IV fluids

Question 1

where is body water

Answer 1

1/3 ECF

2/3 ICF

Question 2

where is water in ECF

Answer 2

1/4 plasma (8% total)

3/4 ISF (25% total)

Question 3

how much fluid and lytes are needed per day

Answer 3

4-2-1 rule
4 ml/kg/h for 1st 10kg
2 for next 10
1 for rest

Question 4

def. effective osmole

Answer 4

particle that doesn’t cross cell membrane

• Na, K, glucose
• NOT ethanol and urea

Question 5

what are 2 types of losses

Answer 5

sensible - those you feel - urine

insensible - those you don’t - sweat, resp

Question 6

what is “free water” in 1 L of 70mmol/L fluid

Answer 6

500 ml is isotonic (140)

so 500ml is free

Question 7

4 types of fluid loss

Answer 7

1. pure water loss
2. hypotonic
3. isotonic
4. blood

Question 8

2 ways to lose free water

Answer 8

1. . skin - insensible
2. urine
   - diabetes insipidus
   - urea induced osmotic diuresis

Question 9

3 ways to lose hypotonic

Answer 9

1. skin
   - sweat (20-50 Na)
2. urine
   - most diuretics
   - glucose or mannitol induced
3. GI
   - vomiit
   - diarrhea if due to osmotic laxative

Question 10

4 ways to lose isotonic

Answer 10

1. skin
   - burns
2. GI
   - most diarrhea
   - ileus
3. urine
   - thazides
4. third space losses

Question 11

3 consequences of fluid loss

Answer 11

1. hypovolemia
   - less CO > hypotens> activate SNS
2. possible hypernatremia
   - brain cells shrink> confusion
3. possibly lose other lytes

Question 12

magnitude of blood volume lost for a liter loss of each type

Answer 12

1. pure water loss - 80ml
2. hypotonic - 80-250
3. isotonic - 250-333
4. blood- 1000ml

Question 13

3 hormonal responses to hypovolemia

Answer 13

1. SNS activation
2. RAS activations
3. ADH

Question 14

effects of hormones (3)

Answer 14

1. incr. CO
2. vasoconstrict
3. reduce urine loss and NaCl

Question 15

4 Hx ways to assess loss

Answer 15

1. urine (output, color)
2. thirst/intake
3. dizzy when standing
4. direct evidence of loss
   - blood, surg, GI etc

Question 16

4 hemodynamic signs on Phx

Answer 16

1. JVP
2. postural hypotension
3. postural rise in HR
4. supine hypotens or BP

Question 17

5 other signs of low volume

Answer 17

1. skin and mucous
   - tugor
   - cap refill
2. urine
3. weight loss
4. CNS
   - confusion/coma
5. head
   - fonanelle
   - sunken eyeballs

Question 18

what are three general levels of loss in adults1

Answer 18

mild - 1-2 liters
mod - 2-3
severe - 4-5

Question 19

fomula for free water deficit

Answer 19

[total body water x (plasma [Na] - 140)]/140

Question 20

how much water in man and woman

Answer 20

man 60%

woman 50%

Question 21

4 lab tests to help confirm hypovolemia

Answer 21

1. urine
   - osmolarity rises - test specific gravity
2. ratio of plasma urea:creatinine
   - rises to >8%
   - urea rises faster since reabsorbed with Na
3. hematocrit/hemoglobin
   - compare to previous levels
4. check for other lyte abnormalities

Question 22

3 indications of IV fluids

Answer 22

1. existing large deficit
2. anticipated large def.
3. access to circulation for meds

Question 23

what are crystalloids and colloids

Answer 23

crystalloids - Saline/dextrose
colloids
- large mol. weight substances

Question 24

what happens when give saline

Answer 24

• all stays in ECF

- no change in [Na]

Question 25

what happens when give dextrose

Answer 25

water goes 2/3 ICF, 1/3 ECF | [Na] down

Question 26

what happens when give half normal saline

Answer 26

half is like normal, half is like dextrose

Question 27

what is formula for change in plasma [Na] for giving a liter of fluid

Answer 27

(IV[Na] - patient [Na])/ (total body water +1)

Question 28

3 types of colloids

Answer 28

1. abumin (5 and 25%) 2. starch solutions 3. fresh frozen plasma

Question 29

why give colloid

Answer 29

expect to stay in intravascular better

Question 30

4 steps to give fluids

Answer 30

1. estimate and replace existing deficit 2. replace ongoing def. 3. reassess respnse to ther 4. decide if additional are needed

Question 31

what to give if hypernatremic

Answer 31

- may need free water - may also need isotonic - not too fast

Question 32

what to give if hyponatremic

Answer 32

- avoid free water

Question 33

**** mega important point about hypotonic fluids

Answer 33

don't give to sick patients unless they are hypernatremic | - sick patients make ADH so don't excrete free water

Question 34

4 possible routes

Answer 34

1. periph vein IV 2. central line 3. intraosseous in kids 4. continuous sub cut

Question 35

check cases

Answer 35

it's shreiber