IV Fluids 1- MJ Flashcards
What are the 5 causes of hypovolemia?
- GI losses (bleeding, NG suction, V/D)
- Renal losses (salt and water loss from diuretics, water loss from diabetes insipidus)
- Skin losses (sweat, burns)
- Sequestration without loss (intestinal obstruction, pancreatitis, rhabdomyolysis)
- Hemorrhage/bleeding
What are the 4 types of GI losses that can cause hypovolemia?
- Bleeding
- NG suction
- Vomiting
- Diarrhea
What are the 2 types of renal lossses that can lead to hypovolemia?
- Salt and water loss: diuretics
- Water loss: Diabetes insipidus
What are the 3 things that can cause sequestration without loss leading to hypovolemia?
- Intestinal obstruction
- Pancreatitis
- Rhabdomyolysis
“RIP”
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
Hypovolemia
What is third spacing?
- 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
What are 3 examples of third spacing?
- Ascites
- Edema associated with burns
- Pleural effusions
T/F: Third spacing can cause a relative hypovolemia
TRUE
What are the 3 types of replacement IVF?
- Crystalloids (contains electrolytes)
- Colloids (Contains both large organic macromolecules and electrolytes)
- Blood and blood products
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
Crystalloids
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
Colloids
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
Isotonic Crystalloids
Which is the only IVF that you can bolus?
Isotonic crystalloids (0.9%NS, Lactated Ringer, Plasma Lyte)
Which type of IVF is the “go to” for resuscitation?
Isotonic Crystalloids (0.9%NS, Lactated Ringer, Plasma Lyte)
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)
- Hypertonic crystalloid
What are the different types of crystalloids?
-
Isotonic crystalloids (same salt conc. as blood):
- 0.9% NS
- Lactated Ringer
- Plasma- Lyte
-
Hypertonic crystalloid (higher salt conc than blood):
- 3% NS
-
Hypotonic crystalloid (lower salt conc than blood):
- 0.5 NS
- 0.25 NS
- Other
- D5W (5% dextrose in water)
- D5 1/2NS
Which type of crystalloid?
- Solution w/ lower salt conc. than normal cells of body/blood
- 0.5 NS, 0.25 NS
Hypotonic crystalloids
What is the preferred choice of IVF for treatment of dehydration and hypovolemia?
Isotonic Crystalloid
(NS, LR and Plasma-Lyte can be used for IV boluses)
What is the preferred type of IVF for severe hypovolemia (resuscitation)?
(this should be corrected as rapidly as possible to correct intravascular volume depletion)
Isotonic Crystalloids
In addition to NaCl, what 3 other things does Lactated Ringer contain?
- Lactate
- K+
- Ca2+
Which Isotonic Crystalloid contains less chloride and is the most physiologic solution?
Plasma-Lyte
Which type of IVF is most valuable in situations where there is life threatening hyponatremia w/ significant water excess?
Hypertonic Crystalloid
(3% NS)
Which type of IVF can also be used in neurosurgical patients to decrease cerebral edema?
Hypertonic Crystalloid
(3% NS)
Why do you have to be very cautious with giving Hypertonic Crystalloids?
Overly rapid correction of sodium can lead to central pontine myelinolysis (CPM)
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
Hypotonic Crystalloids
(0.5 NS, 0.25 NS)
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
Other crystalloid
D5W (5% dextrose in water)
When should you use caution in giving D5W?
Patients w/ Diabetes
When do you use D5W? (3 situations)
- hypoglycemia
- Starvation Ketosis
- Hypernatremia w/ a free water deficit
Are colloids less likely or more likely to expand vascular compartment?
MORE likely
When are colloids used?
- 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.
Patiens w/ burns or peritonitis (where there are considerable protein loss from vascular space) can be treated with which type of IVF?
Colloids
**there is no strong data to support the use of colloids in severe hypovolemia (also is more expensive)**
What are the 3 type of colloid IVF?
- Albumin (5% albumin, 25% albumin)
- Dextran (Dextran 40, Dextran 70)–> NOT used
- Hydroxyethyl Starch (Hetastarch)–> NOT used
“HAD”
Which type of IVF is used in edematous patients to mobilize interstitial fluid into the vascular space?
- Albumin preparations (5% albumin or 25% albumin)
- (not useful if serum albumin >2.5mg)
- used as a plasma expander
Which type of IVF is helpful in patients with liver disease, peritonitis or burns or surgical patients experiencing “third spacing”
Albumin Preparations (5% albumin, 25% albumin)
Although there’s a theoretical assumption that colloids lead to better intravascular volume expansion compared to crystalloids, what have studies shown?
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.
What are the 4 different type of blood products?
- Packed RBCs
- Platelets
- Fresh Frozen Plasma
- Cryoprecipitate
Packed RBCs (PRBCs):
- are prepared from _____
- Remain entirely within the ______
- Improves _____ delivery to tissues
- are prepared from whole blood
- Remain entirely within the vascular space
- Improves oxygen delivery to tissues
What are packed RBCs used for?
Blood transfusions
- Hemorrhage (i.e. GI bleed) or severe/symptomatic anemia
