IV Fluid assessment + Hospital based care and MedRec Flashcards
What are the fluid compartment breakdowns
Total body water 55-60%
- intracellular 2/3
- extracellular 1/3
- 4/5 is interstitial (around cells)
- 1/5 is in blood
Which electrolytes have similar concentration in interstitial fluid (ECF) and plasma (2)
Na
K
Which electrolyte is present more in intracellular fluid and which is more in ECF
Na
K
Na (ECF)
K (ICF)
T/F ICF and ECF have the same osmolarity
True
- Na and K balance out
Place in order from more protein to less protein
ICF
Interstitial fluid
Plasma
ICF > plasma > Interstitial fluid
All fluid input to and output from the body occur via which compartment
Intravascular
What are symptoms of hypotension
Dizziness
Tachycardia
Orthostatic hypertension
Specificity/sensitivity not great as these symptoms overlap with dehydration
What is hypovolemia
What are the 2 types and their symptoms
Absolute hypovolemia
Relative hypovolemia
Volume depletion
- decrease in blood volume from intravascular space
2 types
- Absolute hypovolemia
- hemorrhage, V/D, burns, renal losses
- less often due to dehydration - Relative hypovolemia
- fluid moves from intravascular to interstitial (edema) or transcellular spaces
- due to decreased blood colloidal oncotic pressure (BCOP), inflammation, and leaky vessels
What is evidence of end-organ hypoperfusion
Inc Hct
Oliguria (production of small urine)
inc SCr
Cool, clammy skin
delayed capillary refill
Define hypervolemia
What does it cause (3)
Excess blood volume in intravascular space
- may spill over into interstitial or transcellular
Causes
- kidney dysfunction
- CHF
- iatrogenic (anything caused by healthcare, i.e giving too much IV fluids)
What are symptoms of hypervolemia (6)
- decrease Hct
- inc JVD
- Weight gain
- hypertension
- Ascites, pleural effusion (third spacing)
- Peripheral, pulmonary, cerebral, or bowel edema
What can too much NaCl cause if not properly used (3)
- increase length of stay
- morbidity
- mortality
eg. ileus, delirium, impaired wound healing
What are indications of IV fluid
Treat volume depletion
Prevent volume depletion
Correct electrolyte abnormalities
What are the routine maintenance fluid needs a human body needs (3)
Fluid = 25-30mL/kg/day
1 mmol/kg/day Na, K+, and Cl-
50-100 g/d glucose/day
What conditions should you check for if EXISTING fluid or electrolyte deficits or excesses exist (3)
- Dehydration
- Fluid overload
- hyperkalamia/hypokalemia
What conditions should you check for if there is ongoing abnormal fluid or electrolyte losses (8)
- Vomiting and NG tube loss
- biliary drainage loss
- high/low volume ileal stoma loss
- diarrhea/excess colostomy loss
- ongoing blood loss
- sweating/fever/dehydration
- pancreatic/jejunal/fistula/stoma loss
- urinary loss (eg. post AKI)
What should you check for in redistribution and other complex issues (6)
- gross oedema
- severe sepsis (hypovolemic)
- Hypernatremia/hyponatremia
- renal, liver, cardiac impairment
- post-operative fluid retention
- malnourished and refeeding issues
Which type of fluid loss has the highest potassium loss
Diarrhea
Colostomy loss
Types of parenteral fluids
Colloids (eg. albumin, dextran, hetastarch)
- large molecules that cannot cross capillary wall
Crystalloids (water and solute)
- sugar (eg. D5W, D10W)
- Salt
- Combos
balanced crystalloids
- PlasmaLyte (Na+, K+, Cl-, Ca2+)
- Ringer’s AKA hartmann’s (Na+, K+, Cl-, Ca2+, bicarb, lactate)
What does these solutions look like
Hypertonic
Isotonic
Hypotonic
Hypertonic
- salt outside, water leave cell
- cell shrivelled
Isotonic
- balanced RBC
Hypotonic
- salt inside cell, water goes in cell
- RBC blows up
What are examples of isotonic solutions
ECF or ICF?
balanced or unbalanced crystalloids?
0.9% NaCl, Ringer’s, plasmalyte
- Completely ECF
- balanced crystalloids
If you have 1L of 0.9% NaCl where would it go
What: When isotonic fluids are given, they stay within the extracellular fluid (ECF) because they do not cause water to shift into or out of cells.
If you gave 1L of 0.9% NaCl
- 800mL would go to the interstitial space (remember this is part of the ECF)
- 200mL would go to the intravascular space
What are examples of hypotonic solutions?
ECF or ICF?
0.45% NaCl, D5W, combo of both, D10W
- unbalanced crystalloids
Volumes move intracellular
- dextrose metabolized rapidly –> becomes “free water” that distributes across all compartments
What risks do hypotonic solutions have? (2)
Acidosis and hypokalemia
if giving half saline too long = hyponatremia
