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Y3R4 - BMS 🏥 > L12: Fluid Therapy > Flashcards

L12: Fluid Therapy Flashcards

1
Q

MindMap of Fluid Therapy

A
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2
Q

Body water

A
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3
Q

Characters of Fluid movement between the intravascular & interstitial spaces

A
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4
Q

ICF about …… of TBW & ECF about ….. of TBW.

A
  • 55-75%
  • 25-45%

Intravascular (1) : Extravascular (3)

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5
Q

Concentration of electrolytes in body

A
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6
Q

what ion represents a Principal component of ECF?

A

Na

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7
Q

Role of Na in fluid balance

A

Responsible for much of extracellular fluid osmolality.

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8
Q

what ion represents a Principal component of ICF?

A

K

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9
Q

Role of K in action potential

A

key role in the maintenance of transmembrane potentials.

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10
Q

Classification of IV Fluids

A
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11
Q

Compare between Crystalloids & Colloids in terms of:

  • Composition
  • Characters
  • Importance
A
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12
Q

Mindmap of crystalloids & Colloids

A
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13
Q

Def of Crystalloids

A
  • Electrolyte solutions with small molecules that can diffuse freely from intravascular to interstitial fluid compartments.
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14
Q

what is a principal component of Crystalloids?

A

sodium chloride

  • Sodium is principal determinant of extracellular volume, and is distributed uniformly in the extracellular fluid.
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15
Q

Volume effect of Crystalloids

A
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16
Q

Classification of Crystalloids according to tonicity

A
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17
Q

Classification of Crystalloids according to ionization

A
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18
Q

General Characters of Crystalloids

A
  • Contains water & electrolytes.
  • Non-ionic solutions expand all the compartments (Intracellular & extracellular space).
    Sodium cannot gain access into the intracellular space.
  • Hence all sodium will remain in the extracellular space thus expanding
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19
Q

what is One of the most commonly administered crystalloids?

A

Normal Saline

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20
Q

History of Normal Saline

A
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21
Q

Uses of normal saline across the history

A
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22
Q

what are names of Normal Saline?

A

0.9% saline
= Normal saline = Physiological saline = Isotonic saline

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23
Q

why are none of the previous names accurate?

A
  • The concentration of a one-normal (1 N) NaCL solution is 58 grams per liter How? Molecular weights of sodium + molecular weights of chloride = 23 + 35 = 58
  • While 0.9% NaCL contains only 9 grams of NaCL per liter.
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23
Q

Composition of Normal Saline

A
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24
Q

Pharmacological basis of Normal Saline

A
  • Provide major extracellular electrolytes.
  • Corrects both water & electrolyte deficit.
  • Increase intravascular volume substantially.
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25
Q

Volume effects of Normal Saline

A
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25
Q

what are disadvantages of Normal Saline?

A
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26
Q

Indications of Normal Saline

A
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26
Q

Limitations of Normal Saline

A
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26
Q

why is Normal Saline used in hypovolemic shock?

A
  • Distributed in ECS expanding the intravascular volume.
  • Ideal fluid to Increase blood pressure.
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27
Q

History of Ringer Fluids

A
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28
Q

Composition of Ringer Lactate

A
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28
Q

why is Ringer Lactate the most physiological fluid? and what are the advantages of this?

A
  • As the electrolyte content is similar to that of plasma, So Larger volumes can be infused without the risk of electrolyte imbalance.
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28
Q

Pharmacological basis of Ringer Lactate

A

The most physiological fluid:
- As the electrolyte content is similar to that of plasma.

  • So Larger volumes can be infused without the risk of electrolyte imbalance.

Effective in treatment of hypovolemia:
- Due to high Nat content (130mEq/L) -> Rapidly expands intravascular volume.

Useful in correction of metabolic acidosis:
- As sodium Lactate in RL is metabolized to Bicarbonate in the liver.

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29
Q

what is the most physiological fluid?

A

Ringer’s Lactate

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30
Q

Advantages of Ringer Lactate

A

Lack of significant effect on acid base balance.

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31
Q

why isn’t it recommended to give Ringer Lactate with Stored blood?

A

lonized calcium “in ringer’s lactate” Binds to citrated anticoagulant “in stored blood” and Promote formation of clots.

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31
Q

Disadvantages of Ringer Lactate

A
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32
Q

why isn’t Ringer Lactate recommended in critically ill patients with impaired lactate clearence?

A

“due to circulatory shock or hepatic insufficiency” —-> Can 11 serum lactate levels.

