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Finals > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

Discuss how fluid balance changes with age

A

water proportion decreases
salt retention increases

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2
Q

how much of the water is intracellular and extracellular?

A

40/20 of total 60% water

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3
Q

how much normal leakage of albumin occurs from capillaries into interstitial space?

A

5%

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4
Q

what does albumin do in terms of fluid

A

contributes to oncotic pressure

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5
Q

what is the main extracellular ion?

A

Na

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6
Q

true or false, when sodium levels are measured it reflects the amount in the body?

A

true

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7
Q

what is the main intracellular ion

A

K

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8
Q

if a bolus is given of potassium, magnesium or calcium why will levels go up quickly and then drop back down again?

A

hasnt had time to get into cells

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9
Q

why are levels of potassium that can be measured in the blood different to the true levels of potassium in the body?

A

locked in cells which isnt accounted for

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10
Q

what other intracellular ions are present?

A

Mg, Ca

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11
Q

which electrolyte generally has a range of 135-145 mmol/L?

A

Na

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12
Q

which electrolyte usually has a range of 3.5-5 mmol/l?

A

K

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13
Q

which electrolyte has a range of 98-105 mmol/l usually?

A

Cl

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14
Q

what is the usual osmolarity of the blood in mOsm/L?

A

280-300

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15
Q

what does injury lead to

A

water and Na retention, RAS activation, vasoconstriction, ADH release and thirst

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16
Q

what is the reaction to injury

A

salt and water retained for first few days.
urine vol high
escape rate alb increases from 5% to 15%
in recovery water and salt excretion increases

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17
Q

when prescribing IV fluids, remember the 5 Rs what are they?

A

resus
routine maintenance
replacement
redistribution
reassessment

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18
Q

what consideration should be made with regards to resus?

A

on admission how much fluid was lost and how quick

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19
Q

what consideration should be made in relation to routine maintenance?

A

is it needed

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20
Q

what consideration should be made in relation to replacement?

A

has circulating volume been lost due to blood loss or diarrhoea

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21
Q

what consideration should be made in relation to redistribution?

A

has the fluid gone into intra or extra vasc space or cells

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22
Q

why is it important when examining electrolyte levels like sodium you take into account oral or enteral intake from different drugs like bicarbonates?

A

usually sodium bicarbonate hence will increase sodium levels

(Na in drugs)

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23
Q

what fluid type is made from a simple crystal forming molecule such as salt and sugar?

A

crystalloid

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24
Q

what do crystalloids act as?

A

make water isotonic with blood, act as a carrier for water

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25
Q

name a salt and a sugar than can be used to produce a crystalloid?

A

dextrose and sodium chloride

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26
Q

what is the purpose of adding a salt or sugar to fluid before giving it in the blood?

A

make the water as isotonic as possible with blood to act as a carrier for fluid intake

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27
Q

what property of crystalloids mean that they do not cause a permanent rise in blood circulating volume?

A

able to pass freely through semi permeable membrane

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28
Q

list some different properties/ benefits of crystalloids?

A

minimal oncotic pressure
allows fluid to be lost from intra vasc space easily
non physiological
short action on plasma expansion
cheap

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29
Q

glucose acts a carrier for water mainly and sugar is taken into cells leaving water behind. Why is it not recommended in children?

A

drop in sodium levels

30
Q

NaCl can have drawbacks. when used you effectively give 2x Na and 4x Cl requirements a person needs. What effect can high Cl levels have in patients?

A

hyperchloraemic acidosis, breathing difficulty due to respiratory compensation

31
Q

what effect can using sodium chloride have on the renal system?

A

vasoconstriction
reduced renal perfusion
reduced glomerular filtration rate
salt and water retention

32
Q

what effect can sodium chloride have on the GI system?

A

oedema
reduced gastric blood flow
impaired anastomotic healing

33
Q

true or false, balanced salt solution is the safest option for fluid replacement and least likely to cause issues with sodium and chloride?

