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Residency Exam > Introduction to Fluid and Electrolytes (Panopto Video Linkl) > Flashcards

Introduction to Fluid and Electrolytes (Panopto Video Linkl) Flashcards

1
Q

Describe the potential severity of fluid/electrolyte disturbances

A

They may be catastrophic if not treated

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2
Q

Describe the treatability of fluid/electrolyte disorders

A

The majority of these disorders can be easily treated

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3
Q

What percentage of the adult male body is water?

A

60%

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4
Q

What percentage of the adult female body is water?

A

50%

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5
Q

What percentage of an 80 year-old’s total body weight is water?

A

45 to 55%

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6
Q

What percentage of a newborn infant’s total body weight is water?

A

80%

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7
Q

What is total body water composition determined by?

A

Protein and adipose tissue concentration

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8
Q

Why do males typically have a greater total body water composition?

A

As they tend to have a greater proportion of muscle mass

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9
Q

What is the relationship between adipose tissue and total body water composition?

A

As the percentage of body fat increases, the total body water percentage decreases

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10
Q

Why are babies more prone to dehydration than other age groups?

A

As they have a greater extracellular water composition

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11
Q

What is the average amount of total body water in a 70 kg male?

A

42 L

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12
Q

What is the distribution of body water in an adult male?

A

Two-thirds of the water is intracellular and one-third is extracellular

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13
Q

The average 70 kg male has an extracellular water volume of 14 L. How much of this is interstitial and how much is in the plasma?

A

10.5 L is in the interstitial fluid, and 3.5 L is in the plasma

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14
Q

What percentage of total body water is in the interstitial fluid?

A

25%

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15
Q

What percentage of total body water is in the plasma?

A

8%

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16
Q

Describe starling equilibrium

A

The distribution of fluid between intravascular and interstitial space is determined by the balance between hydrostatic pressure of the blood and osmotic pressure from plasma proteins

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17
Q

Describe the hydrostatic pressure at the arterial end of a capillary

A

Arterial ends of capillaries have high hydrostatic pressure

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18
Q

What is the result of arterial ends of capillaries having high hydrostatic pressure?

A

The net filtration pressure pushes fluid out

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19
Q

Describe the hydrostatic pressure at the venous end of a capillary

A

Venous ends of capillaries have low hydrostatic pressure

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20
Q

What is the result of venous ends of capillaries having low hydrostatic pressure?

A

The net filtration pressure draws fluid in

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21
Q

What is the major determinant of colloidal osmotic pressure?

A

Albumin

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22
Q

What does the term “third-space shifting” refer to?

A

Fluid which has not been lost from the body but isn’t available for use intracellularly or extracellularly

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23
Q

What are 6 causes of third-space shifting?

A
  1. Burns
  2. Peritonitis
  3. Massive bleeding into joints or cavities
  4. Liver or renal failure
  5. Lowered plasma proteins
  6. Increased capillary permeability
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24
Q

What does the term osmolality refer to?

A

The number of osmotically active particles per kilogram of water

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25
Q

What does the term osmolarity refer to?

A

The number of osmotically active particles per litre of water

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26
Q

How is osmolarity calculated?

A

1.86 (Na + K) + Glucose + Urea + 10

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27
Q

What is calculated osmolarity approximately equal to?

A

Twice the sodium

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28
Q

What is the relationship between intracellular and extracellular osmolarity?

A

Intracellular osmolarity = extracellular osmolarity

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29
Q

Why must intracellular osmolarity be equal to extracellular osmolarity?

A

Otherwise cells would lyse due to fluid overload, or shrivel due to dehydration

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30
Q

What is the most prominent extracellular cation?

A

Sodium

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31
Q

What is the prominent extracellular cation?

A

Chloride

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32
Q

What are the 2 predominantly intracellular anions?

A

Phosphate and sulfate

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33
Q

What are the 3 predominant extracellular particles?

A

Sodium, chloride and bicarbonate

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34
Q

What are the 2 predominant intracellular particles?

A

Potassium and organic phosphate esters

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35
Q

What are 3 sources of water intake?

A
  1. Oral fluids
  2. Food
  3. Metabolic oxidation
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36
Q

What is the average daily water intake for an adult?

A

2500 mL

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37
Q

What is the average daily water intake from oral fluids for an adult?

A

1400 mL

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38
Q

What is the average daily water intake from food for an adult?

A

700 mL

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39
Q

What is the average daily water intake from metabolic oxidation for an adult?

A

400 mL

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40
Q

What are 4 examples of fluid output from the body?

A
  1. Urine
  2. Lung
  3. Skin
  4. Faeces
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41
Q

What are three examples of insensible fluid loss from the body?

A
  1. Lung
  2. Skin
  3. Faeces
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42
Q

What is the average daily fluid loss for an adult?

A

2500 mL

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43
Q

What is the average daily fluid loss in the urine for an adult?

A

1500 mL

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44
Q

What is the average daily insensible fluid loss from the lungs for an adult?

