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Advanced Pharm-2024 > M12: Fliuds-lecture > Flashcards

M12: Fliuds-lecture Flashcards

1
Q

What are the two major fluid compartments in the body?

A

Intracellular fluid (ICF) and extracellular fluid (ECF)

ICF is the body fluid within cells, while ECF is the fluid outside the cells.

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2
Q

What is the average total body water percentage for adult males and females?

A

60% for males and 50% for females

Body water content decreases with age and varies in newborns and obese individuals.

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3
Q

What is the primary intracellular fluid electrolyte?

A

Potassium

Potassium concentration is critical for cellular metabolism and osmotic pressure.

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4
Q

Which fluid compartment contains plasma and interstitial fluid?

A

Extracellular fluid (ECF)

ECF is crucial for transporting nutrients and removing waste.

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5
Q

What percentage of total body water is typically extracellular in an average adult male?

A

About 20%

This corresponds to approximately 14 liters of fluid.

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6
Q

What is the osmolarity of hypertonic saline (3%)?

A

Around 360 milliosmoles

Hypertonic saline can dehydrate cells, making it useful in cases of brain injury.

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7
Q

What happens to cells when hypotonic fluids are administered?

A

Cells swell

Hypotonic fluids, such as D5 water, increase intracellular volume.

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8
Q

What is the primary oncotic protein in plasma?

A

Albumin

Albumin helps retain plasma water and maintains colloid osmotic pressure.

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9
Q

Fill in the blank: The main purpose of administering fluids to patients is to maintain adequate _______.

A

tissue perfusion

Oxygen delivery!!

Adequate tissue perfusion ensures oxygen delivery to vital organs.

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10
Q

True or False: Electrolytes can pass freely between plasma and interstitial fluid.

A

True

Electrolyte composition in plasma and interstitial fluid is nearly identical.

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11
Q

What is the typical fluid loss from the lungs and skin per day?

A

600 to 900 mL

This is part of the normal output for a patient.

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12
Q

What influences the movement of water between intracellular and extracellular compartments?

A

Tonicity gradient

Water moves based on osmolarity differences between compartments.

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13
Q

What is the effect of isotonic solutions on cells?

A

No change in cell volume

Isotonic solutions, like normal saline, do not cause fluid movement into or out of cells.

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14
Q

What is the average daily input and output of fluids for a patient?

A

2 to 3 liters input, 800 to 1500 mL output

This includes fluid loss through various bodily functions.

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15
Q

What role do kidneys, lungs, feces, and skin play in fluid balance?

A

They contribute to fluid loss

These organs are responsible for maintaining fluid homeostasis.

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16
Q

What happens to interstitial pressure as interstitial fluid volume rises?

A

Interstitial pressure increases

Increased pressure can lead to edema.

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17
Q

What is the primary reason for restoring volume in a shock state?

A

To improve the delivery of oxygen (DO2) to vital organs and enhance microcirculation.

Adequate tissue perfusion is crucial for organ function.

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18
Q

What are crystalloids?

A

Safe, inexpensive fluids used for volume resuscitation, but excessive use can dilute platelets and clotting factors.

Examples include normal saline and lactated Ringer’s solution.

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19
Q

What is the typical volume ratio of crystalloids to colloids needed for the same effect?

A

2 to 6 times greater volume of crystalloids compared to colloids.

This indicates the efficiency of colloids in volume expansion.

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20
Q

What defines isotonic fluids?

A

Fluids that have the same osmotic concentration as plasma, typically in the range of 250 to 375 mOsm/L.

Isotonic fluids do not shift fluid between intracellular and extracellular compartments.

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21
Q

What happens to fluids in hypotonic solutions?

A

Fluids move from the extracellular fluid into the intracellular fluid compartment.

Example: D5W and half normal saline.

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22
Q

What characterizes hypertonic solutions?

