IV Fluids and Admin

Question 1

What is dehydration

Answer 1

Dehydration - loss of total body water without proportional reduction in salt levels, which can lead to hyponatremia

Question 2

Hypovolemia?

Answer 2

Hypovolemia - refers to any condition in which the effective circulating volume is reduced. It can be produced by salt and water loss (as with vomiting, diarrhea, diuretics, bleeding, or third space sequestration) or by physiologically significant water loss alone (insensible water losses or diabetes insipidus)

Question 3

Where does the IV fluid go?

Answer 3

Volume of distribution of infused fluids is dictated by their solute content. In turn, the plasma volume expansion (PVE) effect is directly related to the volume of distribution

PVE = Volume infused/Volume of distribution

Question 4

How much of the IVF will go into the intravascular space?

Answer 4

Only 1/4.

Remember, if you put in 1L of fluid, 3/4 will go into the ECF (750 mL) and within that, 1/3 of it, or 1/4 of the total initial volume, in this case 250 mL will make it in to the intravascular portion of the ECF

Question 5

If we use 5% dextrose in our slaine, where isthe water gonna go?

Answer 5

ICF. Dextrose likes to go into cells

Only like a third goes ECF (300 mL out of 1L) and then about 75 mL goes into the Intravascular space

Question 6

Where does 5% Albumin go?

Answer 6

100% intravascular. 1L in, none goes ICF, all goes straight to the intravascular portion of the ECF

Question 7

Infusion of large volumes of normal saline, 0.9%, for resuscitation is associated with what two conditions and why?

Answer 7

Hyperchloremia and metabolic acidosis

Chloride decreases renin release, secondarily suppresses aldosterone availability and bicarbonate retention

Question 8

Acidosis leads to what?

Answer 8

Dysfunction of various cellular and extracellular mechanisms, most notably coagulation and impaired homeostasis. May explain the increased need for blood products in certain patients as changes in acidity directly influence processes like coagulation

Question 9

Normal saline, 0.9%, infusion with resultant relative ____ induces ____ with a reduction in ___ and ___.

Answer 9

Hyperchloremia
Vasoconstriction
RBF
GFR

Question 10

What should we use more often for IV fluid and why?

Answer 10

Balanced crystalloids

• Lower renal replacement
• Corrects acidosis
• Lower Cr levels
• Increased diuresis
• Better gastric perfusion

Question 11

Inadequate fluid administration can lead to:

Answer 11

Diversion of blood toward vital organs liek the brain and heart and away from nonvital organs like the gut, skin and kidneys. Inadeuqate perfusion of these nonvitals gives you adverse outcomes

Question 12

Excessive administration of fluid adverse effects

Answer 12

1. Excess intravascular fluid leads to increased pressure in venous circulation (rise in venouspressure and decreased GFR) and results in loss of fluid from intravascular space into the interstitium
2. Extra intersititial fluid means development of pulmonary and peripheral edema and consequent compromise of systemic and/or local tissue oxygenation
3. Evidence that intestinal edema is associated with impaired GI function tolerance for enteral nutrition and increased potential for the development of bacterial translocation, leading to development of multiple organ dysfunction syndrome