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PHRM 844 > Lecture 1 - Fluids > Flashcards

Lecture 1 - Fluids Flashcards

1
Q

IBW Male Equation

A

50 kg + (2.3 x in over 60in)

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2
Q

IBW Female Equation

A

45.5 kg + (2.3 x in over 60in)

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3
Q

Dry weight = ___ weight = ___ weight

A

admit, actual

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4
Q

Adjusting Weights

  • NBW is used if ABW > ___ % of IBW
  • NBW Equation: ___
  • applies for calculating ___ parameters
A
  • 130 %
  • NBW = IBW + 0.25(wt - IBW)
  • FEN

FEN = fluid, electrolyte and, nutrition

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5
Q

T or F: use DBW for FEN parameters if ABW > 130%

FEN = fluid, electrolyte and, nutrition

A

F: DBW is used for dosing drugs, not FEN

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6
Q

fluid makes up ___ % body weight
* ___ % intracellular
* ___ % extracellular

A
  • 60
  • 40
  • 20
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7
Q

extracellular fluid is 3/4 ___ and 1/4 ___

A
  • interstitial
  • intravascular
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8
Q

fluid intake = fluid ___

A

losses

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9
Q

sensible loss sources (3)

1-1.5 L/day

A
  • urination
  • defecation
  • wounds
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10
Q

insensible loss sources

1 L/day

A
  • sweating
  • exhaling
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11
Q

volume regulation is governed by (3)

A
  • kidneys
  • thirst
  • hormonal changes
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12
Q

volume regulation

ADH
- reduces production of ___
- increases water ___

A
  • urine
  • retention
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13
Q

volume regulation

Renin-Angiotensin Aldosterone System (RAAS)
- renin secretion
- ___ and ___ regulation (aldosterone)

A
  • Na, water
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14
Q

volume regulation

Atrial Naturetic Peptide (ANP)
- decreases ___ release
- counteracts effects of ___

A
  • ADH
  • RAAS
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15
Q

Tonicity of Fluids - Ranges

  • Isotonic
  • Hypotonic
  • Hypertonic
A
  • 275-290 mOsm/L
  • < 275 mOsm/L
  • > 290 mOsm/L
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16
Q

Osmolarity - measure of ___ concentration
- dependent on ___ and ___

A

solute
* pH and temp

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17
Q

Osmolarity of 0.45% NaCl

A

154 mOsm/L

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18
Q

Total Osmolarity = IV + electrolytes

Calculate osmolarity of 1L of 0.45% NaCl with 20 mEq KCl

A

154 mOsm/L + (20 mEq/L)x(2 mOsm/mEq) = 194 mOsm/mEq

KCl = 2 ions = 2 mOsm/mEq

19
Q

MIVF Requirements

clinical estimate: ___ mL/kg/day

A

30-40 mL/kg/day

20
Q

T or F: Crystalloids can be iso, hyper, and hypotonic

A

T

21
Q

T or F: Colloids are hypotonic only

A

F: HYPERtonic

22
Q

Crystalloids include

A

NS, 1/2 NS, D5W, LR, and balanced salt solutions

23
Q

Colloids include

A

albumin, hetastarch, tetrastarch, blood, plasmanate

24
Q

crystalloid solutions

  • provide ___ and/or ___
  • maintain ___ between intravascular and extravascular compartments
A
  • water, Na
  • osmotic gradient
25
Q

crystalloid soutions

NS is used for intravascular fluid replacement ( ___ )
* ___ and/or ___ replacement

A
  • resuscitation
  • Na, Cl
26
Q

crystalloid soutions

1/2 NS is used for ___ fluids (combination products)

A

maintenance

27
Q

crystalloid soutions

LR (lactated ringers) are used for
- ___ loss
- ___ (trauma, burn, etc)
- approximates human ___

A
  • blood
  • resuscitation
  • plasma
28
Q

crystalloid soutions

D5W is used for ___ replacement
* NOT a ___
* NOT a ___ alone

A

free water
- resuscitative
- MIVF

29
Q

crystalloid soutions

balanced salt solutions contain ___ levels of chloride and buffer solutions
examples (3)

A
  • physiologic
  • LR
  • Normosol-R
  • Plasma-lyte
30
Q

NS vs Balanced Salt

  • ↑ mortality
  • ↑ hyperchloremic metabolic ___
  • ↑ blood transfusions
  • ↑ ___ injury
  • ↑ hyper___
  • ↑ postop ___
A
  • acidosis
  • renal
  • hyperkalemia
  • infection
31
Q

colloid solutions

  • used to increase plasma oncotic ___
  • move fluid from the interstitial to ___
  • “___ expanders”
  • 2nd line for ___ shock
A
  • pressure
  • intravascular
  • plasma/volume
  • hypovolemic
32
Q

Which has a longer half life: colloids or crystalloids?

A

Colloids; increased molecular weight corresponds to increased intravascular retention time

33
Q

T or F: Colloids can be used as MIVF

A

False

34
Q

colloid solutions

Albumin uses
- ___ expansion
- shock
- burn
- acute respiratory distress syndrome
- cardiopulmonary ___
- ____ fluid repletion

A
  • volume
  • bypass
  • intraoperative
35
Q

colloid solutions

Albumin adverse effects
- ___volemia
- ___temia
- infusion related reaction/____

A
  • HYPERvolemia
  • Azo
  • anaphylaxis
36
Q

T or F: Albumin 25% is better for fluid/Na restricted pts

A

T; less volume needs to be given vs 5%

37
Q

T or F: albumin 25% is better for hypovolemic or intravasculalry depleted patients

A

F; 5% is better bc you have to give more volume

38
Q

Synthetic Colloids

Heta and Tetrastarch
- High ___ ratios (# of hydroxyethyl groups per ___)
- results in prolonged intravascular ___
- large molecular weight causes ____
- Saftey concerns with severe ___

use with caution

A
  • substitution, glucose
  • expansion
  • coagulation
  • sepsis
39
Q

colloid solutions

Blood uses
- acute blood loss (___ % of blood volume)
- inadequate ___ from fluids alone
- preoperatively
- low hemoglobin ( < ___ g/dL )

A
  • 30-40%
  • resuscitation
  • 7-8 g/dL
40
Q

colloid solutions

how many mLs in 1 unit of blood?
1 unit increases hemoglobin by about ___ g/dL

A

230-350 mLs
1 g/dL

41
Q

Most common MIVF: ___
- used to increase plasma oncotic ___
- similar composition to urine

A

D5W + 1/2NS + 20 mEq KCl/L
* pressure

42
Q

Monitoring Fluid Status

  • daily weight
  • daily ins/outs
  • volume status (overload, euvolemic, ___ )
  • ___ output (UOP) mL/kg/hr
  • Vitals (HR, BP, invasive ___ parameters)
A
  • dehydration
  • urine
  • hemodynamic

invasive hemodynamic parameteres = Swan-Ganz PA Catheter

43
Q

Signs of dehydration

  • decreased skin ___
  • dry mucus ___
  • delayed ___ refill
  • tachycardia and ___
  • weak ___ pulse
  • decreased urine output (< ___ mL/kg/hr), dark and concentrated
  • BUN/Scr ratio > ___

vary based on age, disease state, meds, cause of fluid depletion

A
  • turgor
  • membranes
  • capillary
  • hypotension
  • peripheral
  • 0.5 mL/kg/hr
  • 20

PHRM 844 (52 decks)

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