fluids or rehydration and is the MOST COMMON posteroperative fluid?
D5 1/2NS
What is a hypertonic fluid that replaces fluid, sodium, and chloride but you need to be careful for volume overload?
D5NS
What is a hypertonic solution that can be used to treat hyponatremia but needs to be used with caution?
3% saline
Hyponatremia is usualyl caused by excess of fluid so be cautious while using.
What urine output are you aiming for when treating with fluids?
30-50 ml/hr of urine.