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33
Q

Indications of Ringer Lactate

A
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34
Q

what is the fluid of choice in Diarrhea-induced dehydration in pediatric patients?

A

Ringer’s lactate

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34
Q

Limitations of Ringer Lactate

A
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35
Q

why is Ringer Lactate CI in vomiting or continuous nasogastric aspiration?

A

Hypovolemia is associated with metabolic alkalosis, As RL provides HCO3 - Worsens alkalosis.

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36
Q

what drugs should you avoid giving Ringer’s lactate with? and why shouldn’t we?

A
  • Amphotericin
  • Ampicillin
  • Thiopental
  • Doxycycline

Calcium binds with these drugs and #I bioavailability & efficiency.

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37
Q

Types of Dextrose Solutions

A
38
Q

Effects of Dextrose Solutions

A
  • Protein sparing effects.
  • Volume effect.
  • Lactate production.
  • Effect of hyperglycemia.
39
Q

Composition of D5W

A
  • Glucose 50 gm/L.
  • Free water.
40
Q

Volume effects of D5W

A
41
Q

Pharmacological basis of D5W

A
  • Corrects Dehydration.
  • Supplies Energy (70kca/L).
  • Administered safely at the rate of 0.5 gm/kg/hr without causing glycosuria.
42
Q

Metabolism of D5W

A
43
Q

Indicatations of D5W

A
44
Q

Limitations of D5W

A
45
Q

Why is D5W CI in neurological Procedures?

A

aggravate Cerebral edema & 1t ICT.

46
Q

D5W in acute Ischemic stroke

A
47
Q

why is D5W CI in hypovolemic Shock?

A
  • Poor expansion of intracellular volume.
  • Faster rate of infusion —-> osmotic diures. —>
    © Worsens shock
    © False impress of the hydration status decreases Fluid replacement.
48
Q

what does D5W cause in cases of hyperinfusion?

A
49
Q

Blood & dextrose solutions should not be administered in same IV line, why?

A

Hemolysis & clumping seen due to hypotonicity of the solution.

50
Q

Composition of D10W

A

1 liter of 10%D has 100 gm glucose

51
Q

Composition of D25W

A

1 liter of 25%D has 250 gm glucose

52
Q

Pharmacological basis of D10W & D25W

A
53
Q

Indications of D10W & D25W

A
54
Q

Limitations of D10W & D25W

A
55
Q

why are D10W & D25W indicated in liver diseases?

A

given as first drip, it inhibits glycogenolysis & gluconeogenesis

56
Q

Composition of DNS

A
57
Q

Volume effects of DNS

A
58
Q

If glucose utilization is impaired as is common in critically ill patients), large-volume infusion of D5W can result in …….

A

cellular dehydration.

59
Q

Pharmacological basis of DNS

A
60
Q

Indications of DNS

A
61
Q

what is DNS not the ideal fluid in salt depletion & hypovolemia?

A
  • Faster rate of infusion —> osmotic diuresis —> Worsens shock
  • False impress of the hydration status - Il Fluid replacement.
62
Q

Limitations of DNS

A
63
Q

Composition of D1/2NS

A
64
Q

Pharamacological Basis of D1/2NS

A
  • Contains 50% salt as compared to DNS & NS
  • Used when there is need for: Calorie, More water, Less salt.
65
Q

Indications of D1/2NS

A
66
Q

Limitations of D1/2NS

A
67
Q

what are examples of Hyperosmolar Fluids?

A
  • Mannitol
  • Hypertonic Saline
68
Q

Def of Mannitol

A

Osmotic diuretic that is metabolically inert in human.

69
Q

Pharmacological basis of Mannitol

A
70
Q

Complications of Mannitol

A
  • Rebound edema.
  • Renal failure.
  • Dehydration: due to osmotic diuresis.
71
Q

Limitations of Mannitol

A
  • Anuria due to severe renal disease.
  • Cannot be used in patients with hypotension.
  • Severe pulmonary congestion or frank pulmonary edema.
  • Active intracranial bleeding except during craniotomy.
  • Severe dehydration.
  • Progressive renal damage or dysfunction after institution of mannitol therapy, including increasing oliguria & azotemia.
72
Q

Types & Composition of Hypertonic saline

A
73
Q

Pharamcological Properties of Hypertonic saline

A
  • The hypertonic nature of these solutions draws water out of the intracellular compartment into the extracellular compartment
74
Q

Indications of Hypertonic saline

A
75
Q

definition of Colloids

A

A saline fluid with large solute molecules that do not readily pass from plasma to interstitial fluid.