A

400 mL

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45
Q

What is the average daily insensible fluid loss from the skin for an adult?

A

400 mL

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46
Q

What is the average daily insensible fluid loss from faeces for an adult?

A

200 mL

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47
Q

What does “insensible” fluid loss refer to?

A

Fluid loss which cannot be measured

48
Q

What is intravascular depletion?

A

Loss of fluid from the plasma

49
Q

How does intravascular depletion manifest clinically?

A

As signs of decreased tissue perfusion

50
Q

Describe the time to onset of intravascular depletion

A

It can occur rapidly

51
Q

CNS signs of intravascular depletion include lightheadedness and what two others?

A

Dizziness
Faintness

52
Q

What are 2 signs of intravascular depletion related to the cardiovascular system?

A
  1. Blood pressure changes (such as orthostasis)
  2. Tachycardia
53
Q

What is orthostasis?

A

Orthostatic hypotension

54
Q

What are 2 signs of intravascular depletion related to the decrease?

A
  1. Decreased urine output
  2. Elevated BUN/creatinine ratio
55
Q

What are 4 potential causes of intravascular depletion caused by external fluid losses?

A
  1. Haemorrhage
  2. Vomiting
  3. Diarrhoea
  4. Burns
56
Q

What are 4 potential causes of intravascular depletion caused by external fluid losses?

A
  1. Haemorrhage
  2. Vomiting
  3. Diarrhoea
  4. Burns
57
Q

What are 4 potential causes of intravascular depletion caused by external fluid losses?

A
  1. Haemorrhage
  2. Vomiting
  3. Diarrhoea
  4. Burns
58
Q

What are 3 potential causes of intravascular depletion caused by internal redistribution?

A
  1. Septic shock
  2. Anaphylactoid shock
  3. Ascites
59
Q

Describe the movement of fluid in septic shock

A

There is significant movement of fluid from the vascular space to the third space

60
Q

What is the general mechanism by which total body water depletion occurs (as opposed to intravascular depletion)?

A

Total body water depletion is a more gradual loss of hypotonic fluid from all body compartments

61
Q

What are the 2 broad causes of total body water depletion?

A
  1. Lack of sufficient oral intake
  2. Excessive insensible losses
62
Q

What is total body water depletion also called?

A

Dehydration

63
Q

What are 5 signs/symptoms

A
  1. Excessive thirst
  2. Dry mucous membranes
  3. Decreased skin turgor
  4. Increased serum sodium
  5. Acute weight loss
64
Q

What are 8 signs/symptoms of hypovolaemia?

A
  1. Cool peripheries
  2. Tachycardia
  3. Reduced skin turgor
  4. sunken eyes
  5. orthostasis
  6. Dry mucous membranes
  7. Decreased urine output
  8. Prolonged capillary refill time
65
Q

What are 8 signs/symptoms of hypovolaemia?

A
  1. Cool peripheries
  2. Tachycardia
  3. Reduced skin turgor
  4. sunken eyes
  5. orthostasis
  6. Dry mucous membranes
  7. Decreased urine output
  8. Prolonged capillary refill time
66
Q

What are 8 signs/symptoms of hypovolaemia?

A
  1. Cool peripheries
  2. Tachycardia
  3. Reduced skin turgor
  4. sunken eyes
  5. orthostasis
  6. Dry mucous membranes
  7. Decreased urine output
  8. Prolonged capillary refill time
67
Q

What are 8 signs/symptoms of hypovolaemia?

A
  1. Cool peripheries
  2. Tachycardia
  3. Reduced skin turgor
  4. sunken eyes
  5. orthostasis
  6. Dry mucous membranes
  7. Decreased urine output
  8. Prolonged capillary refill time
68
Q

What is a late sign of hypovolaemia?

A

Hypotension

69
Q

What are 5 signs/symptoms of hypervolaemia?

A
  1. Increased jugular venous pressure (JVP)
  2. Pitting oedema
  3. Tachypnoea
  4. Bibasal crepitations
  5. Pulmonary oedema on chest X-ray
70
Q

What is tachypnoea?

A

Abnormally rapid breathing

71
Q

What is the role of jugular venous pressure (JVP) in assessing hypervolaemia?

A

Jugular venous pressure (JVP) is a substitute marker of central venous pressure, and when assessing fluid balance is difficult, a central venous pressure line may help to guide fluid management

72
Q

What are the 2 forms of treatment of fluid deficits?

A
  1. Maintenance therapy
  2. Replacement therapy
73
Q

What is maintenance therapy for fluid deficits?

A

Therapy used to replace normal fluid and electrolyte losses.

74
Q

What are maintenance fluid requirements dependent on?

A

The patient’s metabolic rate and energy expenditure

75
Q

What is replacement therapy for fluid deficits?

A

Fluids used to replace fluid and electrolyte losses which occur in excess to normal.

76
Q

What are replacement fluid requirements dependent on?

A

The extent of fluid loss and the patient’s body weight

77
Q

What are replacement fluid requirements dependent on?

