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Nephrology > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

If fluids are isotonic they range from ___ to ___ mOsm/L.

Hypotonic?

Hypertonic?

A

Isotonic: 240-340 mOsm/L

Hypotonic: less thatn 240 mOsm/L

Hypertonic: greater than 340 mOsm/L

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2
Q

What are the two fluid compartments of the body?

A

Intracellular

Extracellular:
-intravascular

  • interstitial
  • third space or transcellular (CSF/joint spaces/vitreous humor)
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3
Q

Describe Colloid and crystalloid fluids.

  • what are they made up of?
  • can they cross cellular membranes?
  • purpose
  • examples of each
A

Colloid: fluids containing larger molecular weight proteins, these dont pass through cell membranes therefore they remain in the intravascular compartment and expand intravascular volume. THey draw fluid from extravascular spaces via their higher oncotic pressure.

Purpose: VOLUME EXPANDERS

Example: ALbumin, plasma protein fraction, sythetic colloids

Crystalloids: fluids will lower molecular weight and low oncotic pressure. Hypo,hyper., and isotonic. Contain small molecules that flow more easily across the cell membranes allowing transfer from bloodstream to cells.

Purpose: increase fluid volume in both interstitial and intravascular spaces.

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4
Q

Crystalloids may be hypertonic, hypotonic, and isotonic…describe what this means and which direction the fluid is moving. Give examples of each.

A

Hypotonic: solution of lower osmotic pressure than blood. They have lower concentration of solutes. Shifts fluids out into the interstitial space.
ex. 0.45NS & D5W (after infusing)

Isotonic: solution containing same salt concentration as blood. Doesnt result in any fluid significant fluid shifts.
ex: 0.9% NS, Lactated Ringers, D5W (before infusion)

Hypertonic: solution of higher osmotic pressure than blood. Shifts fluid from cells and interstitial space into the vasculature.
ex. 7.5% NS, D5 in 1/2NS, Dextrose 5% in NS, Dextrose 10%, D50

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5
Q

WHat is the function of hypotonic fluids and what disorders might they be necessary for? Who do we NEVER give hypotonic solutions to?

A

Hypo: lower the serum osmolality within the vascular space, causing fluid shift from intravascular to intracellular and interstitial spaces.

These solutions hydrate cells, though their use may deplete fluid within the circulatory system

Disorders used for:

  • Hypernatremia
  • DKA
  • Hyperosmolar hyperglycemic state.

NEVER give hypotonic solution to pts who are at risk of increased ICP because it may exacerbate cerbral edema!!! Also, dont use in pts with liver dz, trauma, or burns d/t the potential for depletion of intravascular fluid volume.

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6
Q

SE of hypotonic solutions

A
  • decreased vascular bed volume can worsen existing hypovolemia and hypotension and cause vascular collapse.
  • in older adults confusion* / dizziness may be an indicator of a fluid volume deficit.
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7
Q

Overall function of Isotonic Crystallioids? Hypertonic solutions? Hypotonic solutions?

A

Isotonic:
-increase vascular volume.

Hyper
-volume expanders

Hypo:
-hydrate cells

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8
Q

SE of Hypertonic solutions

A
  • fluid volume overload

- pulmonary edema

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9
Q

We can divide the need for IV fluid therapy into two somewhat simplistic areas, what are these?

A

Maintenance Therapy: replaces normal ongoing losses

Replacement Therapy:

  • hypotension d/t hemorrhage or anesthesia, excess fluid loss d/t diarrhea, vomiting, and decreased oral intake.
  • electrolyte imbalances
  • corrects any existing water and electrolyte deficits.
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10
Q

What is the most osmotically active electrolyte in the body?

A

-Sodium

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11
Q

When determining fluid status it is important to note what?

A
  • urine output
  • serum sodium
  • urine osmolality
  • edema and BP are imporant but do NOT replace the above
  • orthostatic VS
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12
Q

____ therapy is usually undertaken when the individual is not expected to eat or drink normally for a longer time. (eg. perioperatively or pt on ventilator).

What is the best way to monitor fluid gain/loss?

Normal serum Sodium tell you the pt has adequate water balance but not _____ balance.

A

Maintenance therapy

Daily weights

Volume balance.

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13
Q

Water requirement increases _____ml/day for each degree fever greater than 37C

A

100-150ml/day for each degree of fever greater than 37C

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14
Q

How to calculate maintenance fluid flow rates?

A

weight in Kg + 40 = maintenance IV rate/hr

e.g 45kg patient = 85 ml/hr

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15
Q

WIth excessive vomiting or NG suction or excessive diarrhea, the pt may lose hydrogen ions or sodium bicarb respectively, leading to what?

A

Lose H+ = alkalosis

Lose sodium bicarb = acidosis

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16
Q

Hypotension with general anesthesia is NOT initially d/t _____ but is is due to ______.

