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CMT-dos > IV Fluids & Management > Flashcards

IV Fluids & Management Flashcards

1
Q

Adult human body male and female water content

A

60% water in men and 55% water in women
Why is there a total body weight difference between men and women? muscle mass

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2
Q

Intracellular fluid(ICF)

A

All fluid enclosed in cells by plasma membranes

~2/3 of thetotal body water
The fluid volume tends to be very stable because the amount of water in living cells is closely regulated

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3
Q

Extracellular fluid(ECF)

A

Extracellular fluid(ECF)
Fluid outside the cells

~1/3 of the total body water
2 primary constituents:
Intravascular fluid (plasma) - the fluid component of the blood
Interstitial fluid(IF) surrounding all cells

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4
Q

Fluid Spacing

definition

A

Term that describes thedistribution of water present in a body

breaks down into first second and third spacing.

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5
Q

First spacing

A

Normal distribution of fluid in the intracellular compartment and extracellular compartment

Extracellular fluids are distributed between the interstitial compartment (tissue) and intravascular compartment (plasma) in an approximately 75%-25% ratio

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6
Q

Second spacing

A

Abnormal accumulation of interstitial fluid in the body (edema); able to move back into first spacing

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7
Q

Third spacing

A

Mobilization of body fluid to a non-contributory space rendering it unavailable to the circulatory system (ascites)

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8
Q

Osmosis

A
  • Spontaneous movement of water across a semipermeable membrane
  • Water moves from a region of ↓ solute concentration → a region of ↑ solute concentration
  • Tends to equalize the solute concentrations on either side of the membrane
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9
Q

Osmotic pressure
What does it depend on

A
  • Hydrostatic pressurenecessary to counteract the process of osmosis
  • Depends on the solute concentration
    ↑ osmotic pressure with high solute concentration
  • NOT dependent on the mass or size of the molecules
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10
Q

Tonicity

A

The capability of a solution to modify the volume of cells by altering their water content

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11
Q

On the first day in the hospital, a medical resident administers 100% water to a patient instead of normal saline. What are the consequences?

A. RBCs will shrink
B. RBCs will swell and burst
C. Serum Na concentration will increase
D. Total body sodium will decrease
E. Increase in serum pH

A

B. RBCs will swell and burst

water is hypotonic

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12
Q

Osmolality andosmolarity

A

Osmolar concentration of a solution = How much solute is present

In medicine, osmolarity and osmolalitycan be used interchangeably
Normal range: 275–295 mOsm/kg
Calculation of plasma/serum osmolality =2 x (Na+) + (Glucose mg/dL /18) + (BUN/2.8)

80% of the totalosmolarity of IF andplasma is due to Na+ and Cl-ions

50% of the totalosmolarityofICFis due to K+ ions; the remainder is due to other intracellular substances

~osmalarity is talking about amount of solute in volume (L)

~osmolality is amount in weight

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13
Q

Plasma/serum osmolality

iso/hyper/hypo-tonic

A
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14
Q

57-year-old male patient with Hyponatremia (Plasma Na+ < Cell Na+)

So, is the plasma osmolality high or low in this patient?

What type of fluid would we NOT want to give this patient? Why?

A

Low
Hypotonic, they are always deficient in sodium

hypertonic solution to replenish

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15
Q

Water Balance is influenced by

A

Water intake = Water output
Influenced by:
Dietary intake
Physical activity level
Age
Environmental conditions
Majority of intake = GI tract
Majority of output = Urine

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16
Q

Regulation of Water Intake & Loss

Hypothalamic Thirst Center

A

Stimulated when osmoreceptors
Increase in plasma osmolality (2-3%)
Decrease in blood volume or pressure (10-15%)

Patient will experience:
Dry mouth
Sensation of thirst

Drinking water → inhibition of the thirst center
Inhibitory feedback signals include:
Relief of dry mouth
Activation of stomach and intestinal stretch receptors

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17
Q

Regulation of Water Intake & Loss

Antidiuretic hormone (ADH)

A

Hypothalamus will stimulate the releases (ADH) from the posterior pituitary gland in a patient with dehydration

ADH works at the level of the kidneys to recover water from urine

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18
Q

Regulation of Water Intake & Loss

Aldosterone

A

Kidneys have a renin-angiotensin hormonal system that increases the production of angiotensin II → stimulate thirst and stimulate the release of the hormone aldosterone from the adrenal glands

Increases the reabsorption of sodium in the distal tubules of the nephrons in the kidneys, and water follows the reabsorbed sodium back into the blood

19
Q

IV fluids

Common indications (4)

A
  1. Fluid resuscitation
  2. Correction of electrolyte imbalances
  3. Maintenance of fluids for patients that cannot take fluids enterally
  4. IV medication delivery
20
Q

IV fluids

2 categories with differing compositions

A

Crystalloid solutions
Contain small molecular weight solutes (minerals, dextrose) and sterile water

Colloid solutions
Contain large molecular weight solutes (albumin, blood pr oducts) and sterile water

21
Q

Crystalloid Solutions

general

A

Most commonly used IV fluids
Consist of aqueous electrolyte solutions with varying concentrations

DO NOT readily cross plasma membranes, but
DO cross capillary membranes

Will this fluid be distributed to the interstitial space?
Will this fluid be distributed to the intracellular space?