A

true

34
Q

why is sodium chloride a good option to use in the case of TBI? traumatic brain injury

A

want to reduce brain swelling
if sodium levels high in blood keeps fluid out of brain

35
Q

what is normal saline

A

a solution containing 1g equivalent per litre

36
Q

is 0.9% NaCl isotonic to blood?

A

yes

37
Q

what are the downsides of NaCl?

A

giving more Na and Cl than needed, vasoconstriction in kidneys and gut (cramps and increase creatinine)

38
Q

what is the role of chloride in the body

A

acid-base, body becomes more acidic and body compensates by breathing if too much Cl

39
Q

colloids are larger molecules that are non crystal forming, name some different examples?

A

blood
gelatine
dextrose

40
Q

true or false, colloids do not escape from capillaries and stay in the intra vasc space to exert oncotic pressure?

A

true

41
Q

can colloids pass through semi permeable membranes?

A

no

42
Q

what are the downsides to colloids

A

allergic reactions and expense, can escape which leads to later problems

43
Q

are capillaries more or less permeable in critical illness?

A

more

44
Q

true or false, crystalloids are associated with oedema?

A

true

45
Q

what is the routine maintenance of water in ml/kg/day?

A

25-30

46
Q

when is albumin good?

A

for treating sepsis

47
Q

list some patients groups in which the routine maintenance of water is reduced to 20-25 ml/kg/day

A

frail, renal or cardiac impairment, malnourished

48
Q

what is the routine maintenance of sodium and potassium daily?

A

1mmol/kg

49
Q

what is the lowest number of calories that must be consumed each day to prevent starvation ketosis?

A

400

50
Q

what is an example of redistributed fluid?

A

ascites

51
Q

eg of fluid losses

A

stoma output
urine loss

52
Q

what are the 4ds of fluid stewardship?

A

drug
dosing
duration
de escalation

53
Q

What electrolyte change can cause concussion and loss of consciousness

A

low Na

54
Q

4 stages of fluid therapy ROSE

A

resus
optimisation
stabilisation
evacuation

55
Q

symptoms of hyponatremia

A

weakness, solenmness and seizures

56
Q

different classes of medication that can cause hyponatremia?

A

thiazides
loop diuretics
SSRIs
typical and atypical antipsychotics

57
Q

Causes of hyponatremia include

A

loss of body fluid, inappropriate ADH secretion, fluid overload

58
Q

treatment of hyponatremia should raise sodium levels by 0.5mmol in increments of?

A

1h

59
Q

problems with giving sodium too quickly in hyponatremic patients?

A

if increase sodium levels outside brain
pulls water out
brain shrinks
demyelination
permanent brain injury

60
Q

in order to equilibrate sodium levels between brain and surrounding blood vessels should it be given quickly or slowly?

A

slow

61
Q

hypernatremia symptoms

A

irritable, lethargy, confusion, coma

62
Q

causes of high Na

A

withholding water and inadvertent Na admin

63
Q

what happens when you correct high Na too quickly

A

brain swelling

64
Q

what should be considered in terms of formulations and sodium?

A

effervescent contains high Na amounts and shown to increase CV mortality

65
Q

what happens if K given peripherally in high concs

A

extravasates and local tissue necrosis

66
Q

what happens if K given too fast

A

lethal - cardiac arrest

67
Q

if someone has low K even after intervention and they have low Mg, what should you do?

A

correct Mg and kidney more likely to retain Mg than K= more likely to retain K

68
Q

what is it about K admin that can kill?

A

the rate it is being given (independent of route)

69
Q

when is conc important for K?

A

when given peripherally (central = dilutes K very quickly)

70
Q

max peripheral conc K

A

40mmol/L

71
Q

max central K conc

A

no max as high blood flow around, cant tip dilute blood flow quick

72
Q

safe K rates
a. w cardiac monitor
b. w/out

A

10mmol/hr
20-30mmol/hr

Finals (29 decks)

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