Paulson - Intro to Fluids Flashcards by Alice Richards

water balance is determined by

water intake

water output

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3 forms of water input

ingested water

water in food

water from oxidation

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4 forms of water output

urine

skin

respiratory tract

stool

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2 types of body water

intracellular

extracellular/intravascular

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intracellular body water accounts for __ of total body water

extracellular/intravascular body water accounts for __ of total body water

intracellular: ⅔

extracellular/intravascular: ⅓

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intravascular compartment is called __

intracellular compartment is called __

intravascular: first space
intracellular: second space

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space where fluid doesn’t usually accumulate but may

third space

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examples of third space (3)

pleural cavity

peritoneal cavity

edema in extracellular space

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drugs are administered into __ space

and should distribute evenly to __ space

first

second

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4 conditions that can cause third spacing

surgery

major trauma

burns

inflammation

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fluid related implication of third spacing

fluid/lytes/meds not bioavailable

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2 types of fluid therapy

maintenance

replacement

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replacement of ongoing water losses of water and lytes under normal physiologic conditions (urine, sweat, respiration, stool)

maintenance therapy

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correction of existing water and lyte deficits from GI, skin, urinary, bleeding, third spacing

replacement therapy

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3 things that increase maintenance fluid requirements

tachypnea

fever

diuretics

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3 reasons for hypovolemia in surgical pt’s

NPO pre/post surgery

blood loss

third spacing

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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

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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

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most physiologic replacement in normal circumstances

D5½NS + 20 mEq K/L

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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

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3 ex of dehydration deficit to account for in maintenance fluid therapy

dry

tachycardic

shock

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dry deficit accounts for __% loss

5% if < 5 yo

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tachycardic deficit accounts for __% loss

10% if < 5yo

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shock deficit accounts for __ % loss

15% if < 5 yo

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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

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

type of fluid that counteracts acidosis

isotonic crystalloid that contains 0.9% NaCl in sterile water and approximates plasma

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