A

Hypertonic solutions have a higher osmotic concentration than plasma, usually greater than 375 mOsm/L.

Example: 3% normal saline.

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23
Q

What are the common synthetic colloids mentioned?

A

Dextran, hydroxyethyl starch (HES), and albumin.

Each has different volumes of fluid they can pull into the plasma.

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24
Q

What is the definition of hypovolemia?

A

A state where there is a decrease in extracellular fluid volume, often indicated by sodium levels greater than 145 mEq/L.

Common causes include nausea, vomiting, and diarrhea.

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25
Q

What are signs and symptoms of extracellular fluid volume deficit?

A
  • Hypotension
  • Oliguria
  • Tachycardia
  • Dry mucus membranes

These symptoms indicate decreased tissue perfusion.

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26
Q

What laboratory findings indicate volume deficits?

A
  • Elevated BUN and creatinine
  • Elevated AST and ALT
  • Hemoconcentration (elevated hematocrit)

These help confirm hypovolemia and assess organ function.

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27
Q

What is the typical sodium level in volume overload?

A

135 mEq/L or less.

Volume overload is characterized by excess fluid intake.

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28
Q

What are signs of fluid overload?

A
  • Hypertension
  • Elevated CVP
  • Pulmonary edema
  • Peripheral edema
  • Ascites

Indicates fluid retention in the body.

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29
Q

What is the role of sodium in the extracellular fluid?

A

Sodium is the primary determinant of fluid volume and osmotic pressure in the extracellular compartment.

Normal sodium levels range from 135 to 145 mEq/L.

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30
Q

What are the signs and symptoms of symptomatic hyponatremia?

A
  • Weakness
  • Confusion
  • Neurochanges
  • Nausea
  • Vomiting
  • Seizures

Severe hyponatremia can lead to significant neurological issues.

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31
Q

What characterizes isotonic hyponatremia?

A

Serum sodium is less than 135 mEq/L with normal serum osmolality (around 280 mOsm/L).

Causes include hyperlipidemia and elevated serum protein.

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32
Q

What is hypotonic hyponatremia?

A

Hyponatremia with serum osmolality less than 270 mOsm/L.

Treatment focuses on addressing the underlying cause.

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33
Q

Fill in the blank: The primary intracellular ion is _______.

A

[potassium]

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34
Q

Fill in the blank: The normal range for sodium is _______.

A

[135 to 145 mEq/L]

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35
Q

True or False: Colloids generally induce an immune response.

A

True

Colloids are synthetic and can lead to allergic reactions.

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36
Q

What is the significance of fishbone diagrams in clinical settings?

A

They provide a quick way to summarize and compare laboratory values for patient assessment.

Useful for reporting and documentation during clinical practice.

37
Q

What is the normal range for serum sodium levels?

A

135-145 mEq/L

Sodium levels outside this range indicate hyponatremia or hypernatremia.

38
Q

What defines hypotonic hyponatremia?

A

Osmolality less than 270 mOsm/kg

It is classified based on extracellular volume status.

39
Q

What is the treatment approach for hypotonic hyponatremia?

A

Treat the underlying cause

This may involve fluid management based on the patient’s volume status.

40
Q

What are the classifications of hypotonic hyponatremia based on extracellular volume status?

A
  • Euvolemic
  • Hypovolemic
  • Hypervolemic
41
Q

What is the most common cause of hypotonic hyponatremia?

A

Hypothyroidism

It can be evaluated by checking TSH and T4 levels.

42
Q

In hypovolemic hypotonic hyponatremia, what indicates greater sodium loss than water loss?

A

Sodium loss greater than water loss

This condition often presents with decreased skin turgor and orthostatic changes.

43
Q

What urine sodium levels suggest third spacing of fluid?

A

Urine sodium less than 10 mEq/L

This indicates that sodium is being conserved due to volume depletion.

44
Q

What are common causes of hypertonic hyponatremia?

