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Fall 2014 - Pharm GI/ENT > GI IV Fluids > Flashcards

GI IV Fluids Flashcards

1
Q

What is a crystalloid?

A

based on a solution of sterile water with added electrolytes to approximate the mineral content of human plasma

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2
Q

What is the purpose of giving a crystalloid IV?

A

reduce colloid osmotic pressure via hemodilution

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3
Q

What is a colloid?

A
  • often based on crystalloid solutions, so contains water and electrolytes
  • also contain colloid substance that does not freely diffuse across semipermeable membranes (eg albumin, dextran)
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4
Q

What is the purpose of a colloid?

A

maintain or increase colloid osmotic pressure

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5
Q

Are crystalloids or colloids used more often? Why?

A
  • crystalloids preferred

- colloids are substantially more expensive and lack date showing their superiority

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6
Q

What is special about Lactated Ringers?

A
  • most closely mimics the electrolyte concentration of human plasma
  • also has a small amount of lactate included
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7
Q

What is the most common dextrose crystalloid?

A

D5W

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8
Q

What components make up D5W?

A

5% dextrose and sterile water

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9
Q

What is the normal level of plasma osmolality?

A

290 (normal range 240-340)

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10
Q

Water makes up what % of body weight in men and women?

A
  • men 60%

- women 50%

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11
Q

What is the breakdown of total body water intra vs extracellular?

A
  • intra: 2/3

- extra: 1/3

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12
Q

What is the normal obligatory fluid intake for adults in a day? What is the breakdown (where do they get their fluids)?

A
  • 2600 mL/day
  • ingested water 1400 mL
  • water in food 850 mL
  • water of oxidation 350 mL
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13
Q

What is the normal obligatory fluid output for adults in a day? What is the breakdown (where do they eliminate their fluids)?

A
  • about 2600 mL/day
  • urine 1500 mL
  • skin 500 mL
  • respiratory tract 400 mL
  • stool 200 mL
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14
Q

How does volume depletion occur?

A

Na+ and/or water loss from different sites (GI, renal, skin/resp, third space)

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15
Q

How does volume depletion occur in GI system?

A

vomiting, diarrhea, bleeding

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16
Q

How does volume depletion occur in renal system?

A

effects of diuretics, osmotic diuresis, salt wasting nephropathies, hypoaldosteronism

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17
Q

How does volume depletion occur in skin/respiratory system?

A

insensible losses, sweat, burns

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18
Q

How does volume depletion occur with third-space sequestration?

A

intestinal obstruction, crush injury, fracture, acute pancreatitis

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19
Q

How does volume depletion manifest clinically (signs and sxs)?

A
  • primarily related to decreased tissue perfusion
  • early S/S: lassitude (exhaustion, weariness), easy fatiguability, thirst, muscle cramps, postural dizziness
  • more severe fluid loss: abdominal or chest pain, lethargy, confusion
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20
Q

How can one tell clinically that interstitial volume is decreased?

A
  • examine skin and mucous membranes
  • skin tenting, dry or clammy skin, dry buccal mucosa
  • parched or cracked lips, deep set or sunken eyes
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21
Q

How can one tell clinically that plasma volume is decreased?

A
  • reductions in BP and venous pressure in jugular veins

- tachycardia, cap refill >2-3 seconds

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22
Q

What can happen clinically due to electrolyte and acid-base imbalances that happen with volume depletion?

A
  • muscle weakness to due hyperkalemia/hypokalemia
  • polyuria and polydipsia due to hyperglycemia or severe hypokalemia
  • lethargy, confusion, seizures, and coma due to hyponatremia, hypernatremia or hyperglycemia
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23
Q

What are the 3 goals of dehydration treatment?

A
  1. identify and correct underlying cause of hypovolemia
  2. restore euvolemia with fluid similar in composition to what was lost
  3. replace ongoing losses
24
Q

How is mild dehydration treated vs severe dehydration?

