Fluid and Electrolytes Part One

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  1. ____% of our Bodies are Water.
  2. ___% : Plasma
  3. ___%: Interstitial Fluid
  4. ___%: Minor components
  5. ___%: Intracellular Fluid
  6. Total Body Water for Average 70kg Male: 
    40-42 L
  7. Total Body Water for Avg. 70 kg Male: 
    approx. ____ mL/kg
    600 mL/kg
  8. Total Body Water: 
    Intracellular fluid ____L
  9. What fraction of total body water is Intracellular Fluid?
  10. Total Body Water:
    Extracellular Fluid ___L
    14 L
  11. What fraction of total body water is Extracellular Fluid?
  12. What are the two sub-compartments of Extracellular Fluid?
    • 1. Interstitial Fluid
    • 2.Plasma (AKA Intravascular Space)
  13. Total Body Water: 
    Interstitial Fluid ___L
    11 L
  14. Total Body Water:
    Plasma (AKA Intravascular Space) ___L
    3 L
  15. What are the two components of Plasma (AKA Intravascular Fluid)?
    • 1. Noncellular components
    • 2. Cellular components (ie. RBC's, WBC's)
  16. What is the main difference between plasma and interstitial fluid?
    How does this difference effect the colloid osmotic pressure?
    Main difference between plasma and interstitial fluid is the concentration of proteins.

    The plasma has a larger concentration (20 mmHg greater) of proteins that create an osmotic gradient. This gradient is what keeps fluid in the plasma (AKA intravascular space)
  17. Equivalent Weight of  Substance=
    Image Upload 1

    • For example: 
    • Calcium: Molecular Weight is 40 and it contains 2 charges so:

    Equivalent Weight of Calcium= Image Upload 2
  18. True or False:
    It is important to know the difference between reported units of electrolytes.
  19. Name the components found at higher concentration in the extracellular fluid. [4 Things]
    • 1. Sodium [Image Upload 3]
    • 2. Chloride [Image Upload 4]
    • 3. Bicarbonate [Image Upload 5]
    • 4. Calcium [Image Upload 6]
  20. Name the components found at higher concentration in the intracellular fluid. [Five things]
    • 1. Potassium [Image Upload 7]
    • 2. Organic Acids [ pyruvate and lactate]
    • 3. Phosphate [Image Upload 8]
    • 4. Magnesium [Image Upload 9]
    • 5. Protein
  21. Sodium [Image Upload 10]  Concentration in
    1. Plasma
    2. Interstitial
    3. ICF
    • 1. Plasma: 140
    • 2. Interstitial: 142
    • 3. ICF: 10
  22. Potassium [Image Upload 11]  Concentration in
    1. Plasma
    2. Interstitial
    3. ICF
    • 1. Plasma: 4
    • 2. Interstitial: 4
    • 3. ICF: 150
  23. Magnesium [Image Upload 12] Concentration in:
    1. Plasma
    2. Interstitial
    3. ICF
    • 1. Plasma: 2
    • 2. Interstitial: 2
    • 3. ICF: 40
  24. Calcium [Image Upload 13] Concentration In
    1. Plasma
    2. Interstitial
    3. ICF
    • 1. Plasma: 5
    • 2. Interstitial: 3
    • 3. ICF: 1
  25. Chloride [Image Upload 14] Concentration In
    1. Plasma
    2. Interstitial
    3. ICF
    • 1. Plasma: 103
    • 2. Interstitial: 117
    • 3. ICF: 10
  26. Bicarbonate [Image Upload 15] Concentration in:
    1. Plasma
    2. Interstitial
    3. ICF
    • 1. Plasma: 25
    • 2. Interstitial: 27
    • 3. ICF: 7
  27. Phosphate [Image Upload 16] Concentration In:
    1. Plasma
    2. Interstitial
    3. ICF
    • 1. Plasma: 2
    • 2. Interstitial: 2
    • 3. ICF: 0
  28. What does the Donnan Effect Describe?
    [AKA Donnan- Gibbs Effect]
    -Explains the disequilibrium between different compartments in the extracellular space

    -Colloid Osmotic pressure is due to the proteins in the plasma (AKA Intravascular Space)

    • -Colloid Osmotic Pressure is 28 mmHg 
    • 19 mmHg is plasma proteins
    • 9 mmHg are charged ions held in place by the proteins (explains why there are different concentrations of ions in different compartments)
  29. Composition of Extracellular Fluid is carefully regulated by:
    The Kidneys!
  30. Plasma Concentration of Phospholipids:
    280 mg/dL
  31. Plasma Concentration of Cholesterol:
    150 mg/dL
  32. Plasma Concentration of Neutral Fat (AKA triglycerides):
    125 mg/dL
  33. Plasma Concentration of Glucose:
    100 mg/dL
  34. Plasma Concentration of Urea:
    15 mg/dL
  35. Plasma Concentration of Lactic Acid:
    10 mg/dL
  36. Plasma Concentration of Uric Acid:
    3 mg/dL
  37. Plasma Concentration of Creatinine:
    1.5 mg/dL
  38. Plasma Concentration of Bilirubin:
    .5 mg/dL
  39. Plasma Concentration of Bile Salts:
    Trace Amounts
  40. Average person should take in approximately _____ mL in Food and Drink each day.
    2200 mL
  41. Average person gains approximately ___ mL of fluid from oxidation each day.
    300 mL
  42. On average, we lose ___% daily water in our urine.

