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MJ- F2 E5- Renal > IV Fluids 1- MJ > Flashcards

IV Fluids 1- MJ Flashcards

1
Q

What are the 5 causes of hypovolemia?

A
  1. GI losses (bleeding, NG suction, V/D)
  2. Renal losses (salt and water loss from diuretics, water loss from diabetes insipidus)
  3. Skin losses (sweat, burns)
  4. Sequestration without loss (intestinal obstruction, pancreatitis, rhabdomyolysis)
  5. Hemorrhage/bleeding
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2
Q

What are the 4 types of GI losses that can cause hypovolemia?

A
  1. Bleeding
  2. NG suction
  3. Vomiting
  4. Diarrhea
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3
Q

What are the 2 types of renal lossses that can lead to hypovolemia?

A
  1. Salt and water loss: diuretics
  2. Water loss: Diabetes insipidus
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4
Q

What are the 3 things that can cause sequestration without loss leading to hypovolemia?

A
  1. Intestinal obstruction
  2. Pancreatitis
  3. Rhabdomyolysis

“RIP”

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5
Q

The following are clinical features of what?

  • Increased thirst
  • decreased sweating
  • Decreased skin turgor & dry mucus membranes
  • Oliguria with increased urine concentration
  • CNS depression
  • Weakness and muscle cramps
  • Decreased BP
  • postural hypotension/dizziness
  • ›Increased pulse
  • postural pulse increase
A

Hypovolemia

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6
Q

What is third spacing?

A
  • Fluid accumulation in the interstitium of tissues (EDEMA)
  • Occurs when fluid accumulates in areas that normally have no fluid/minimal fluid
  • Pt looks fluid overloaded but has a relative hypovolemia
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7
Q

What are 3 examples of third spacing?

A
  • ›Ascites
  • ›Edema associated with burns
  • ›Pleural effusions
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8
Q

T/F: Third spacing can cause a relative hypovolemia

A

TRUE

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9
Q

What are the 3 types of replacement IVF?

A
  1. Crystalloids (contains electrolytes)
  2. Colloids (Contains both large organic macromolecules and electrolytes)
  3. Blood and blood products
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10
Q

Which replacement IVF?

  • Fluids that contains electrolytes which easily pass through vascular endothelial membrane barriers followed by water, leading to their equilibrating between the intravascular & extracellular space
A

Crystalloids

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11
Q

Which type of Replacement IVF?

  • Fluids that contain both large organic marcomolecules and electrolytes
  • The Lrg molecules can’t cross endothelial membrane (capillary walls)–> fluids retained w/in intravascular space more than crystalloids due to higher oncotic pressure
A

Colloids

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12
Q

Which type of crystalloid?

  • Solutions w/ the same salt concentration as normal cells of the body and blood
  • Types= Normal Saline (0.9% NS), Lactated Ringer, Plasma-Lyte
A

Isotonic Crystalloids

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13
Q

Which is the only IVF that you can bolus?

A

Isotonic crystalloids (0.9%NS, Lactated Ringer, Plasma Lyte)

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14
Q

Which type of IVF is the “go to” for resuscitation?

A

Isotonic Crystalloids (0.9%NS, Lactated Ringer, Plasma Lyte)

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15
Q

Which type of cyrstalloid?

  • Solutions w/ higher salt concentrations than normal cells of the body and blood
  • 3% NS
  • Can be used to tx hyponatremia but have to be careful (CANT bolus)
A
  • Hypertonic crystalloid
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16
Q

What are the different types of crystalloids?

A
  • Isotonic crystalloids (same salt conc. as blood):
    1. 0.9% NS
    2. Lactated Ringer
    3. Plasma- Lyte
  • Hypertonic crystalloid (higher salt conc than blood):
    1. 3% NS
  • Hypotonic crystalloid (lower salt conc than blood):
    1. 0.5 NS
    2. 0.25 NS
  • Other
    • D5W (5% dextrose in water)
    • D5 1/2NS
17
Q

Which type of crystalloid?

  • Solution w/ lower salt conc. than normal cells of body/blood
  • 0.5 NS, 0.25 NS
A

Hypotonic crystalloids

18
Q

What is the preferred choice of IVF for treatment of dehydration and hypovolemia?

