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Question 1

• Water makes up 60% of body weight of average adult
  
  • 40% of body weight is water stored in ____________; 28L in 70kg man
• 20% of body weight is water stored in ___________________; 14L

Answer 1

• Water makes up 60% of body weight of average adult
  
  • 40% of body weight is water stored in intracellular fluid space (ICF); 28L in 70kg man

20% of body weight is water stored in extracellar fluid space (ECF); 14L

Question 2

• ECF is then divided into __________ and ___________, separated by capillary membrane w micropores.

Answer 2

• ECF is then divided into intravascular and interstitial, separated by capillary membrane w micropores.

Question 3

• Intravascular volume depends on_____________ that help to retain H20 inside. Hydrostatic pressure drives H20 out.

Answer 3

• Intravascular volume depends on plasma oncotic pressure (POP) that help to retain H20 inside. Hydrostatic pressure drives H20 out.

Question 4

• ICF and ECF are separated by ______, which makes sure Na+ stays mainly in ECF

Answer 4

Na+ pump

Question 5

• What clinically important flux occurs in the GI tract?

Answer 5

• GI tract and ECF exchange fluid and electrolytes that help to secrete and reabsorp digestive juices. Flux helps to maintain internal fluid balance.

Question 6

• What factors help to maintain fluid balance?

Answer 6

• Intake, output, N20, Na+ and K+.

Question 7

• How does illness and injury change the balance of fluids/electrolytes and distribution needs?

Answer 7

1. . Non-specific metabolic response to stress
2. Fluid/electrolyte handling attributable to specific organ or the effects of drugs/IV therapy
3. Restricted recent food intake or malnutrition

Question 8

Isotonic fluids

Answer 8

1. NS,
2. LR,
3. D5W (+/-)

Question 9

Hypotonic fluids

Answer 9

• ½ NS,
• D5W (+/-)

Question 10

Hypertonic fluids:

Answer 10

1. 3% NaCl,
2. D10W,
3. D5 ½ N
4. D5 NS
5. D5LR

Question 11

• What should be used to correct:
  
  1. Hypernatremia
  2. Hyponatremia
  3. Blood loss
  4. Hypokalemia or metabolic acidosis

Answer 11

1. Hypotonic solutions
2. Isotonic or hypertonic saline
3. Isotonic saline and/or blood
4. Add K+ or bicarb

Question 12

• If fluids are adequadately resuscitated, but there are ongoing losses. What is needed?
• What about if adequately replaced and no ongoing losses?

Answer 12

• Replacement or redistribution?
• Routine maintaince

Question 13

• If fluids are inadeagately replaced, what occurs?

Answer 13

• Need for resuscitation.

Question 14

• If resuscitation results in successful resuscitation and no ongoing losses, what is needed?

Answer 14

• Routine maintaince.

Question 15

• Patient is undergoing routine maintaince of fluid. What do we do if
  
  • New losses occur due to hemorrhage?
  • Inadequate maintenance or ongoing losses?
  • IV fluids are no longer needed?

Answer 15

1. Resucitation is needed
2. Replace and redistribute
3. Oral/enteral maintance

Question 16

• The normal person requires how much water a day and how much Na+ and K+

Answer 16

• 25-30mL/kg of water a day
• 1 mmol/kg of Na+ and K+.

Question 17

4. Discuss common indications for initiating and maintaining intravenous (I.V.)

therapy.

adults

Answer 17

• Children
  
  • Correct dehydration that most commonly occurs due to gastroenteritis
  • Administer IV ABX
• Adults
  
  • Maintain fluid and electrolytes
  • Replace or supplement blood components
  • Provide nutrients
  • Administer meds

Question 18

Identify adverse events that may occur when common crystalloid solutions are

infused intravenously.

• 1. LR
• 2. Isotonic saline
• 3. Hypertonic saline (3% NS) used to treat hyponatremia
• 4. D5w (isotonic)
     *

Answer 18

• 1. LR
     * form clots in the middle of transfusion
     * Avoid in rhabdomylosis and use NS insead
• 2. Isotonic saline
  
  • can cause metabolic acidosis w a_ggressive resuscitation_
• 3. Hypertonic saline (3% NS) used to treat hyponatremia
  
  • Requires investigation as to what CAUSED the low Na+.
  • Sxs are more significant when deciding for hypertonic saline
• 4. D5W (isotonic)
  
  • electrolyte shift d/t hypotoncity after initial response phase
    *

Question 19

• D5 ½ NS is istonic. However, which is better: D5 ½ NS or NS and LR?

Answer 19

• NS and LR
• D5 ½ NS becomes more hypertonic after its initial response

Question 20

how much to maintain fluid in 24 kg kid?

Answer 20

100 * 10

50 * 10

20 * 4

=1580 in 24 hours or 66mL min

Question 21

• Volume loss in children is calculated by comparing what?

Question 22

• How of fast should fluid volume that is LOST be replaced children?

Answer 22

1/2 in first 8 hours

rest over 16 hours

Question 23

to calculate deficit:

1kg weight loss = 1 liter = 1000mL

Question 24

• In an adult, how can we determine the volume deficit?

Answer 24

• No formula. Weigh loss provides the best estimate.

Question 25

* What clinical and labs can be used to find out the possible prescence of volume depletion in adults?

Answer 25

* **BP**, **JVP,** **urine Na+**, **UO** * If baseline values are available pt isn’t bleeding, then **hematocrit**

Question 26

* In an adult, the rate of fluid replacement depends on what?

Answer 26

* **Severity**

Question 27

* With **severe volume depletion of hypovolemic sho**ck, what is given and how fast?

Answer 27

* **1-2 L of isotonic saline** as fast as possible, to restore tissue perfusion * **Continued at a rapid rate until signs of hypovolemia** improves (low BP, low UO, impaired mental status)

Question 28

* With mild-moderate volume depletion of hypovolemic shock, what is given and how fast?

Answer 28

* Not rapidly. **Rate of administration should be faster than rate of continued fluid loss** * **UO** + **estimated insensible losses (30-50mL/hour)** + **any other fluid loss (GI losses)** * 50-100mL/hour greater than fluid loss.

Question 29

* Most patients are treated with what fluids?

Answer 29

* **Isotonic or ½ isotonic saline**