    (or how many mL on average)

  43. When we sweat, we can lose an average of ___ mL.
    100 mL
  44. During Heavy exercise, we can lose as much as ___ L.
    5 L!
  45. In insensible water loss, we can lose up to ____ each day.
    500-1 L!
  46. We lose approximately ___ each day from our GI tract.
    100-150 mL

    100-200mL later on in lecture
  47. How do kidneys help maintain water and electrolyte balance?
    Kidneys increase or decrease the amounts eliminated through mediators (mediators=hormones)
  48. Name 3 hormones secreted that aid in the maintenance of fluid and electrolyte balance.
    • 1. ADH 
    • 2. ANP (Atrial natriuretic peptide)
    • 3. Aldosterone
  49. How does ADH affect absorption? 
    (Describe entire process)
    1. Osmoreceptors in the hypothalamus identify the osmolarity of blood moving through it

    2. A change of even 2% is detected by the osmoreceptors and in response, they secrete ADH

    3. ADH secretion stimulates the insertion of aquaporins

    4. Aquaporins will allow more water absorption
  50. What is osmolarity?
    Number of osmotically active particles per L of solvent
  51. What is Osmolality?
    Number of osmotically active particles per kg
  52. Osmolarity can be calculated (approximately) through what formula?
    Image Upload 17

    • Example
    • Image Upload 18
    • 292 is average normal osmolarity
  53. Density of Water is approximately ____; which makes osmolarity and osmolality:

    effectively equal
  54. What is tonicity?
    Basically: IV solution vs. Plasma

    Compares osmotic pressure of a parenteral solution to that of plasma 

    ex. hypo, iso, hyper
  55. What does the colloid osmotic pressure represent? (AKA oncotic pressure)
    Osmotic pressure exerted by the plasma proteins (and also Na, Glucose, and BUN)
  56. Calculate Osmolarity for D5W

    MW: Image Upload 19
    Image Upload 20

    • *osmoles: same because gluocse is NOT an ion
    • so:
    • Image Upload 21 OR Image Upload 22
  57. Calculate Osmolarity for .9NaCl

    MW: Image Upload 23
    Image Upload 24

    *osmoles x2 because NaCl has 2 ions

    Image Upload 25 OR Image Upload 26
  58. D5NS Osmolarity? 

    *no math just explain how you'd find it
    Find osmolarity for D5W.

    Find osmolarity for NS.

    Add the two together.

    Ex. Image Upload 27
  59. True or False: 
    In regard to things crossing the membrane, water is the only thing crossing: NOT electrolytes.
  60. Describe the cell placed in isotonic solution. (280 mOsm/L)
    Image Upload 28
  61. Describe the cell placed in hypotonic solution. (200mOsm/L)
    Image Upload 29
  62. Describe the cell place in hypertonic solution. (360mOsm/L)
    Image Upload 30
  63. The cell changes tonicity in an attempt to:
  64. Describe the change intracellular and extracellular compartments go through when a HYPOTONIC solution is added.
    • 1. Intracellular volume increases (by a greater extent than extracellular) (although both increase)
    • 2. Intracellular & Extracellular Volume Increase
    • 3. Intracellular & Extracellular Osmolarity Decrease
  65. Describe the change intracellular and extracellular compartments go through when a HYPERTONIC solution is added.
    1. Intracellular volume decreases

    2. Extracellular volume increases by a greater extent than what was given (because fluid is coming out of cells)

    3. Intracellular and extracellular osmolarity increases
  66. Describe the change intracellular and extracellular compartments go through when an ISOTONIC solution is added.
    1. Intracellular volume & osmolarity stay the same

    2. Extraceullar volume increases & osmolarity stays the same.
  67. Value for tonicity of ISOTONIC Solution.
    250-375 mOsm/L
  68. Value for tonicity of HYPOTONIC Solution.
    <250 mOsm/L
  69. Value for Tonicity of HYPERTONIC solution.
    >375 mOsm/L
  70. This type of solution is used to expand extracellular fluid (little goes into the intracellular compartment)
  71. ___% of isotonic fluid will move into the interstitial space.

    __% of isotonic fluid will move into the intravascular space.


    *all depends on the relative volume of the compartment; interstitial space is 3x larger than intravascular space
  72. Explain why dextrose solutions can be both isotonic and hypotonic.
    When giving D5W, initially it is isotonic. The dextrose gets taken up by the cells for energy, leaving the water. 

    The water dilutes the environment of the cells and therefore creates a hypotonic environment.