A
  • mild: usually via oral

- severe: usually requires IV

25
What should patients with significant anemia, hemorrhage or third-spacing need?
-blood transfusion and colloid
26
What is the solution of choice in normonatremia and mildly hyponatremia patients or initially in HoTN/shock patients?
-isotonic or normal (0.9%) saline
27
What type of fluid should be used when extracellular fluid volume expansion is desired?
isotonic
28
What might severe hyponatremia require?
hypertonic (3%) saline
29
Replacement Therapy
-corrects any existing water and electrolyte deficits
30
Maintenance Therapy
-replaces ongoing losses of water and electrolytes under normal physiologic conditions, via urine, sweat, respiration and stool
31
What is the goal of fluid REPLACEMENT therapy?
-correct existing abnormalities in plasma electrolytes and volume status
32
What type of fluid is given for replacement therapy?
-depends on type of fluid lost and any concurrent fluid or electrolyte disorders
33
What might provide a reasonable estimate of fluid losses?
-weight loss if the pre and post-deficit body weights are known
34
If weight loss is not known, how is volume depletion assessed?
- with clinical and laboratory parameters | - eg BP, skin turgor, urine output, urine sodium excretion, osmolality
35
At what rate must severe volume depletion or hypovolemic shock be given fluids?
- 1-2 liters of NS given as rapidly as possible | - then continued at a rapid rate until clinical signs normalize
36
At what rate should mild to moderate hypovolemia be given fluids?
- optimal rate somewhat arbitrary | - 50-100 mL/hour in excess of continued losses
37
What patients require caution with IV fluids and why?
- hypo/hypernatremia: overly rapid correction of Na_ can lead to irreversible neurologic damage - pts at risk of fluid overload: renal/cardiac/hepatic failure, older adults
38
What 4 components must be considered in maintenance IV therapy?
1. water 2. sodium 3. potassium 4. carbohydrates (minimize protein catabolism)
39
What component will kill a patient first with IV therapy if a mistake is made in calculations?
potassium
40
What are the water requirements for patients? (Holliday Segar Formula)
- pt weight in kilos plus 40 mL/hour | - OR 60 mL/hr + 1 mL/kg/hr for any increment of weight over 20kg (max of 120 mL/hr)
41
How much sodium and potassium are needed each day?
- Sodium: 1-2 mEq/kg/day | - Potassium: 0.5-1 mEq/kg/day
42
How much dextrose does the average adult need each day?
-for 70 kg man, 100-150 gm/day | -can try to do 50 times the L/day of H2O
43
What does replacement of water losses from the skin and respiratory tract depend upon?
-resp rate, ambient temp, humidity, body temp
44
How does a fever affect water loss and fluid replacement?
for each degree of body temp >37 C, water losses increase by 100-150 mL/day
45
What should insensible losses be replaced by?
-5% dextrose or hypotonic saline
46
Which GI losses have a greater than average K+ loss?
- diarrheal #1 | - also gastric and salivary
47
What types of renal losses occur and why?
- sodium: diuretic use, recovery phase of ATN, post-obstructive diuresis, interstitial renal dz, mineralocorticoid deficiency - potassium: recovery phase of ATN, renal tubular acidosis, diuretic use, catabolic states, hyperaldosteronism
48
What are 3 common problems with IV fluids?
- over or under HYDRATION - too much or not enough SODIUM - too much or not enough POTASSIUM
49
How might underhydration occur with IV fluids?
- wrong rate of fluid for body weight - not calculating for other losses - not calculating for pre-existing fluid deficits
50
How might overhydration occur with IV fluids?
- wrong rate of fluid for body weight - not taking into account pre-existing fluid overload - not considering renal dysfunction
51
Why might a pt receive too much sodium with IV fluids?
- using endless bags of normal saline in euvolemic patient | - not monitoring serum sodium for someone who has had many bags of IV fluid
52
Why might a pt receive too little sodium with IV fluids?
- using hypotonic fluids in pts who are very ill or for prolonged periods - not monitoring serum sodium for someone who has had many bags of IV fluid
53
Why might a pt receive too much potassium with IV fluids?
- not monitoring potassium | - not considering renal dysfunction
54
Why might a pt receive too little potassium with IV fluids?
- forgetting to include potassium (esp post-op) | - not calculating for losses of K+ rich fluid (diarrhea, vomit)
55
Monitoring of IV Therapy
- vitals signs - clinical appearance: volume excess (edema) or volume depletion (decreased turgor and BP) - daily weight - urine output and specific gravity - serum electrolytes (for inpatient, 1x/day)

Fall 2014 - Pharm GI/ENT (14 decks)

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