A
  • Profound hyperglycemia
  • DKA
  • HHNK
45
Q

What defines hypernatremia?

A

Sodium levels greater than 145 mEq/L with high serum osmolality

This condition may require fluid replacement and sodium intake limitation.

46
Q

What is considered hypokalemia?

A

Potassium levels less than 3.5 mEq/L

This can lead to arrhythmias and specific EKG changes.

47
Q

What EKG changes are associated with hypokalemia?

A
  • Flat T-wave
  • ST depression
  • U-wave
48
Q

What is the treatment for hypokalemia?

A

IV potassium replacement

Administer slowly and monitor levels to avoid complications.

49
Q

What characterizes hyperkalemia?

A

Potassium levels greater than 5.0 mEq/L

It can lead to serious cardiac arrhythmias and may require emergent treatment.

50
Q

What are common treatments for hyperkalemia?

A
  • Calcium gluconate
  • Insulin with glucose
  • Beta agonists
  • Diuretics
  • Dialysis
51
Q

What are isotonic IV fluids used for?

A

To replace normal fluid losses

Common isotonic fluids include normal saline and lactated Ringer’s solution.

52
Q

What is the osmolarity of normal saline (0.9%)?

A

308 mOsm/L

This can lead to hyperchloremic metabolic acidosis if used excessively.

53
Q

Why is lactated Ringer’s solution considered more balanced than normal saline?

A

It has an osmolarity closer to plasma and provides lactate for metabolism

It should be avoided in patients with hepatic hypoperfusion.

54
Q

What does ‘third spacing’ refer to?

A

Fluid sequestered in a compartment not interacting with intracellular or extracellular fluid

Common in conditions like trauma, surgery, and organ failure.

55
Q

How should fluids be calculated for a patient with a fluid deficit?

A

Replace the deficit with isotonic fluids and add maintenance requirements

Example: For a 1L deficit, give 500 mL in the first hour, then 250 mL over the next two hours.

56
Q

What is the concern with using Lactated Ringer’s solution in patients with hepatic hypoperfusion?

A

It can worsen the condition due to excess lactate metabolism in the liver.

Lactate can be problematic in patients with liver issues.

57
Q

What is the osmolarity of 3% normal saline (NS)?

A

1030 mOsm/L

This hypertonic solution draws fluid from intracellular to extracellular space.

58
Q

What are the primary uses of 3% normal saline?

A
  • Treatment of cerebral edema
  • Severe symptomatic hyponatremia

Caution is required to avoid hypernatremia and hyperchloremia.

59
Q

What is the osmolarity of half normal saline (0.4%)?

A

154 mOsm/L

This hypotonic solution shifts fluid into cells.

60
Q

Why is half normal saline not used in head injuries?

A

It can increase cerebral edema and intracranial pressure (ICP).

It has a low sodium content.

61
Q

What happens to 5% dextrose in water (D5W) as it metabolizes?

A

It becomes free water, which is hypotonic.

Avoid in cerebral head injuries.

62
Q

What is the osmolarity of D5 in half normal saline?

A

406 mOsm/L

This hypertonic solution becomes half normal saline upon metabolism.

63
Q

What do colloids do in IV fluid therapy?

A

They act as volume or plasma expanders and have high oncotic pressure.

Colloids stay within blood vessels longer than crystalloids.

64
Q

What is the risk associated with using colloids in patients with sepsis?

A

Colloids can leak into interstitial spaces and pull more fluid out of the vascular space.

This can worsen edema.

65
Q

What is the preferred method of hydration and nutrition for patients?

A

Enteral feeding and hydration.

IV fluids should only be used when oral intake is not possible.

66
Q

What is the average insensible loss of fluids per day?

A

Around 2300 mL

Insensible losses include breathing, sweating, and feces.

67
Q

When replacing blood loss with crystalloid, what is the replacement ratio?

A

2 mL of crystalloid for every 1 mL of blood loss.

