Lecture 1 - Fluids

Question 1

IBW Male Equation

Answer 1

50 kg + (2.3 x in over 60in)

Question 2

IBW Female Equation

Answer 2

45.5 kg + (2.3 x in over 60in)

Question 3

Dry weight = ___ weight = ___ weight

Answer 3

admit, actual

Question 4

Adjusting Weights

• NBW is used if ABW > ___ % of IBW
• NBW Equation: ___
• applies for calculating ___ parameters

Answer 4

• 130 %
• NBW = IBW + 0.25(wt - IBW)
• FEN

FEN = fluid, electrolyte and, nutrition

Question 5

T or F: use DBW for FEN parameters if ABW > 130%

FEN = fluid, electrolyte and, nutrition

Answer 5

F: DBW is used for dosing drugs, not FEN

Question 6

fluid makes up ___ % body weight
* ___ % intracellular
* ___ % extracellular

Answer 6

• 60
• 40
• 20

Question 7

extracellular fluid is 3/4 ___ and 1/4 ___

Answer 7

• interstitial
• intravascular

Question 8

fluid intake = fluid ___

Answer 8

losses

Question 9

sensible loss sources (3)

1-1.5 L/day

Answer 9

• urination
• defecation
• wounds

Question 10

insensible loss sources

1 L/day

Answer 10

• sweating
• exhaling

Question 11

volume regulation is governed by (3)

Answer 11

• kidneys
• thirst
• hormonal changes

Question 12

volume regulation

ADH
- reduces production of ___
- increases water ___

Answer 12

• urine
• retention

Question 13

volume regulation

Renin-Angiotensin Aldosterone System (RAAS)
- renin secretion
- ___ and ___ regulation (aldosterone)

Answer 13

• Na, water

Question 14

volume regulation

Atrial Naturetic Peptide (ANP)
- decreases ___ release
- counteracts effects of ___

Answer 14

• ADH
• RAAS

Question 15

Tonicity of Fluids - Ranges

• Isotonic
• Hypotonic
• Hypertonic

Answer 15

• 275-290 mOsm/L
• < 275 mOsm/L
• > 290 mOsm/L

Question 16

Osmolarity - measure of ___ concentration
- dependent on ___ and ___

Answer 16

solute
* pH and temp

Question 17

Osmolarity of 0.45% NaCl

Answer 17

154 mOsm/L

Question 18

Total Osmolarity = IV + electrolytes

Calculate osmolarity of 1L of 0.45% NaCl with 20 mEq KCl

Answer 18

154 mOsm/L + (20 mEq/L)x(2 mOsm/mEq) = 194 mOsm/mEq

KCl = 2 ions = 2 mOsm/mEq

Question 19

MIVF Requirements

clinical estimate: ___ mL/kg/day

Answer 19

30-40 mL/kg/day

Question 20

T or F: Crystalloids can be iso, hyper, and hypotonic

Answer 20

T

Question 21

T or F: Colloids are hypotonic only

Answer 21

F: HYPERtonic

Question 22

Crystalloids include

Answer 22

NS, 1/2 NS, D5W, LR, and balanced salt solutions

Question 23

Colloids include

Answer 23

albumin, hetastarch, tetrastarch, blood, plasmanate

Question 24

crystalloid solutions

• provide ___ and/or ___
• maintain ___ between intravascular and extravascular compartments

Answer 24

• water, Na
• osmotic gradient

Question 25

# crystalloid soutions NS is used for intravascular fluid replacement ( ___ ) * ___ and/or ___ replacement

Answer 25

* resuscitation * Na, Cl

Question 26

# crystalloid soutions 1/2 NS is used for ___ fluids (combination products)

Answer 26

maintenance

Question 27

# crystalloid soutions LR (lactated ringers) are used for - ___ loss - ___ (trauma, burn, etc) - approximates human ___

Answer 27

* blood * resuscitation * plasma

Question 28

# crystalloid soutions D5W is used for ___ replacement * NOT a ___ * NOT a ___ alone

Answer 28

free water - resuscitative - MIVF

Question 29

# crystalloid soutions balanced salt solutions contain ___ levels of chloride and buffer solutions examples (3)

Answer 29

- physiologic - LR - Normosol-R - Plasma-lyte

Question 30

# NS vs Balanced Salt * ↑ mortality * ↑ hyperchloremic metabolic ___ * ↑ blood transfusions * ↑ ___ injury * ↑ hyper___ * ↑ postop ___

Answer 30

* acidosis * renal * hyperkalemia * infection

Question 31

# colloid solutions - used to increase plasma oncotic ___ - move fluid from the interstitial to ___ - "___ expanders" - 2nd line for ___ shock

Answer 31

* pressure * intravascular * plasma/volume * hypovolemic

Question 32

Which has a longer half life: colloids or crystalloids?

Answer 32

Colloids; increased molecular weight corresponds to increased intravascular retention time

Question 33

T or F: Colloids can be used as MIVF

Answer 33

False

Question 34

# colloid solutions Albumin uses - ___ expansion - shock - burn - acute respiratory distress syndrome - cardiopulmonary ___ - ____ fluid repletion

Answer 34

* volume * bypass * intraoperative

Question 35

# colloid solutions Albumin adverse effects - ___volemia - ___temia - infusion related reaction/____

Answer 35

* HYPERvolemia * Azo * anaphylaxis

Question 36

T or F: Albumin 25% is better for fluid/Na restricted pts

Answer 36

T; less volume needs to be given vs 5%

Question 37

T or F: albumin 25% is better for hypovolemic or intravasculalry depleted patients

Answer 37

F; 5% is better bc you have to give more volume

Question 38

# Synthetic Colloids Heta and Tetrastarch - High ___ ratios (# of hydroxyethyl groups per ___) - results in prolonged intravascular ___ - large molecular weight causes ____ - Saftey concerns with severe ___ | use with caution

Answer 38

* substitution, glucose * expansion * coagulation * sepsis

Question 39

# colloid solutions Blood uses - acute blood loss (___ % of blood volume) - inadequate ___ from fluids alone - preoperatively - low hemoglobin ( < ___ g/dL )

Answer 39

* 30-40% * resuscitation * 7-8 g/dL

Question 40

# colloid solutions how many mLs in 1 unit of blood? 1 unit increases hemoglobin by about ___ g/dL

Answer 40

230-350 mLs 1 g/dL

Question 41

Most common MIVF: ___ - used to increase plasma oncotic ___ - similar composition to urine

Answer 41

D5W + 1/2NS + 20 mEq KCl/L * pressure

Question 42

# Monitoring Fluid Status - daily weight - daily ins/outs - volume status (overload, euvolemic, ___ ) - ___ output (UOP) mL/kg/hr - Vitals (HR, BP, invasive ___ parameters)

Answer 42

* dehydration * urine * hemodynamic | invasive hemodynamic parameteres = Swan-Ganz PA Catheter

Question 43

# Signs of dehydration * decreased skin ___ * dry mucus ___ * delayed ___ refill * tachycardia and ___ * weak ___ pulse * decreased urine output (< ___ mL/kg/hr), dark and concentrated * BUN/Scr ratio > ___ | vary based on age, disease state, meds, cause of fluid depletion

Answer 43

* turgor * membranes * capillary * hypotension - peripheral * 0.5 mL/kg/hr * 20