76
Q

History of Colloids

A
  • The term colloid is derived from Greek word “Glue”
  • These solutions are also called suspensions.
77
Q

Characters of Colloids

A
78
Q

General Characteristcs of Colloids

A
79
Q

Capillary Fluid Exchange

A
80
Q

Crysatlloid fluid effect on COP

A

Decrease The plasma COP (dilutional effect): Which favors the movement of these fluids out of the bloodstream.

81
Q

Colloid fluid effect on COP

A
82
Q

Colloid fluid is about ……. more effective in expanding the plasma volume than the crystalloid fluid.

A

3 times

83
Q

Characteristics of IV colloids fluids per 100 ml infusion

A
84
Q

Classification of colloids

A
85
Q

Formation of Albumin

A

Albumin is a versatile plasma protein, synthesized only in the liver.

86
Q

Half-Life of Albumin

A

Approximately 20 days.

87
Q

Types of Albumin

A
  • 5% albumin
  • 25% albumin
88
Q

Compare between 5% albumin & 25% in terms of:

  • Concentration
  • COP
  • Volume Effect
  • Rate
A
89
Q

Importance of Albumin

A
  • Principal determinant of plasma colloid osmotic pressure COP 75-80 % of the oncotic pressure”.
  • Principal transport protein in blood.
  • Has significant antioxidant activity.
  • Helps maintain the fluidity of blood by inhibiting platelet aggregation.
90
Q

Indications of Albumin

A
91
Q

Limitations of Hyperoncotic (25%) albumin

A
  • Should not be used for volume resuscitation in patients with blood loss, Because it does not replace lost volume, but instead shifts fluid from one compartment to another.
  • Has been associated with an If risk of renal injury & death in patients with circulatory shock.
92
Q

Limitations of 5% albumin

A

Safe to use as a resuscitation fluid…
* Except possibly in traumatic head injury

93
Q

Limitations commom in both Hyperoncotic (25%) albumin & 5% albumin

A
  • Fast infusion > Rapidly If circulatory volume ..* vascular overload & pulmonary edema.
  • Dehydrated patient may require additional fluids along with albumin.
  • Contraindicated in severe anemia & cardiac failure.
  • Should not be used as parenteral nutrition.
94
Q

Elimination of HES

A

Metabolism:
- Hydrolysis by amylase enzymes in the bloodstream, which cleave the parent molecule until it is small enough to be cleared.

Excretion:
- Cleared by the kidneys. Cleared by the kidneys.

95
Q

Nature of HES

A
  • Chemically modified polysaccharide.
  • Derivatives of amylopectin “which is a highly branched compound of starch”.
  • Composed of long chains of branched glucose polymers, Substituted periodically by hydroxyl radicals (OH) “which resist enzymatic degradation”
96
Q

Disadvantages of Albumin

A

Cost effectiveness:
- Albumin is expensive as compared to synthetic colloids.

Cause volume overload:
- In septic shock, the release of inflammatory mediators has been implicated in If the ‘leakiness’ of the vascular endothelium.

  • So The administration of exogenous albumin may compound the problem by adding to the interstitial edema.
97
Q

Phsyiochemical properties of HES

A
98
Q

Advantages of HES

A

Cost effectiveness
- HES is less expensive as compared to albumin & is associated with a comparable volume of expansion.

Maximum allowable volume:
- Maximum volume which can be transfused of “medium weight HES (130 kDa) with medium degree of substitution (0.4)” is greater as compared to other synthetic colloids like dextrans.

  • decrease The estimated incidence of anaphylactic reactions compared to other colloids.
99
Q

Indications of HES

A
  • Stabilization of systemic hemodynamics.
  • Anti-inflammatory properties.
  • HES has been shown to preserve intestinal microvascular perfusion in endotoxemia, Due to their anti-inflammatory properties.
100
Q

Disadvantages of HES

A
101
Q

How does HES affect coagulation?

A

By decreasing The following:
- Fibrinogen.
- Platelet aggregation.
- WWF (Von Willebrand Factor).
- Factor Vill.

leading to
- Increasing PTT, PT & bleeding time.

102
Q

HES & Increasing serum amaylase Concentration

A
  • During use.
  • & 3-5 days after discontinuation.
103
Q

HES products with medium to high MW are associated with ……

A
  • Oliguria.
  • Increase Creatinine.
  • Acute Kidney Injury

In critically Ill patients with preexisting renal impairment

Y3R4 - BMS 🏥 (18 decks)

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