Lecture 1 - Fluids Flashcards
IBW Male Equation
50 kg + (2.3 x in over 60in)
IBW Female Equation
45.5 kg + (2.3 x in over 60in)
Dry weight = ___ weight = ___ weight
admit, actual
Adjusting Weights
- NBW is used if ABW > ___ % of IBW
- NBW Equation: ___
- applies for calculating ___ parameters
- 130 %
- NBW = IBW + 0.25(wt - IBW)
- FEN
FEN = fluid, electrolyte and, nutrition
T or F: use DBW for FEN parameters if ABW > 130%
FEN = fluid, electrolyte and, nutrition
F: DBW is used for dosing drugs, not FEN
fluid makes up ___ % body weight
* ___ % intracellular
* ___ % extracellular
- 60
- 40
- 20
extracellular fluid is 3/4 ___ and 1/4 ___
- interstitial
- intravascular
fluid intake = fluid ___
losses
sensible loss sources (3)
1-1.5 L/day
- urination
- defecation
- wounds
insensible loss sources
1 L/day
- sweating
- exhaling
volume regulation is governed by (3)
- kidneys
- thirst
- hormonal changes
volume regulation
ADH
- reduces production of ___
- increases water ___
- urine
- retention
volume regulation
Renin-Angiotensin Aldosterone System (RAAS)
- renin secretion
- ___ and ___ regulation (aldosterone)
- Na, water
volume regulation
Atrial Naturetic Peptide (ANP)
- decreases ___ release
- counteracts effects of ___
- ADH
- RAAS
Tonicity of Fluids - Ranges
- Isotonic
- Hypotonic
- Hypertonic
- 275-290 mOsm/L
- < 275 mOsm/L
- > 290 mOsm/L
Osmolarity - measure of ___ concentration
- dependent on ___ and ___
solute
* pH and temp
Osmolarity of 0.45% NaCl
154 mOsm/L
Total Osmolarity = IV + electrolytes
Calculate osmolarity of 1L of 0.45% NaCl with 20 mEq KCl
154 mOsm/L + (20 mEq/L)x(2 mOsm/mEq) = 194 mOsm/mEq
KCl = 2 ions = 2 mOsm/mEq
MIVF Requirements
clinical estimate: ___ mL/kg/day
30-40 mL/kg/day
T or F: Crystalloids can be iso, hyper, and hypotonic
T
T or F: Colloids are hypotonic only
F: HYPERtonic
Crystalloids include
NS, 1/2 NS, D5W, LR, and balanced salt solutions
Colloids include
albumin, hetastarch, tetrastarch, blood, plasmanate
crystalloid solutions
- provide ___ and/or ___
- maintain ___ between intravascular and extravascular compartments
- water, Na
- osmotic gradient
crystalloid soutions
NS is used for intravascular fluid replacement ( ___ )
* ___ and/or ___ replacement
- resuscitation
- Na, Cl
crystalloid soutions
1/2 NS is used for ___ fluids (combination products)
maintenance
crystalloid soutions
LR (lactated ringers) are used for
- ___ loss
- ___ (trauma, burn, etc)
- approximates human ___
- blood
- resuscitation
- plasma
crystalloid soutions
D5W is used for ___ replacement
* NOT a ___
* NOT a ___ alone
free water
- resuscitative
- MIVF
crystalloid soutions
balanced salt solutions contain ___ levels of chloride and buffer solutions
examples (3)
- physiologic
- LR
- Normosol-R
- Plasma-lyte
NS vs Balanced Salt
- ↑ mortality
- ↑ hyperchloremic metabolic ___
- ↑ blood transfusions
- ↑ ___ injury
- ↑ hyper___
- ↑ postop ___
- acidosis
- renal
- hyperkalemia
- infection
colloid solutions
- used to increase plasma oncotic ___
- move fluid from the interstitial to ___
- “___ expanders”
- 2nd line for ___ shock
- pressure
- intravascular
- plasma/volume
- hypovolemic
Which has a longer half life: colloids or crystalloids?
Colloids; increased molecular weight corresponds to increased intravascular retention time
T or F: Colloids can be used as MIVF
False
colloid solutions
Albumin uses
- ___ expansion
- shock
- burn
- acute respiratory distress syndrome
- cardiopulmonary ___
- ____ fluid repletion
- volume
- bypass
- intraoperative
colloid solutions
Albumin adverse effects
- ___volemia
- ___temia
- infusion related reaction/____
- HYPERvolemia
- Azo
- anaphylaxis
T or F: Albumin 25% is better for fluid/Na restricted pts
T; less volume needs to be given vs 5%
T or F: albumin 25% is better for hypovolemic or intravasculalry depleted patients
F; 5% is better bc you have to give more volume
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
- substitution, glucose
- expansion
- coagulation
- sepsis
colloid solutions
Blood uses
- acute blood loss (___ % of blood volume)
- inadequate ___ from fluids alone
- preoperatively
- low hemoglobin ( < ___ g/dL )
- 30-40%
- resuscitation
- 7-8 g/dL
colloid solutions
how many mLs in 1 unit of blood?
1 unit increases hemoglobin by about ___ g/dL
230-350 mLs
1 g/dL
Most common MIVF: ___
- used to increase plasma oncotic ___
- similar composition to urine
D5W + 1/2NS + 20 mEq KCl/L
* pressure
Monitoring Fluid Status
- daily weight
- daily ins/outs
- volume status (overload, euvolemic, ___ )
- ___ output (UOP) mL/kg/hr
- Vitals (HR, BP, invasive ___ parameters)
- dehydration
- urine
- hemodynamic
invasive hemodynamic parameteres = Swan-Ganz PA Catheter
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
- turgor
- membranes
- capillary
- hypotension
- peripheral
- 0.5 mL/kg/hr
- 20