A

Isotonic Crystalloid

(NS, LR and Plasma-Lyte can be used for IV boluses)

19
Q

What is the preferred type of IVF for severe hypovolemia (resuscitation)?

(this should be corrected as rapidly as possible to correct intravascular volume depletion)

A

Isotonic Crystalloids

20
Q

In addition to NaCl, what 3 other things does Lactated Ringer contain?

A
  • Lactate
  • K+
  • Ca2+
21
Q

Which Isotonic Crystalloid contains less chloride and is the most physiologic solution?

A

Plasma-Lyte

22
Q

Which type of IVF is most valuable in situations where there is life threatening hyponatremia w/ significant water excess?

A

Hypertonic Crystalloid

(3% NS)

23
Q

Which type of IVF can also be used in neurosurgical patients to decrease cerebral edema?

A

Hypertonic Crystalloid

(3% NS)

24
Q

Why do you have to be very cautious with giving Hypertonic Crystalloids?

A

Overly rapid correction of sodium can lead to central pontine myelinolysis (CPM)

25
Q

Which type of IVF?

  • Distribute throughout the total body water
  • ›Used for maintenance fluids
  • ›Are inadequate for replacing intravascular volume deficits
  • ›Not used for treatment of dehydration/hypovolemia
A

Hypotonic Crystalloids

(0.5 NS, 0.25 NS)

26
Q

Which type of IVF?

  • ›Similar total body water distribution to the hypotonic crystalloids
  • ›Used to treat hypoglycemia, starvation ketosis
  • ›Used in hypernatremia with a free water deficit
A

Other crystalloid

D5W (5% dextrose in water)

27
Q

When should you use caution in giving D5W?

A

Patients w/ Diabetes

28
Q

When do you use D5W? (3 situations)

A
  • hypoglycemia
  • Starvation Ketosis
  • Hypernatremia w/ a free water deficit
29
Q

Are colloids less likely or more likely to expand vascular compartment?

A

MORE likely

30
Q

When are colloids used?

A
  • ›When crystalloids fail to sustain plasma volume due to low osmotic pressure
  • ›Example: patients with burns or peritonitis where there is considerable protein loss from vascular space.
31
Q

Patiens w/ burns or peritonitis (where there are considerable protein loss from vascular space) can be treated with which type of IVF?

A

Colloids

**there is no strong data to support the use of colloids in severe hypovolemia (also is more expensive)**

32
Q

What are the 3 type of colloid IVF?

A
  1. Albumin (5% albumin, 25% albumin)
  2. Dextran (Dextran 40, Dextran 70)–> NOT used
  3. Hydroxyethyl Starch (Hetastarch)–> NOT used

“HAD”

33
Q

Which type of IVF is used in edematous patients to mobilize interstitial fluid into the vascular space?

A
  • Albumin preparations (5% albumin or 25% albumin)
  • (not useful if serum albumin >2.5mg)
  • used as a plasma expander
34
Q

Which type of IVF is helpful in patients with liver disease, peritonitis or burns or surgical patients experiencing “third spacing”

A

Albumin Preparations (5% albumin, 25% albumin)

35
Q

Although there’s a theoretical assumption that colloids lead to better intravascular volume expansion compared to crystalloids, what have studies shown?

A

Studies show that even though albumin WAS found in increase serum albumin levels and mean arterial pressure,

there was NO difference in 28 or 90 day mortality.

36
Q

What are the 4 different type of blood products?

A
  1. Packed RBCs
  2. Platelets
  3. Fresh Frozen Plasma
  4. Cryoprecipitate
37
Q

Packed RBCs (PRBCs):

  • are prepared from _____
  • Remain entirely within the ______
  • Improves _____ delivery to tissues
A
  • are prepared from whole blood
  • Remain entirely within the vascular space
  • Improves oxygen delivery to tissues
38
Q

What are packed RBCs used for?

A

Blood transfusions

  • Hemorrhage (i.e. GI bleed) or severe/symptomatic anemia

MJ- F2 E5- Renal (13 decks)

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