A

The extent of fluid loss and the patient’s body weight

78
Q

What are 3 causes of increased fluid requirements?

A
  1. Fever
  2. Excessive sweating
  3. Increased metabolism
79
Q

What is an example of increased metabolism leading to increased fluid loss?

A

Hyperventilation leading to water loss from the lungs

80
Q

When designing a fluid regimen, what are the two main factors which need to be considered pertaining to volume?

A
  1. Basal or maintenance needs
  2. Replacement fluid requirements (to replace any fluid lost through trauma, etc.)
81
Q

What are 3 means to estimate fluid deficits?

A
  1. Weight changes
  2. Serum electrolytes (particularly sodium)
  3. Urine electrolytes/specific gravity
82
Q

What is the normal maintenance fluid rate?

A

2750 mL over 24 hours

83
Q

What is the general process to determining the rate of fluid replacement therapy?

A

You replace the first half of the deficit over the first 8 hours, then the second half of the deficit over the next 16 hours

84
Q

What are 3 classes of parenteral solutions?

A
  1. Crystalloids
  2. Colloidal solutions
  3. Oxygen-carrying resuscitation solutions
85
Q

What are 2 examples of crystalloid parenteral solutions?

A
  1. 5% dextrose
  2. 0.9 NaCl
86
Q

What are 2 examples of colloidal parenteral solutions?

A
  1. Albumin
  2. Dextrans
87
Q

What are 2 examples of oxygen-carrying resuscitation parenteral solutions?

A
  1. Blood
  2. Packed red blood cells
88
Q

What are the 2 main types of resuscitation fluids?

A
  1. Crystalloid solutions
  2. Colloid solutions
89
Q

What are the 2 main types of maintenance fluids?

A
  1. Electrolytes
  2. Nutritional fluids
90
Q

What is the role of resuscitation fluids?

A

To replace acute loss (secondary to haemorrhage , gastrointestinal loss, loss to the third space, etc.)

91
Q

What is the role of maintenance fluid therapy?

A
  1. Replace normal loss in patients who cannot replace this orally
  2. Nutritional support
92
Q

What is the overarching purpose of fluid resuscitation?

A

To replenish fluid in the vascular space to maintain perfusion to the kidneys and brain, and maintain blood pressure

93
Q

What is the role of isotonic saline solution ?

A

To replace acute/abnormal fluid loss and increase extracellular fluid

94
Q

What does extracellular fluid consist of?

A

Interstitial fluid and plasma

95
Q

What is an example of a hypotonic solution?

A

5% dextrose

96
Q

What is an example of a hypotonic solution?

A

5% dextrose

97
Q

What is the role of hypotonic solutions?

A

To replace normal fluid loss

98
Q

Describe the distribution of fluid replacement of hypotonic solutions

A

They predominantly increase intracellular fluid, with less effect on extracellular fluid

99
Q

What does Ringer’s solution contain?

A

Sodium, potassium and calcium salts

100
Q

What is the difference between Ringer’s solution and Hartmann’s solution?

A

Hartmann’s solution also includes sodium lactate

101
Q

What is the purpose of sodium lactate in Hartmann’s solution?

A

This decreases the chance of acidosis occurring

102
Q

Describe the metabolism of lactate

A

Lactate is metabolised into bicarbonate by the liver

103
Q

What is isotonic saline solution primarily used for?

A

Extracellular fluid replacement

104
Q

What is a concern regarding the composition of isotonic saline solution?

A

It contains a much higher concentration of chloride than the physiological concentration

105
Q

Describe the concentration of chloride in Ringer’s solution and Hartmann’s solution to that in isotonic saline?

A

These solutions have much lower chloride concentrations than isotonic saline

106
Q

What is a potential hazard of Hartmann’s solution in liver impairment?

A

There is a risk of lactic acidosis secondary to the impaired metabolism of lactate

107
Q

What is a potential hazard of Hartmann’s solution in renal impairment?

A

Renal patients are predisposed to potassium overload, and the solution contains potassium

108
Q

What is the role of hypotonic saline replacement?

A

To treat patients who are hypertonic due a primary depletion of their extracellular fluid

109
Q

What is the primary monitoring parameter necessary when administering hypotonic saline?

A

Serum sodium

110
Q

What is the role of intravenous hypertonic saline administration?

A

Treatment of symptomatic hyponatraemia

111
Q

What is the rationale of giving higher concentrations of IV dextrose?

A

To administer more calories

112
Q

Does Hartmann’s solution contain any calories?

A

No

113
Q

What is the role of parenteral fluid administration?

A

Parenteral fluid is only employed in severe cases or when the patient cannot, should not, or will not drink

114
Q

What is the first-line treatment option for mild dehydration?

A

Oral fluid replacement

115
Q

What is another route of fluid replacement (other than oral and IV)?

A

subCUTANEOUS

116
Q

How much fluid can be replaced a day subcutaneously?

A

Up to 3 L

Residency Exam (22 decks)

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