Fluids

Question 1

Total body water %

Answer 1

60% of the adult human body is water

3 main compartments

• Intracellular (ICF) 67%
• Interstitial fluid (ISF) 25%
• Plasma volume (PV) 8%

Question 2

Bulk pressure

Answer 2

Balance of 2 main pressures

• Hydrostatic pressure (blood pressure)
• Colloid osmotic pressure due to plasma proteins

Question 3

Crystalloids

Answer 3

Contains

• Electrolytes (Na, K, Cl)
• Small molecules (glucose, lactate)
• Does NOT contain proteins/large molecules

Used to:

• Treat dehydration
• Used as a replacement/maintenance fluids
• Expand plasma volume (3% NaCl)
• Mangae specific fluid and electrolyte

Question 4

Saline - Normal, Hypotonic and Hypertonic

Answer 4

Normal saline 0.9% NaCl (154mmol). Osmolarity is 300 mOsm/L Normal saline = isotonic solution
- The only fluid used with administration of blood cell products

Hypotonic/half normal saline 0.45% NaCl

Hypertonic saline 3%

Lactated ringer has 130 Na, 109 Cl, and 4 K

D5W, Plasmalyte

Question 5

Crystalloids - Indications

Answer 5

Acute liver failure
Acute nephrosis
Burns
Hypovolemic shock
Renal dialysis
Many other conditions

Question 6

Crystalloids - Adverse Effects

Answer 6

Edema - peripheral or pulmonary (fluid overload)
May dilute plasma prtoeins
Effects may be short-lived
Many other effects

Question 7

Colloids - Function

Answer 7

• Increase colloid osmotic pressure
• Move fluid from interstitial compartment to plasma compartment
• “Plasma volume expanders” to restore BP
• Dextran 40 or 70 (big glucose polymers), draws water into blood vessels
• Hetastarch and hydroxyethyl startch (HES) are synthetic and derived from cornstarch
• Modified gelatin
• 5% or 25% albumin (from human donors)

Question 8

Colloids - Indication

Answer 8

Fluid resuscitation due to

• Trauma
• Burns
• Sepsis
• Hypovolemic shock

Question 9

Colloids vs. Crystolloids

Answer 9

• Colloids are more expensive, harder to use
• Maybe combination would be best
• No answer to which one is better, depends on the situation

Question 10

Colloids - Indication

Answer 10

Superior to crystalloids in PV expansion

- But more expensive

Question 11

Colloids - Adverse effects

Answer 11

Usually safe, but concerns in renal failure

Disadvantages

• may cause altered coagulation - excess bleeding
• no oxygen-carrying capacity

Question 12

Blood Products

Answer 12

Most expensive and least available fluid because they require human donors

Increased COP and PV

• Pull fluid from interstitial space into vessels
• Plasma expanders

RBC products carry oxygen
- Increase supply of various products eg clotting factors

Question 13

Blood Products - Indications

Answer 13

Cryoprecipitate and plasma protein factors (PPF)
- Management of acute bleeding (>50% slow blood loss or 20% acutely)

Fresh frozen plasma ( FFP)
- Increase clotting factor levels in clients with demonstrated deficiency = coagulation disorder

Pack RBC’s and whole blood

• To increase oxygen-carrying capacity
• Anemia
• Substantial hemoglobin deficits
• Blood loss >25% of total blood volume

Question 14

Blood Products - Adverse effects

Answer 14

Transfusion reactions
- Blood type and cross-match

Transmission of pathogen to recipient (hepatitis, HIV)

Question 15

Client Care

Answer 15

• Administer colloids slowly
• Monitor for fluid overload and possible heart failure
• For blood products, follow administration procedures closely
• Monitor closely for signs of transfusion reactions

Question 16

2 Principle Electrolytes

Answer 16

Principal ECF electrolytes

• Sodium (Na)
• Chloride (Cl)

Principle ICF electrolyte
- Potassium (K)

Question 17

Potassium General

Answer 17

Most abundant + electrolyte inside cells

• 95% of body’s potassium is intracellular
• Normal ECF is 3.5-5 mmol

Question 18

Hypokalmia

Answer 18

<3.5 mmol/L
Causes:
- Loop and thiazide diuretics, vomiting, diarrhea, malabsorption, black real licorice, diets …

Patient awareness

• Muscle weakness and or lethargy
• Cardiac dysrhythmia (irregular pulse)
• Paralytic ileus (decrease in bowel motility)

Treatment

• Oral preparations, be aware of diarrhea, vomiting etc that can influence absorption
• IV admin: pain at injection site and phlebitis

Question 19

Hyperkalemia

Answer 19

> 5 mmol/L

Many causes

• Supplements
• ACE inhibitors
• Potassium sparing diuretics, burns, trauma, metabolic acidosis …

Cardiac rhythm irregularities leading to possible ventricular fibrillation and cardiac arrest

• Muscle weakness, paralysis
• Paresthesia (tingling)

Treatment
- IV sodium bicarbonate, dextrose with insulin …

Should never exceed 10 mmol/hour

Question 20

Plasma sodium

Answer 20

135 - 145 mmol/L