Principles Of Fluid And Electrolyte Therapy Flashcards by Derrick Obeng

What are the two main types of fluid

Crystalloids
Colloids

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Give some examples of crystalloids

Normal saline
Ringers lactate
Dextrose saline
Badoe’s solution
5% or 10% dextrose
Fluid 5:4:1 (for cholera)
GIRS
Darrow’s solution

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Give some examples of colloids

Blood
Plasma
Hemacel
Dextran

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Give a difference between a crystalloid and a colloid

Crystalloids are small molecules while colloids are large molecules (collagen)

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What are some indications for giving IV fluids

Dehydration
Shock
Intestinal failure
Surgery
Nutritional TPN
Drug administration

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What are some complications of Iv fluids

Overload
Embolism
DVT
Immune reactions
Infections
Bleeding (dextran)

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How many mls of water can be lost by an average adult through breathing and the skin

1700 mls

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What is the net loss of water in the average adult

3400 mls

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In certain conditions such as metabolic acidosis, you cannot give ………….. So you give …………..

Ringer’s lactate, Normal saline

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In dehydration, water is lost from which compartment

ECF

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If dehydration becomes chronic, water is lost from the ………….. compartment as well

ICF

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During burns, there is fluid distribution from the …………. to the ……………

Intravascular space to the extravascular space

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What are some symptoms of dehydration

Sunken eyes
Dry inelastic skin (decreased skin turgor)
Tachycardia
Tachypnoea
Collapsed veins
Capillary refill time (increased)
Altered sensorium
Reduced urine output

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What is the urine output of a person

0.5/1ml/kg
30-50

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On going losses are mostly ……… losses

GIT

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A person came with a deficit. The doctor decided to calculate the fluid deficit and add it to the maintenance. What is this called

On-going losses

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What fluid is contraindicated in a dehydrated patient

5% dextrose

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A patient who is hemodynamically stable is given ………. for maintenance

4:2:1/kg/hr

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How is hyponateiemua treated

It depends on the type whether it is chronic or acute, hypovolemic, hypervolemic or normovolemic

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What kinds of saline could be given for hyponatremia

Isotonic saline
Hypertonic saline
Fluid restriction
Diuresis??

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What are some things that fluid provide

Solvent from reactions
pH
Exchange of nutrients
Excretion
Excitability (nerve impulses)
Temperature regulation
Chemical signals

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What is the percentage of TBW in men

About 60%

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What is the percentage of TBW in women

About 50%

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What is the % of ICF per body weight

40% of body weight
2/3 of TBW

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What is the % of ECF per body weight

20% of body weight 1/3 of TBW

What is the % of TCF per body weight

1% of body weight

What is the % of TCF in the ECF

5% of the ECF

What is the % of plasma per body weight

4% of body weight

What is the % of plasma in the ECF

20% of the ECF

What is the % of IF per body weight

15% of body weight

What % of IF in found in the ECF

75% of the ECF

What are the three main compartments water shift through

IC IVF ISF

Water in interstitial compartment recirculated by lymphatics and eventually back into the intravascular space True or false

True

Mention one ion found in both the ICF and ECF

Na K Mg

What ions are found in the ICF

Na K Mg Phosphorus Proteins

What ions are found in the ECF

Na Cl K Ca Mg HCO3

What is the volume of water lost through the urine in a day in the tropics

1500

What is the volume of water lost through stools by a healthy adult in the tropic region

200

There is no potassium lost through sweat True or false

True

What is the volume of K lost through urine in a day in the tropics

What is the volume of K lost through faeces in a day in the tropics

What is the volume of Na lost through urine in a day in the tropics

114

What is the volume of Na lost through sweat in a day in the tropics

10-16

What is the volume of Na lost through faeces in a day in the tropics

What fluid and electrolytes should be given to a surgical patient who is not eating and not passing stool

3L of water 130mmol of Na 50mmol of K 100g of Glucose

Where is it obtained from

1 litre Ringers lactate + 2 litres of 5% dextrose +3g KCl/24hrs 1 litre normal saline + 2 litres of 5% dextrose + 3g KCl /24hrs Badoes solution 3l / 24hrs

Dehydration is a state of negative fluid balance. It strictly means loss of water alone but usually accompanied by Na. It is characterized by loss of ECF, but ICF may be involved True or false

