IV fluids Flashcards

1
Q

where is body water

A

1/3 ECF

2/3 ICF

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2
Q

where is water in ECF

A

1/4 plasma (8% total)

3/4 ISF (25% total)

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3
Q

how much fluid and lytes are needed per day

A

4-2-1 rule
4 ml/kg/h for 1st 10kg
2 for next 10
1 for rest

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4
Q

def. effective osmole

A

particle that doesn’t cross cell membrane

  • Na, K, glucose
  • NOT ethanol and urea
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5
Q

what are 2 types of losses

A

sensible - those you feel - urine

insensible - those you don’t - sweat, resp

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6
Q

what is “free water” in 1 L of 70mmol/L fluid

A

500 ml is isotonic (140)

so 500ml is free

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7
Q

4 types of fluid loss

A
  1. pure water loss
  2. hypotonic
  3. isotonic
  4. blood
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8
Q

2 ways to lose free water

A
  1. . skin - insensible
  2. urine
    - diabetes insipidus
    - urea induced osmotic diuresis
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9
Q

3 ways to lose hypotonic

A
  1. skin
    - sweat (20-50 Na)
  2. urine
    - most diuretics
    - glucose or mannitol induced
  3. GI
    - vomiit
    - diarrhea if due to osmotic laxative
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10
Q

4 ways to lose isotonic

A
  1. skin
    - burns
  2. GI
    - most diarrhea
    - ileus
  3. urine
    - thazides
  4. third space losses
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11
Q

3 consequences of fluid loss

A
  1. hypovolemia
    - less CO > hypotens> activate SNS
  2. possible hypernatremia
    - brain cells shrink> confusion
  3. possibly lose other lytes
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12
Q

magnitude of blood volume lost for a liter loss of each type

A
  1. pure water loss - 80ml
  2. hypotonic - 80-250
  3. isotonic - 250-333
  4. blood- 1000ml
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13
Q

3 hormonal responses to hypovolemia

A
  1. SNS activation
  2. RAS activations
  3. ADH
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14
Q

effects of hormones (3)

A
  1. incr. CO
  2. vasoconstrict
  3. reduce urine loss and NaCl
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15
Q

4 Hx ways to assess loss

A
  1. urine (output, color)
  2. thirst/intake
  3. dizzy when standing
  4. direct evidence of loss
    - blood, surg, GI etc
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16
Q

4 hemodynamic signs on Phx

A
  1. JVP
  2. postural hypotension
  3. postural rise in HR
  4. supine hypotens or BP
17
Q

5 other signs of low volume

A
  1. skin and mucous
    - tugor
    - cap refill
  2. urine
  3. weight loss
  4. CNS
    - confusion/coma
  5. head
    - fonanelle
    - sunken eyeballs
18
Q

what are three general levels of loss in adults1

A

mild - 1-2 liters
mod - 2-3
severe - 4-5

19
Q

fomula for free water deficit

A

[total body water x (plasma [Na] - 140)]/140

20
Q

how much water in man and woman

A

man 60%

woman 50%

21
Q

4 lab tests to help confirm hypovolemia

A
  1. urine
    - osmolarity rises - test specific gravity
  2. ratio of plasma urea:creatinine
    - rises to >8%
    - urea rises faster since reabsorbed with Na
  3. hematocrit/hemoglobin
    - compare to previous levels
  4. check for other lyte abnormalities
22
Q

3 indications of IV fluids

A
  1. existing large deficit
  2. anticipated large def.
  3. access to circulation for meds
23
Q

what are crystalloids and colloids

A

crystalloids - Saline/dextrose
colloids
- large mol. weight substances

24
Q

what happens when give saline

A
  • all stays in ECF

- no change in [Na]

25
what happens when give dextrose
water goes 2/3 ICF, 1/3 ECF | [Na] down
26
what happens when give half normal saline
half is like normal, half is like dextrose
27
what is formula for change in plasma [Na] for giving a liter of fluid
(IV[Na] - patient [Na])/ (total body water +1)
28
3 types of colloids
1. abumin (5 and 25%) 2. starch solutions 3. fresh frozen plasma
29
why give colloid
expect to stay in intravascular better
30
4 steps to give fluids
1. estimate and replace existing deficit 2. replace ongoing def. 3. reassess respnse to ther 4. decide if additional are needed
31
what to give if hypernatremic
- may need free water - may also need isotonic - not too fast
32
what to give if hyponatremic
- avoid free water
33
**** mega important point about hypotonic fluids
don't give to sick patients unless they are hypernatremic | - sick patients make ADH so don't excrete free water
34
4 possible routes
1. periph vein IV 2. central line 3. intraosseous in kids 4. continuous sub cut
35
check cases
it's shreiber