Paulson - Intro to Fluids Flashcards
water balance is determined by
water intake
water output
3 forms of water input
ingested water
water in food
water from oxidation
4 forms of water output
urine
skin
respiratory tract
stool
2 types of body water
intracellular
extracellular/intravascular
intracellular body water accounts for __ of total body water
extracellular/intravascular body water accounts for __ of total body water
intracellular: ⅔
extracellular/intravascular: ⅓
intravascular compartment is called __
intracellular compartment is called __
intravascular: first space
intracellular: second space
space where fluid doesn’t usually accumulate but may
third space
examples of third space (3)
pleural cavity
peritoneal cavity
edema in extracellular space
drugs are administered into __ space
and should distribute evenly to __ space
first
second
4 conditions that can cause third spacing
surgery
major trauma
burns
inflammation
fluid related implication of third spacing
fluid/lytes/meds not bioavailable
2 types of fluid therapy
maintenance
replacement
replacement of ongoing water losses of water and lytes under normal physiologic conditions (urine, sweat, respiration, stool)
maintenance therapy
correction of existing water and lyte deficits from GI, skin, urinary, bleeding, third spacing
replacement therapy
3 things that increase maintenance fluid requirements
tachypnea
fever
diuretics
3 reasons for hypovolemia in surgical pt’s
NPO pre/post surgery
blood loss
third spacing
steps to calculate maintenance therapy
- calculate body wt
- calculate fluid needed over 24 hr
- divide total ml by 24 hr for a ml/hr rate
calculation for fluid needed over 24 hr
100 ml/kg for frist 10 kg
50 ml/kg for second 10 kg
20 ml/kg for each kg over 20
most physiologic replacement in normal circumstances
D5½NS + 20 mEq K/L
what is the 4/2/1 rule for hourly rate of maintenance fluids
4 ml for kg 1-10
2 ml for kg 11-20
1 ml for each kg kg 21 or higher
3 ex of dehydration deficit to account for in maintenance fluid therapy
dry
tachycardic
shock
dry deficit accounts for __% loss
3
5% if < 5 yo
tachycardic deficit accounts for __% loss
6%
10% if < 5yo
shock deficit accounts for __ % loss
9%
15% if < 5 yo
3 indications of dry deficit
dry mm
dry tongue
poor turgor
steps to calculate dehydration deficit
if output losses from NGT, you can measure and replace
ml for ml
NGT losses have high __ levels
Cl
signs of volume overload (4)
jvd
lung crackles
edema
dyspnea
tx for volume overload (3)
fluid restriction
diuretics
lower the rate
types of IV fluids
plasma
ns
½ ns
rl (lactated ringers)
5%D
plasmalyte
gel
3% saline
5% alb
30% alb
which type of IV fluid is meant to mimic human plasma
plasmalyte
solute made of large proteins like albumin or other molecules that remain intravascular to draw water from cells to intravascular space
colloids
caution w. colloids
cell dehydration
fluid w. lytes as solute
crystalloids
lytes in crystalloids (4)
Na
K
Ca
Cl
classification of crystalloids (4)
isotonic
hypertonic
hypotonic
hypotonic/hypertonic
isotonic crystalloids contain
the same amt of lytes as normal plasma
hypertonic crystalloids contain
more lytes than body plasma
hypotonic crystalloids contain
less lytes than body plasma
isotonic crystalloid that has NaCl, KCl, CaCl, and Na lactate in sterile water
lactated ringers (LR)
indications for LR
ml for ml replacement for blood loss:
trauma
surgery
burns
type of fluid preferred if large volumes are needed for fluid resuscitation
LR
type of fluid that counteracts acidosis
LR
isotonic crystalloid that contains 0.9% NaCl in sterile water and approximates plasma
NS
large volumes of ns can cause
hyperchloremic metabolic acidosis
indications for NS (2)
flush wounds
administer w. blood products
do NOT administer ns
long term
type of fluid that contains 0.45% NaCl in water
½ NS
½ NS is __tonic
hypo
indication for ½ NS
hypernatremic pt who does not need extra glucose → DM
indication for D5W (5% dex in water)
rehydrating pt who is hypernatremic
pt on Na restriction
D5W is __tonic
hypo
contraindication for D5W (2)
uncontrolled diabetic
hypokalemic
what will free water do to a pt
kill them
mc postoperative fluid
D5½NS
indication for D5½NS
daily maintenance of body fluids for rehydration
D5NS is __tonic
hyper
D5NS replaces
fluid
sodium
Cl
caution w. D5NS
volume overload → edema
3% saline is __tonic
hyper
indication for 3% saline
used cautiously for severe hyponatremia → common cause of hyponatremia is fluid overload
50-100 ml bolus of 3% saline raises serum Na
2-3 mEq
→ may be repeated 1-2 times
parameters for raising serum Na
not to exceed:
10-12 mEq/L in first 24 hr
18 mEq/L in first 48 hr
fluid rate depends on (3)
severity of volume depletion
condition of pt
other dz’s
how to determine success of fluid replacement (5)
urine output
bp/hr nl
mental status
capillary refill
frequent monitoring
monitoring of fluid replacement should include (3)
physical appearance
frequent lab monitoring
vitals
