IV Fluids 1- MJ

Question 1

What are the 5 causes of hypovolemia?

Answer 1

1. GI losses (bleeding, NG suction, V/D)
2. Renal losses (salt and water loss from diuretics, water loss from diabetes insipidus)
3. Skin losses (sweat, burns)
4. Sequestration without loss (intestinal obstruction, pancreatitis, rhabdomyolysis)
5. Hemorrhage/bleeding

Question 2

What are the 4 types of GI losses that can cause hypovolemia?

Answer 2

1. Bleeding
2. NG suction
3. Vomiting
4. Diarrhea

Question 3

What are the 2 types of renal lossses that can lead to hypovolemia?

Answer 3

1. Salt and water loss: diuretics
2. Water loss: Diabetes insipidus

Question 4

What are the 3 things that can cause sequestration without loss leading to hypovolemia?

Answer 4

1. Intestinal obstruction
2. Pancreatitis
3. Rhabdomyolysis

“RIP”

Question 5

The following are clinical features of what?

• Increased thirst
• decreased sweating
• Decreased skin turgor & dry mucus membranes
• Oliguria with increased urine concentration
• CNS depression
• Weakness and muscle cramps
• Decreased BP
• postural hypotension/dizziness
• ›Increased pulse
• postural pulse increase

Answer 5

Hypovolemia

Question 6

What is third spacing?

Answer 6

• Fluid accumulation in the interstitium of tissues (EDEMA)
• Occurs when fluid accumulates in areas that normally have no fluid/minimal fluid
• Pt looks fluid overloaded but has a relative hypovolemia

Question 7

What are 3 examples of third spacing?

Answer 7

• ›Ascites
• ›Edema associated with burns
• ›Pleural effusions

Question 8

T/F: Third spacing can cause a relative hypovolemia

Answer 8

TRUE

Question 9

What are the 3 types of replacement IVF?

Answer 9

1. Crystalloids (contains electrolytes)
2. Colloids (Contains both large organic macromolecules and electrolytes)
3. Blood and blood products

Question 10

Which replacement IVF?

• Fluids that contains electrolytes which easily pass through vascular endothelial membrane barriers followed by water, leading to their equilibrating between the intravascular & extracellular space

Answer 10

Crystalloids

Question 11

Which type of Replacement IVF?

• Fluids that contain both large organic marcomolecules and electrolytes
• The Lrg molecules can’t cross endothelial membrane (capillary walls)–> fluids retained w/in intravascular space more than crystalloids due to higher oncotic pressure

Answer 11

Colloids

Question 12

Which type of crystalloid?

• Solutions w/ the same salt concentration as normal cells of the body and blood
• Types= Normal Saline (0.9% NS), Lactated Ringer, Plasma-Lyte

Answer 12

Isotonic Crystalloids

Question 13

Which is the only IVF that you can bolus?

Answer 13

Isotonic crystalloids (0.9%NS, Lactated Ringer, Plasma Lyte)

Question 14

Which type of IVF is the “go to” for resuscitation?

Answer 14

Isotonic Crystalloids (0.9%NS, Lactated Ringer, Plasma Lyte)

Question 15

Which type of cyrstalloid?

• Solutions w/ higher salt concentrations than normal cells of the body and blood
• 3% NS
• Can be used to tx hyponatremia but have to be careful (CANT bolus)

Answer 15

• Hypertonic crystalloid

Question 16

What are the different types of crystalloids?

Answer 16

• Isotonic crystalloids (same salt conc. as blood):
  
  1. 0.9% NS
  2. Lactated Ringer
  3. Plasma- Lyte
• Hypertonic crystalloid (higher salt conc than blood):
  
  1. 3% NS
• Hypotonic crystalloid (lower salt conc than blood):
  
  1. 0.5 NS
  2. 0.25 NS
• Other
  
  • D5W (5% dextrose in water)
  • D5 1/2NS

Question 17

Which type of crystalloid?

• Solution w/ lower salt conc. than normal cells of body/blood
• 0.5 NS, 0.25 NS

Answer 17

Hypotonic crystalloids

Question 18

What is the preferred choice of IVF for treatment of dehydration and hypovolemia?

