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Foundations II- Nephrology > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

Total body water =

A

60% total body weight

ICF: 2/3
ECF: 1/3

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2
Q

Who will have more body water; normal weight ind. or obese ind.?

A

normal weight pt

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3
Q

Ways that we get water input? output?

A

fluid intake, H20 in food, metabolically produced H20

insensible loss, sweat, feces, urine

input = output

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4
Q

What are some causes of hypovolemia?

A

GI losses, renal losses, sweat losses (sweats, burns), sequestration without loss

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5
Q

What are some examples of sequestration without loss?

A

Intestinal obstruction, pancreatitis, rhabdomyolysis

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6
Q

Clinical features of hypovolemia

A

Increased thirst, decreased sweating

Decreased skin turgor & drymm

Oliguria

CNS depression

Weakness and muscle cramps

Decreased BP; postural

hypotension/dizziness

tachycardia

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7
Q

What is third spacing?

A

fluid getting into spaces where its not supposed to be

fluid accumulation in the interstitium of tissues

  • ascites
  • pleural effusions
  • edema assoc. with burns
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8
Q

third spacing can causes…

A

relative hypovolemia

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9
Q

What are the types of replacement IVF?

A

crystalloids

colloids

blood and blood products

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10
Q

What are crystalloids?

A

fluids that contains crystal-forming elements (electrolytes) which easily pass through vascular endothelial membrane barriers followed by water, leading to their equilibrating between the intravascular & extracellular space

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11
Q

What are colloids?

A

Fluids that contain both large organic marcomolecules and electrolytes

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12
Q

What are blood and blood products?

A

RBC’s are similar to colloids because they stay in vascular space

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13
Q

What are some examples of crystalloids?

A

normal saline

LR

plasma-lyte

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14
Q

What are the different types of crystalloids?

A

isotonic crystalloids

hypertonic crystalloid

hypotonic crystalloids

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15
Q

Describe isotonic crystalloids

A

NaCl

They distribute uniformly throughout the ECF space.

Internists tent to prefer NS and surgeons LR…intensivists prefer Plasma-Lyte.

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16
Q

What are isotonic crystalloids used for?

A

for tx of dehydration/hypovolemia

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17
Q

What is hypertonic crystalloid?

A

3% NS

use very cautiously!

  • good in situations where there is life-threatening hyponatremia
  • also somestimes used in neurosurg pts to decrease cerebral edema
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18
Q

When you use hypertonic crystalloid need to be careful not to cause….

A

central pontine myelinolysis

-Overly rapid correction of sodium can lead to osmotic demyelination

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19
Q

How do hypotonic crystalloids work?

A

distribute throughout the total body water, used for maintenance fluids

not used for tx of dehydration/hypovolemia- not really used in general

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20
Q

What is D5W?

A

another type of crystalloid

5% dextrose in water

used to tx hypoglycemia

used in hypernatremia with a free water deficit

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21
Q

Describe colloids

A

More likely to expand vascular compartment

Used when crystalloids fail to sustain plasma volume due to low osmotic pressure
-when there is sig. protein loss

22
Q

What are the dif. types of colloid fluids?

A

Albumin** used clinically

Dextran

Hydroxyethyl Starch

23
Q

When do we use Albumin?

A

Used in edematous patients to mobilize interstitial fluid into the vascular space
-not really used if albumin is norm.

24
Q

Which pts are albumin helpful in?

A

in patients with liver disease, peritonitis or burns or surgical patients experiencing “third spacing”

25
Q

Crystalloid v. Albumin

A

Albumin temporarily increases MAP

BUT no dif. in mortality

26
Q

What are the dif. types of blood products?

A

Packed red blood cells (PRBCs)

Platelets

Fresh frozen plasma (FFP)

Cryoprecipitate

27
Q

Most commonly used blood product?

A

PRBCs

28
Q

Describe PRBCs

A

prepared from whole blood, remain entirely within vascular space

used for blood transfusions

  • improves oxygen delivery to tissues
  • need to type and screen/cross
29
Q

I unit of PRBCs should increase Hgb by…

A

1g

30
Q

When do we transfuse blood?

A

if: actively bleeding, sxs or Hgb <7

31
Q

When are platelets used?

A

in patients with thrombocytopenia or impaired platelet function to prevent or treat bleeding

32
Q

What is fresh frozen plasma (FFP)? What is it used for?

A

Contains all factors of the soluble coagulation system

Used to correct major bleeding complications in patients on warfarin and/or with a vitamin K deficiency

33
Q

When do you give FFP?

A

when INR is elevated?

34
Q

What is another agent that works similar to FFP?

A

PCCs

prothrombin complex concentrates

35
Q

What is cryoprecipitate?

A

Prepared by thawing fresh frozen plasma and collecting the precipitate.

-It contains high concentrations of factor VIII & fibrinogen

36
Q

When are cryoprecipitate used?

A

in pts with low fibrinogen, typically in the setting of massive hemorrhage or consumptive coagulopathy.

37
Q

What are the dif ways that we can give IVF (time wise)?

A

bolus

maintenance

replacement

38
Q

Describe Bolus IVF

A

NS, LR, and Plasma-Lyte can be given as a bolus depending on the clinical situation

can give 250ml-IL

caution in pts with HF

39
Q

How do you determine how much fluids to give?

A

depending on how dry they are

can give a L at a time, reassessing btwn each

(Assuming no HF or other concern from volume overload)

40
Q

Describe maintenance IVF

A

Maintains/accounts for ongoing losses of water and electrolytes under normal physiologic conditions via urine, sweat, respirations, and stool

goal is to provide water and lyte balance

41
Q

When are maintenance IVF used?

A

when pts are not eating/drinking norm.

42
Q

What are some common fluids for maintenance?

A

NS, plasma-lyte, LR

D5/0.5NS +/- 20 meg KCL

43
Q

What can we used to determine rate for maintenance IVF?

A

“the Kg method” (body weight) to determine water needs

44
Q

How are calculated maintenance IVF different for peds as opposed to adults

A

“Kg method”

but children require less sodium than adults

45
Q

What are the 3 most common rates for maintenance fluids in adults?

A

75ml/hr, 100ml/hr, 125ml/hr

46
Q

maintenance IVF & potassium can be used to tx…

A

hypokalemia or for maintenance fluids if pt NPO

47
Q

Role for replacement IVF?

A

Corrects any existing water and electrolyte deficits caused by GI, urinary, skin, or blood losses or “third-spacing”

48
Q

amount of replacement fluids in surg pts should be determine based on?

A

UOP and vitals

49
Q

Replacement fluids in burn pts?

A

use parkland formula

-total fluid required during 1st 24 hrs

(percentage of 2nd/3rd deg burns) x (body weight in kg) x 4ml

50
Q

How do you determine percentage of body burned?

A

rule of nines

Foundations II- Nephrology (7 decks)

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