Isotonic, Hypotonic, Hypertonic, Mixed, or Concentrated

22
Q

Isotonic crystalloid solutions

Normal Saline (0.9% NaCl)

A

Contains equal mEq/L of Na+ and Cl-
↑ extracellular volume
No change in intracellular volume

Indications:
Fluid resuscitation
Maintenance fluid therapy
Solvent for IV drugs

23
Q

Isotonic crystalloid solutions

Normal Saline (0.9% NaCl)
RISKS

A

Hyperchloremic non-anion gap metabolic acidosis
Seen with large volume administration; Cl- can have negative effects on kidney function
Fluid overload

24
Q

Isotonic crystalloid solutions

Lactated Ringer’s Solution (LR)

A

Contains Na+, Cl-, K+, Ca2+, and lactate
↑ extracellular volume
Minimally ↑ intracellular volume
Mild buffering action to prevent acidosis

Indications:
Fluid resuscitation
Maintenance fluid therapy

25
Q

Lactated Ringer’s Solution (LR)

risks

A

Risks:
Accumulation of lactate in patients with liver failure
Possible hyperkalemia
Fluid overload

26
Q

Hypotonic crystalloid solutions

Dextrose Solutions

types and indications

A

Types:
5% dextrose in water (D5W)
10% dextrose in water (D10W)
↑ extracellular volume and ↑ intracellular volume

Indications:
Correction of free water deficit (mild hypernatremia)
Maintenance fluid therapy in specific cases-Hypoglycemia, Ketosis secondary to alcohol or fasting

27
Q

Dextrose solutions

risks

A

Risks:
Hyponatremia
Hypokalemia
Hyperglycemia
Cerebral and pulmonary edema

28
Q

Hypotonic crystalloid solutions

Saline Solutions

types and indications

A

Types:
0.45% NaCl (1/2 NS)
0.22% NaCl (1/4 NS)
↑ extracellular volume and ↑ intracellular volume

Indications:
Correction of free water deficit (mild hypernatremia)
Maintenance fluid therapy in specific cases

29
Q

Hypotonic crystalloid solutions

Saline solution risks

A

Risks:
Hyponatremia
Cerebral and pulmonary edema

30
Q

Comparison of common crystalloid solutions

A

dont memorize, just helpful

31
Q

Hypertonic crystalloid solutions

types and general

A

Types:
3% NaCl
5% NaCl
Contains high equal mEq/L of Na+ and Cl-
↓ intracellular volume and ↑ extracellular volume
Indications:
Severe hyponatremia
Treatment of cerebral edema

FYI…Infuse at a slow rate and check serum sodium frequently when hypertonic saline is being administered!

32
Q

Hypertonic crystalloid solutions

risks

A

Risks:
Osmotic demyelination syndrome – damage to the myelin sheath of nerves in the CNS caused by a sudden rise in the osmolarity of the blood

don’t worry about this for exam

33
Q

Mixed crystalloid solutions

Dextrose in saline solutions

A

5% dextrose in 0.9% NaCl (isotonic) or 5% dextrose in 0.45% NaCl (hypotonic)

Indications:
Fluid resuscitation
Maintenance fluid therapy

34
Q

Mixed crystalloid solutions

Isotonic bicarbonate (1.3% NaHCO3)

A

Isotonic bicarbonate (1.3% NaHCO3)
Indications:
Correction of severe metabolic acidosis; usually reserved for very low pH ≤ 7.1
Urinary alkalinization: to decrease the toxicity of specific drugs (salicylate toxicity, chemotherapy, IV contrast)
Correction of true bicarbonate deficit
Severe diarrhea
Renal tubular acidosis with metabolic acidosis and hyperkalemia

35
Q

Mixed crystalloid solutions

risks

A

Metabolic alkalosis
Hypernatremia
Hyperglycemia

36
Q

Concentrated crystalloid solutions

8.4% sodium bicarbonate

indication and risks

A

Available in ampules of 50 mL (50 mEq)
Indications:
Antidote for sodium channel blocker toxicity (antiarrhythmics – classes 1A, 1B, and 1C, carbamazepine, lamotrigine, tricyclic antidepressants, cocaine)
Severe metabolic acidosis

Risks:
Metabolic alkalosis
Hypernatremia

37
Q

Concentrated crystalloid solutions

50% dextrose in water (D50W)

general and risk

A

Available in ampules of 25 mL or 50 mL

Indications:
Rapid reversal of hypoglycemia
Adjunctive treatment of hyperkalemia when combined with insulin – will enhance the uptake of K+ in the cells

Risks:
Hyperglycemia

38
Q

Colloidal solutions

general

A

Solutions that contain large proteins or cells

DO NOT readily cross capillary membranes and therefore remain in the intravascular space

39
Q

Colloidal solutions

Albumin

general and risks

A

Albumin (25% Human albumin)
A naturally occurring colloid and the most abundant protein inplasma
↑ extracellular volume

Indications:
Cirrhosis
Critically ill patients (ARDS, septic shock, severe burns, etc.)

Risks:
Fluid overload
Allergic reactions

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41
Q

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CMT-dos (95 decks)

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