In shock and trauma, the ratio may be 3:1.

68
Q

What is the goal of maintenance IV fluids?

A

Adequate hydration and organ perfusion.

Adjustments may be needed based on patient condition.

69
Q

How do you calculate a patient’s ideal body weight?

A

Height in cm - 100.

Example: A 72-inch male has an ideal body weight of around 80 kg.

70
Q

What is adjusted body weight used for?

A

When actual body weight is greater than 130% of the calculated ideal body weight.

Important for calculating fluids and medications in obese patients.

71
Q

What is the 421 rule used for?

A

Calculating hourly fluid rates for adults and children.

Different rules apply for adults versus children.

72
Q

How much fluid does a 15 kg patient require using the 421 rule?

A

50 mL per hour.

Calculation: 10 kg -> 40 mL, 5 kg -> 10 mL.

73
Q

What is the formula for calculating maintenance IV fluid for a 75 kg patient?

A

40 mL for the first 10 kg, 20 mL for the next 10 kg, plus 55 mL for the remaining.

Total: 115 mL per hour.

74
Q

What should be monitored daily in patients receiving IV fluids?

A

Daily weights and fluid needs.

Adjustments are necessary based on clinical status.

75
Q

What is the formula for calculating daily fluid requirements in adults using the 150/20 rule?

A

Divide total fluid requirement by 24 to get hourly rate.

The 150/20 rule is used to calculate daily fluid needs based on body weight.

76
Q

How many milliliters per kilogram are used for the first 10 kilograms in the 150/20 rule?

A

100 ml per kg.

This is for the first 10 kg of body weight in adults.

77
Q

How many milliliters per kilogram are used for the next 10 to 20 kilograms in the 150/20 rule?

A

50 ml per kg.

This applies to the body weight between 10 kg and 20 kg.

78
Q

How many milliliters per kilogram are used for body weight over 20 kilograms in the 150/20 rule?

A

20 ml per kg.

This is for body weight exceeding 20 kg.

79
Q

What should be monitored in patients receiving IV fluids?

A

Weights and fluid losses.

Monitoring is crucial to adjust fluid therapy accurately.

80
Q

In obese patients, which weight should be used for calculating fluid requirements?

A

Adjusted body wt:
Ideal body weight +
0.4(actual wt-IBW)

This method reduces fluid requirements compared to using actual body weight.

81
Q

True or False: Fluids have consequences and should be given carelessly.

A

False.

Fluids must be administered purposefully with consideration for how much and how often.

82
Q

What is the total daily fluid requirement for a 75 kg patient using the 150/20 rule?

A

2700 ml per day.

This is calculated based on the breakdown of body weight in the 150/20 rule.

83
Q

How do you calculate the hourly maintenance IV fluids for a 75 kg patient?

A

Divide total daily requirement by 24 hours.

For a 75 kg patient, it results in approximately 112.5 ml per hour.

84
Q

What is the hourly fluid requirement for an 85 kg male who has been NPO for 10 hours?

A

Approximately 116 ml per hour.

This is based on a total requirement of 2800 ml per day.

85
Q

Fill in the blank: The total fluid deficit for a patient NPO for 10 hours is ______.

A

1166 ml.

This deficit must be accounted for in the patient’s fluid regimen.

86
Q

What is the initial fluid administration in the first hour for a patient with a deficit of 1166 ml?

A

Half of the deficit plus maintenance.

The total for the first hour would be around 699 ml.

87
Q

What is added to the fluid administration in the second and third hours for a patient with a deficit?

A

The remaining deficit divided into quarters plus maintenance.

For example, approximately 291 ml would be added in subsequent hours.

88
Q

What key calculations must be understood for the quiz on IV fluid management?

A

Ideal body weight, actual body weight, maintenance IV fluids, and fluid replacement.

Mastery of these calculations is essential for effective fluid management.

Advanced Pharm-2024 (19 decks)

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