A

NOT initially d/t loss of volume but is d/t LOSS OF VASCULAR TONE. “ enlarges the tank”

17
Q

Replacement therapy for hypovolemia d/t decreased intake or excess excretion? D/t vomiting or diarrhea?

A
  • Excess excretion:
  • 0.45% NS until labs are back
  • If serum Na greater than 145 change to 0.25% NS
  • If serum Na less thatn 138 change to 0.9% NS
  • initially run at 125ml/hr unless hemodynamically unstable

Vomiting or diarrhea:
-0.9%NS until labs back

  • if serum Na greater than 1.5 change to 0.45% NS
  • initially run at 125 unless hemodynamically unstable
18
Q

Replacement therapy if hypovolemia d/t hemorrhage, tachycardic, tachypneic, SBP less than 90, pale, cool, clammy, confused?

Replacement therapy if hypovolemia d/t burns?

A
  • Bolus 1-2 liters 0.9% NS or LR through large bore IVs until labs are back.
  • continue fluid resuscitation based on VS and Urine output.
  • Packed RBC as soon as available.

BURNS:
-bolus 1-2 Liters 0.9NS or LR through large bore IVs until labs are back

  • continue fluid resuscitation based on VS and Urine output
  • consider albumin early to maintain pressure and limit edema
  • monitor electrolytes, ABGs, and VS
19
Q

What are some parameters used to assess volume deficit?

A
  • blood pressure
  • urine output
  • jugular venous pressure
  • urine sodium concentration
20
Q

WHat are the signs and sx of hypovolemic shock? How do we treat?

A
  • anxiety/agitation
  • confusion
  • rapid breathing
  • low BP
  • rapid pulse, often weak and thready
  • cool, pale skin
  • decreased or no urine output
  • low body temp

Tx:
-rapid infusion of 1-2L of isotonic saline (0.9% NS)

21
Q

Signs and Sx of fluid overload?

A
  • edema ( i.e in the feet and ankles)
  • difficulty breathing while lying down
  • crackles on auscultation
  • high BP
  • irritated cough
  • jugular venous distension
  • SOB
  • Strong rapid pulse
22
Q

Management of Fluid overload

A
  • PREVENTION!!!!!
  • Sodium restriction
  • fluid restriction
  • diuretics
  • dialysis
23
Q

How do colloid solutions work? Examples

A
  • expands intravascular volume by drawing fluid from the interstitial spaces into intravascular compartment through their higher oncotic pressure.
  • has same effects as hypertonic crystalloid solution but it requires administration of less total volume and have longer duration of action because their molecules remain within the intravascular space longer.*

e. g:
- albumin/dextran
- hydroxyethalstarches

24
Q

Colloid Solutions: albumin CI

A
  • severe anemia
  • Heart failure
  • known sensitivity
  • ACEi (need to be withheld for 24hrs before administration of albumin b/c risk of atypical rxn such as flushing and hypotension
25
Q

Precautions when using colloid solutions

A
  • pt at risk for developing fluid volume overload
  • use 18 gauge or larger needle for infusion
  • monitor pt signs and sx of hypovolemia including: increased BP, dyspnea or crackles in the lungs, edema
  • monitor I/O
  • may interfere with platelet function and increase bleeding times
  • anaphylactoid rxn may occur
26
Q

What is the usual IV of choice?

What is the only use for D5W as stand alone fluid?

which fluid is isotonic and fluid of choice for volume depletion d/t trauma/burns?

A

0.9% NS

D5W used for stand alone fluid is when serum Na is greater than 145 and the patient is symptomatic with hypernatremia

Lactated Ringers

27
Q

Manifestations of dehydrated patient?

A
  • tachycardia, weak pulses and postural hypotension
  • flulshed dry skin
  • dry mucous membranes
  • decreased urine output
  • increased hematocrit
  • increased serum sodium level
28
Q

Orthostatic BP
-pt is considered to be “tilt positive” or “tilting” if they have a change of ___BPM with pulse and decrease of ___ in SBP

A

15BPM

10 in SBP

29
Q

When to give 09% NS?

A
  • low extracellular fluid
  • hemorrhage, severe vomiting/diarrhea, fistulas
  • shock
  • mild hyponatremia
  • metabolic acidosis
  • Fluid of choice for resuscitation efforts
  • only fluid used with admin. of blood products
30
Q

WHen to give Lactated Ringers?

A
  • fluid of choice for burn injuries
  • used to replace GI tract fluid loss (Diarrhea or vomiting)
  • fluid loss d/t burns/trauma
  • pts with blood loss or hypovolemia d/t third space fluid shifts.
  • this is most physiologically adaptable fluid b/c its electrolyte content is most closely related to the bodys serum and plasma
31
Q

Where is LR metabolized? What is it converted to? Who is LR often administered to? Who should not receive LR?

A

LR is metabolized in the liver where it is converted to bicarbonate.

often administered to pts with metabolic acidosis.

-pts with Liver dz b/c they cant metabolize the lactate and those with pH greater than 7.5

Nephrology (8 decks)

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