Answer 18

Isotonic Crystalloid

(NS, LR and Plasma-Lyte can be used for IV boluses)

Question 19

What is the preferred type of IVF for severe hypovolemia (resuscitation)?

(this should be corrected as rapidly as possible to correct intravascular volume depletion)

Answer 19

Isotonic Crystalloids

Question 20

In addition to NaCl, what 3 other things does Lactated Ringer contain?

Answer 20

• Lactate
• K+
• Ca2+

Question 21

Which Isotonic Crystalloid contains less chloride and is the most physiologic solution?

Answer 21

Plasma-Lyte

Question 22

Which type of IVF is most valuable in situations where there is life threatening hyponatremia w/ significant water excess?

Answer 22

Hypertonic Crystalloid

(3% NS)

Question 23

Which type of IVF can also be used in neurosurgical patients to decrease cerebral edema?

Answer 23

Hypertonic Crystalloid

(3% NS)

Question 24

Why do you have to be very cautious with giving Hypertonic Crystalloids?

Answer 24

Overly rapid correction of sodium can lead to central pontine myelinolysis (CPM)

Question 25

**Which type of IVF?** * **Distribute throughout** the total body water * ›Used for **_maintenance fluids_** * ›Are **inadequate for replacing intravascular volume deficits** * ›_Not_ used for treatment of dehydration/hypovolemia

Answer 25

**Hypotonic Crystalloids** | (0.5 NS, 0.25 NS)

Question 26

Which type of IVF? * ›Similar total body water distribution to the hypotonic crystalloids * ›Used to **treat hypoglycemia, starvation ketosis** * ›Used in **hypernatremia with a free water deficit**

Answer 26

Other crystalloid D5W (5% dextrose in water)

Question 27

When should you use caution in giving D5W?

Answer 27

Patients w/ **Diabetes**

Question 28

When do you use D5W? (3 situations)

Answer 28

* hypoglycemia * Starvation Ketosis * Hypernatremia w/ a free water deficit

Question 29

Are colloids less likely or more likely to expand vascular compartment?

Answer 29

MORE likely

Question 30

When are colloids used?

Answer 30

* ›When **crystalloids fail to sustain plasma volume** due to low osmotic pressure * ›Example: patients with **burns or peritonitis** where there is considerable protein loss from vascular space.

Question 31

Patiens w/ **burns or peritonitis** (where there are considerable protein loss from vascular space) can be treated with which type of IVF?

Answer 31

Colloids \*\*there is no strong data to support the use of colloids in severe hypovolemia (also is more expensive)\*\*

Question 32

What are the 3 type of colloid IVF?

Answer 32

1. **Albumin** (5% albumin, 25% albumin) 2. **Dextran** (Dextran 40, Dextran 70)--\> NOT used 3. **Hydroxyethyl Starch** (Hetastarch)--\> NOT used "HAD"

Question 33

Which type of IVF is used in **_edematous patients_** to mobilize interstitial fluid into the vascular space?

Answer 33

* **Albumin preparations** (5% albumin or 25% albumin) * (not useful if serum albumin \>2.5mg) * used as a plasma expander

Question 34

Which type of IVF is helpful in patients with **liver disease, peritonitis or burns** or surgical patients experiencing **_“third spacing”_**

Answer 34

**Albumin Preparations** (5% albumin, 25% albumin)

Question 35

Although there's a theoretical assumption that colloids lead to better intravascular volume expansion compared to crystalloids, what have studies shown?

Answer 35

Studies show that even though albumin WAS found in increase serum albumin levels and mean arterial pressure, ## Footnote **there was NO difference in 28 or 90 day mortality.**

Question 36

What are the 4 different type of blood products?

Answer 36

1. Packed RBCs 2. Platelets 3. Fresh Frozen Plasma 4. Cryoprecipitate

Question 37

**Packed RBCs** (PRBCs): * are prepared from \_\_\_\_\_ * Remain entirely within the \_\_\_\_\_\_ * Improves _____ delivery to tissues

Answer 37

* are prepared from **_whole blood_** * Remain entirely within the **_vascular space_** * Improves **_oxygen_** delivery to tissues

Question 38

What are **packed RBCs** used for?

Answer 38

**Blood transfusions** * Hemorrhage (i.e. GI bleed) or severe/symptomatic anemia