True

What are some causes of dehydration

Decreased fluid intake Increase losses via renal, GIT or insensible losses Fluid shift (ascites, effusions and capillary leak states such as burns and sepsis)

What are the various forms of dehydration

Acute or chronic Mild or moderate or severe Isonatraemic or hypernatraemic or hyponatraemic

Some clinical manifestations of dehydration is related to

Intravascular volume depletion Physiologic compensation attempts that takes place

For patients who are unstable with ongoing losses (eg peritonitis), IV is given at what rate

A faster rate (with a wide bore cannula)

What are some types of fluid to be given to a dehydrated patient

Ringer’s lactate Normal saline Dextrose saline

How is deficit given

1L in 30-45 mins

What are some parameters to assess in a patient with dehydration

BP, RR, pulse Veins Sensorium Oxygen saturation Urine Output Temperature

What is the amount of fluid you should give to a hemodynamically stable patient

100: 50: 20ml /kg – in 24 hours or 4:2:1/kg/hr in an hour

What is the equation for flow rate (min)

Flow rate duration(min) = Volume (ml) x drop factor

What are some electrolytes which give us problems

Na K Mg Ca

What is the normal range for sodium

135-145 mmol/l

What are some causes of hyponatremia

Diarrhoea Vomiting Peritonitis Fistulae Burns Wounds Severe hyperglycaemia Dehydrated patient infused with Na free fluids

What is the range for mild hyponatremia

130-134 mmol/L

What is the range for severe hyponatremia

< 125 mmol/L or (<120mmol/L)

What is the normal range for moderate hypokalemia

125-129 mmol/L (or 120-129 mmol/L)

What are some symptoms of hyponatremia

Nausea Headache Lethargy Seizures Coma Underlying disease

How do you treat hyponatremia

You correct the dehydration or shock by replacing the Na deficit

In the treatment of Na deficit, how do you calculate to know the Na deficit

Na deficit = TBW * (Na goal - Na in plasma) = 0.6 * your weight * (Na goal - Na plasma)

What are some lab investigations to be done in hyponatremia

BUE Cr

What are some signs in hyponatremia

Shock Dehydration

In a serious symptomatic hyponatremia, what is the infusion given to the patient

IV infusion of hypertonic saline target increase of 6 mmol/L over 24 hours (not exceeding 12 mmol/L)

For patients with reduced circulating volume, extracellular volume should be restored with what

An IV infusion of 0.9% saline or a balanced crystalloid solution at 0.5 to 1.0 mL/kg per hour

What is hypernatremia

A rise in serum sodium concentration to a value exceeding 145 mmol/L

What is the greatest risk factor for hypernatremia

Age older than 65 years

What are some renal causes of hypernatremia

Loop diuretics Polyureic phase of ATN Post obstructive diuresis of kidney Nephrologist diabetes insipidus

What are some common causes of hypernatremia

Endocrine syndromes Failure of renal tubular cells to respond to ADH Increase salt intake or infusion Water loss

What are some extra renal causes of hypernatremia

Endocrine syndromes Vomiting Diarrhoea NGT suctioning Sweating Fever Infusion of HTS/increased salt intake

What are some symptoms of hypernatremia

Muscle weakness Lethargy Restlessness Insomnia Coma in severe cases (central pontine myelinolysis)

What are some investigations to be done in hypernatremia

Serum electrolytes (Na+, K+, Ca2+) BUN Glucose level Urine electrolytes (Na+, K+) Urine and plasma osmolality

Treatment of hypernatremia depends on …………… status

Volume

How do you treat hypervolemic patients with hypernatremia

When using diuretics, tread cautiously

How do you treat non-volemic patients with hypernatremia

Free water replacement with hypotonic fluids

How do you treat hypovolemic patients with hypernatremia

Use isotonic fluid to offset deficit

What are general things to consider in hypernatremia patients

In asymptomatic patients, don’t correct too rapidly (cerebral edema) Acute (no more than 1-2 mmol/hr) Chronic (no more than 0.5-1 mmol/hr) Sodium levels should not be corrected at a rate more than 8 mmol/day Acute (< 24hours, chronic > or =24 hours)

What is the normal range for potassium in the body

3.5-5.5 mmol/L or 3.6-5.2 mmol/L