Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the purpose of giving a crystalloid IV?

A

reduce colloid osmotic pressure via hemodilution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the purpose of a colloid?

A

maintain or increase colloid osmotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Are crystalloids or colloids used more often? Why?

A
  • crystalloids preferred

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common dextrose crystalloid?

A

D5W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What components make up D5W?

A

5% dextrose and sterile water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the normal level of plasma osmolality?

A

290 (normal range 240-340)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A
  • men 60%

- women 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A
  • intra: 2/3

- extra: 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does volume depletion occur?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does volume depletion occur in GI system?

A

vomiting, diarrhea, bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does volume depletion occur in renal system?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does volume depletion occur in skin/respiratory system?

A

insensible losses, sweat, burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does volume depletion occur with third-space sequestration?

A

intestinal obstruction, crush injury, fracture, acute pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

What should patients with significant anemia, hemorrhage or third-spacing need?

A

-blood transfusion and colloid

26
Q

What is the solution of choice in normonatremia and mildly hyponatremia patients or initially in HoTN/shock patients?

A

-isotonic or normal (0.9%) saline

27
Q

What type of fluid should be used when extracellular fluid volume expansion is desired?

A

isotonic

28
Q

What might severe hyponatremia require?

A

hypertonic (3%) saline

29
Q

Replacement Therapy

A

-corrects any existing water and electrolyte deficits

30
Q

Maintenance Therapy

A

-replaces ongoing losses of water and electrolytes under normal physiologic conditions, via urine, sweat, respiration and stool

31
Q

What is the goal of fluid REPLACEMENT therapy?

A

-correct existing abnormalities in plasma electrolytes and volume status

32
Q

What type of fluid is given for replacement therapy?

A

-depends on type of fluid lost and any concurrent fluid or electrolyte disorders

33
Q

What might provide a reasonable estimate of fluid losses?

A

-weight loss if the pre and post-deficit body weights are known

34
Q

If weight loss is not known, how is volume depletion assessed?

A
  • with clinical and laboratory parameters

- eg BP, skin turgor, urine output, urine sodium excretion, osmolality

35
Q

At what rate must severe volume depletion or hypovolemic shock be given fluids?

A
  • 1-2 liters of NS given as rapidly as possible

- then continued at a rapid rate until clinical signs normalize

36
Q

At what rate should mild to moderate hypovolemia be given fluids?

A
  • optimal rate somewhat arbitrary

- 50-100 mL/hour in excess of continued losses

37
Q

What patients require caution with IV fluids and why?

A
  • 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
Q

What 4 components must be considered in maintenance IV therapy?

A
  1. water
  2. sodium
  3. potassium
  4. carbohydrates (minimize protein catabolism)
39
Q

What component will kill a patient first with IV therapy if a mistake is made in calculations?

A

potassium

40
Q

What are the water requirements for patients? (Holliday Segar Formula)

A
  • 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
Q

How much sodium and potassium are needed each day?

A
  • Sodium: 1-2 mEq/kg/day

- Potassium: 0.5-1 mEq/kg/day

42
Q

How much dextrose does the average adult need each day?

A

-for 70 kg man, 100-150 gm/day

-can try to do 50 times the L/day of H2O

43
Q

What does replacement of water losses from the skin and respiratory tract depend upon?

A

-resp rate, ambient temp, humidity, body temp

44
Q

How does a fever affect water loss and fluid replacement?

A

for each degree of body temp >37 C, water losses increase by 100-150 mL/day

45
Q

What should insensible losses be replaced by?

A

-5% dextrose or hypotonic saline

46
Q

Which GI losses have a greater than average K+ loss?

A
  • diarrheal #1

- also gastric and salivary

47
Q

What types of renal losses occur and why?

A
  • 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
Q

What are 3 common problems with IV fluids?

A
  • over or under HYDRATION
  • too much or not enough SODIUM
  • too much or not enough POTASSIUM
49
Q

How might underhydration occur with IV fluids?

A
  • wrong rate of fluid for body weight
  • not calculating for other losses
  • not calculating for pre-existing fluid deficits
50
Q

How might overhydration occur with IV fluids?

A
  • wrong rate of fluid for body weight
  • not taking into account pre-existing fluid overload
  • not considering renal dysfunction
51
Q

Why might a pt receive too much sodium with IV fluids?

A
  • using endless bags of normal saline in euvolemic patient

- not monitoring serum sodium for someone who has had many bags of IV fluid

52
Q

Why might a pt receive too little sodium with IV fluids?

A
  • 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
Q

Why might a pt receive too much potassium with IV fluids?

A
  • not monitoring potassium

- not considering renal dysfunction

54
Q

Why might a pt receive too little potassium with IV fluids?

A
  • forgetting to include potassium (esp post-op)

- not calculating for losses of K+ rich fluid (diarrhea, vomit)

55
Q

Monitoring of IV Therapy

A
  • 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions