Lytes/fluids Flashcards
Extra cellular fluids
1/3 of our fluids
Plasma and interstitial fluid between cells
passive transport in and out of cell depending on osmotic and hydrostatic pressure
Electrolytes pass with active transport
Types of fluids
Crystalloids and colloids
Crystalloids-contains water and various electrolytes and small water soluble molecules
Colloids-large and soluble molecules including proteins- blood, albumin, higher osmotic pressure
Types of crystalloids
Isotonic-same osmolality as body 280-295
Hypotonic-less than 250, fluid moves from the ECF to the ICF shifts into the cell and swells the cell “hippo”
Hypertonic - greater than 375, pulls fluid from ICF inside the cell to the ECF, dehydrated the cell in order to have fluid external the ECF
Lab values
Osmolality 280-290
Sodium 135-145
Potassium 3.5-5.2
Calcium 4.4-5.2
Magnesium 1.8-2.4
Bicarbonate 22-26
Lactate 1
Normal saline
0.9 % NaCl consider isotonic but
308 osmolality slightly hypertonic
154 sodium and 154 chloride
Higher chloride concentration than blood to be careful can cause hyperchlormic metabolic acidosis
AKI effects GFR
Inflammation
Lactated ringers
Isotonic
Osmolarity of 273
Slightly hypotonic and has 130 of sodium, potassium 4, Chloride 109, calcium 4, lactate 2
More close to plasma levels
May lead to slight intercellular fluid shift which can worsen cerebral edema and increase ICP
Patients with hepatic hypo perfusion cannot metabolize as well
Plasmalyte
Isotonic
Osmolarity of 295
Sodium 140, potassium 5, chloride 98, magnesium 4, acetate 27
Similar to plasma
Lower risk for hyperchloremia can use with RBC as well
3% sodium chloride
Hypertonic
Draws fluid from the ICF to the ECF
Used in cerebral edema shrinks the cells
Treatment for severe symptomatic hyponatremia
Can results in intravascular overload if given too fast
0.5 normal saline or half NS
Hypotonic
Osmolarity 154
Half amount of sodium and chloride
Sodium 77, chloride 77
Shift from ECF to ICF, increase in cell size
Can lead to increase cerebral edema and increased ICP so do not give in head injury patients
Can be used for hyperbatremia patients and replace patients free water deficit
Rapid administration can lead to cell lysis and depletion of intravascular volume and lead to cardiovascular collapse
Saline with dextrose
Dextrose for hypoglycemia, alcohol, or fasting ketoacidosis, hyperkaliema with insulin
No dextrose for uncontrolled diabetes or hypokalemia
High doses in critically ill patients can increase glucose and metabolism and increased secretion of epinephrine
5%, 10% dextrose, 5% dextrose and water or D5W-Osmolality of 253 but free water hypotonic-not for head trauma
Others- 5% in half NS or D5 half NS, osmolality of 406, hypotonic
5% dextrose and normal saline or D5 NS, osmolality of 560, isotonic
5% dextrose and LR-osmolality of 527 hypertonic and isotonic
10% dextrose and water- osmolality 505, hypertonic, hypotonic too
Colloids
Volume or plasma expanders
High oncotic pressure
Stay in the vessel longer than crystalloids and do not escape into interstitial space
Potential for harm in sepsis and ARDS
Blood, albumin (5% or 25%, assist in preserving renal function in critically ill patients), dextran,
hydroxyethyl and hessian behaves like a colloid potential for hemorrhagic shock, sepsis, liver disease
Maintenance fluids, and fluid replacement
Maintenance fluid should address the patient basic physiological need, including both insensible and and sensible fluid losses
Fluid replacement goes beyond normal losses and includes condition like vomiting diarrhea burns
Choosing replacement
No surgery with isotonic or 1/2 isotonic saline
Hypotonic solutions can be used for high sodium
Isotonic or hypertonic ceiling can be used for low sodium
Isotonic saline or blood can be used with blood loss
Potassium or bicarbonate substances may need to be added a patient with high potassium and acidosis
Rate of correction of volume depletion depends on severity
With severe volume depletion or shock at least one to 2 L of isotonic fluids as rapidly as possible
Rapid fluid resuscitation does not needed though and wild, moderate hypovolemia
To avoid worsening of the volume deficit, the rate of fluid administration must be greater than the rate of continued fluid losses, which is equal to the urine output plus estimated insensible losses which is usually 30 to 50 mL per hour plus any fluid loss is like G.I. loss that may be present
Complication
Electrolyte arrangements
Be careful And those were Real failure, especially receiving potassium solutions
Monitor for fluid overload, especially in CHF patients
Normal saline is slightly acidic can precipitate metabolic acidosis
Hyponatremia
Low sodium is defined as less than 135 usually caused by excess if total body water would compare to total body sodium
Determine underlying cause- 3 types, isotonic, hypotonic and hypertonic
Hypertonic serum om is greater than 290 can be caused by high glucose
Isotonic called pseudo hyponatremia increase in serum osmolality to 284 to 295 due to protein in the blood and high cholesterol
Hypotonic, nutrient and serum ophthalmology lesson 280 can either be hypovolemic hypervolemic or euvolemic .
Hypovolemic total body water decreases more than decrease in total body serum due to G.I. loss like vomiting, diarrhea or third spacing low albumin small bowel obstruction use of diuretics use of osmotic dias
With hypervolemic the total body water increases our greater than the increases in total body sodium usually due to renal issues nephrotic syndrome, congestive heart failure, cirrhosis iatrogenic
Euvolemic are usually do drugs like SSRI , desmopressin, oxytocin, thiazides, antipsychotic, MDMA, ecstasy, NSAIDs, SIADH, Addisons, hypothyroidism, primary polydipsia, potomania, excessive fluids
Hypernatremia
Elevated sodium is when the concentration is greater than 145 usually do a water deficit and excess salt
Usually associated with low volume
Can be seen in nausea, vomiting, prolonged nasal gastric drainage burns, excessive, sweating, renal losses, diabetes, insipidus
If in a hospital setting usually due to improper formula, mixing excessive sodium bicarb, ingestion, salt, tablet, poisoning, seawater, drowning hyper aldosterone, too much sodium fluids
Hypokalemia
Due to decrease potassium intake, cellular shifts cellular, uptake, increase potassium loss, and skin, G.I. or kidney
After associated with cardiac disease, renal failure, malnutrition, and shock
Sodium disorder symptoms
Low sodium- anorexia, nausea, vomiting, fatigue, headache, muscle cramps, altered, mental status, agitation, seizures, coma
High- irritability, agitation, lethargy, somnolence, and coma, increase in thirst
Hyperkalemia
Can be pseudo due to false elevation and lab value due to homolysis or lab handling
Due to increase potassium uptake, cellular movement decrease renal excretion, rhabdomyolysis and crush injuries, metabolic acidosis, insulin deficiency and diabetic ketoacidosis, tumor Ly syndrome or any type of hematologic cancer
Meds such succinylcholine
Hypomagnesemia
Chronic disease, alcohol use G.I. loss, renal loss other conditions
Symptoms include mild tremor, generalized weakness to cardiac ischemia and death
Can be due to poor absorption for starvation, alcoholism, critically, ill patient on TPN or those unlike diuretics, proton pump, inhibitors aminoglycosides and potters and B de Jackson certain chemotherapy agents
Positive trousseau and Chvostek sign
Torsedes!!!
Use caution in replacement with those with GFR less than 30
Signs of potassium disorders
Low-muscle weakness, paralysis, respiratory failure, and death rhabdomyolysis cardiac arrhythmias T wave will be flattened, followed by ST depression presence of a U wave
If associated with low magnesium as well, high high risk for cardiac arrhythmia such as torsades de pointes
High- high blood pressure and swelling in the setting of renal disease hypo perfusion muscle tenderness rubbed myosis jaundice if a hemolytic condition muscle weakness, flaccid paralysis, and decrease tendon reflex, will also see a peaked tea wave on EKG that will eventually widen and turn into v tach
Potassium treatment
For low give 10 MEQ a potassium replacement to increase the level 0.1
For instance, if your serum potassium is 3.6 and you want it to be before you will need to order 40 MEQ.
Hypermagnesemia
Deal with a cute or chronic kidney disease can also be due to proton pumps, malnourishment alcohol, alcoholism, hypothyroidism, cortical, adrenal, insufficiency, hyperparathyroidism, and calcium metabolism involving hypercalcemia lithium base drugs those who take anticholinergics or opioids or have IBS or use laxatives or antacids containing magnesium tumor, lysis syndrome wrapped on my lysis acidosis
Symptoms include weakness, nausea, dizziness, and confusion, decrease reflexes, worsening, confusional, state, drowsiness, bladder, processes, flushing, headache, constipation, muscle, paralysis, paralytic, alias, decrease, breathing, right, low blood, pressure, EKG changes that show sinus Bradie, and blocks, and cardiac arrest
Treatment is calcium gluconate or chloride IV fluids loop diuretics dialysis
Hypophosphatemia
Due to decrease dietary intake like in my absorption, alcoholism, malnutrition, vitamin D deficiency hyperthyroidism for sailing diaries genetics like fanconi syndrome, diabetic, ketoacidosis, feeding syndrome
Fatigue weakness, bone pain, depending on the severity, respiratory failure, muscle weakness
Replace with oral or IV potassium with phosphorus