    Cells will swell until equilibrium is reached.
  73. Name four reasons we give Dextrose.
    • 1. Provide calories for energy for the cells, sparing the body protein. (limit protein catabolism)
    • 2. Prevent ketosis from oxidation of fat
    • 3. Help move potassium from extracellular to intracellular (helpful if given with insulin for treatment of hyperkalemia)
    • 4. Prevent hypoglycemia
  74. What is the maximum amount of glucose we can give before glycosurea occurs?
    Image Upload 31
  75. What is glycosurea?
    The spill of glucose into the urine.
  76. What solution does Sue say we use 90% of the time?
    Lactated Ringers
  77. Which solution is near physiologic in electrolye composition?
    Lactated Ringers
  78. Lactate is metabolized into:
  79. If you give too much Lactated Ringers, what could happen? Why?
    Lactate in the LR is metabolized into Bicarbonate ion. 

    Too much bicarbonate ion could push the patient into metabolic alkalosis and possible hyperkalemia.
  80. Which patient population should you use caution when giving LR?
    Renal Disease

    -could cause hyperkalemia and renal disease
  81. Which isotonic fluid is typically used to replace surgical losses?
    Lactated Ringers
  82. Why don't we typically give NaCl to replace surgical losses?
    NaCl solution contains Na and Cl could push the patient into hyperchloremic metabolic acidosis.
  83. Hypothetically, we can calculate the volume needed to infuse through what equation?
    Image Upload 32

    **see notes for examples of Isotonic and Hypotonic fluid replacement; this formula helps explain the science behind why we use LR instead of D5W
  84. When using a crystalloid/isotonic to replace loss:

    ___:___ Rule
    3:1 Rule

    For every 1 mL of blood loss, replace with 3 mL of crystalloid/isotonic
  85. True or False: Fluid will distribute according to the volumes of the various compartments.

    Ex. 1 L D5W

    • 2/3 Intracellular (670mL)
    • 1/3 Extracellular
    •    Interstitial (250mL)
    •    Plasma (83mL)
  86. Name the 3 Colloids Discussed in Class.
    • 1. Albumin 
    • 2. Hetastarch
    • 3. Dextran
  87. What is Albumin made of?
    Human serum Albumin pasteurized and heat treated
  88. ALBUMIN 5%
    -How many grams albumin?
    -How many mL?
    -How much Na?
    -How much K?
    • -12.5 g Albumin
    • -250 mL
    • -145 mEq Na
    • -<2 mEq K
  89. ALBUMIN 25%
    -how many grams albumin?
    -how many mL?
    • -12.5 grams Albumin
    • -50 mL
  90. What is the approximate half life of Albumin?
    16 hours
  91. True or False:
    Albumin is isotonic to plasma.
  92. Albumin expands plasma volume ____x its normal value.
  93. True or False:
    Albumin is generally safe at normal values.
  94. Hetastarch is made of:
    multipolymer chain polysaccharide
  95. Hespan 6% is in ____.
    Normal Saline

    *type of Hetastarch
  96. Hextend 6% is in ____.
    Lactated Ringers

    *type of hetastarch
  97. Which hetastarch is associated with a prolonged PTT?
    Hespan 6%
  98. What is the intravascular half of Hetastarch?
    10 hours to days
  99. True or False:
    High doses of Hespan is generally safe.

    Higher doses can lead to a decreases in vWb factor, decrease in fibrinogen, and decreased platelet aggregation
  100. Limit use of Hetastarch to:
    Image Upload 33
  101. Dextran is made of:
    Water soluble glucose polymer
  102. Dextran 70 is the high molecular weight Dextran; whereas Dextran 40 is the:
    low molecular weight Dextran
  103. What is the half life of Dextran 70?
    approx. 12 hours 

    -can last up to 72 hours and can interfere with platelet activation
  104. What is the intravascular half life of Dextran 40?
    2-4 Hours
  105. Which colloid is associated with anaphylactoid reactions?

    1:3000 administrations

    caused by IgE antibodies most of us already have
  106. Which colloid has robust anticoagulant properties?
  107. What happens when the Dextran70 dose is >1500mL?
    increased bleeding times caused by decreased platelet adhesiveness
  108. Impaired coagulation due to Dextran may not be apparent for:
    6-9 hours following infusion
  109. Which colloid is sometimes used for irrigation?

    • -in hyteroscopy or prostatectomy
    • -can absorb and lead to noncardiogenic pulmonary edema and cerebral edema
  110. What patient populations would benefit from an infusion of dextrose (or solution with dextrose in it)?
    Infants and Patients on Insulin
  111. True or False: 
    As replacing fluid, it is important to keep in mind the loss in drains, nasogastric tube, and wounds.

    -May need to add electrolytes to our fluid.
  112. Why don't we give Dextrose to all surgical patients?
    Stress of surgery causes a hyperglycemic response.
  113. True or False:
    Hyperglycemia can cause osmotic diuresis.
  114. Describe the three main categories and associated values for conventional fluid management.
    *based on tissue trauma, values vary depending on source

    • 4-6 ml/kg/hr for mimimal tissue trauma
    • 6-8 ml/kg/hr for moderate tissue trauma
    • 8-12 ml/kg/hr for severe tissue trauma
  115. What are important considerations for patients fluid status under anesthesia? (3 Things)
    • 1. Vasodilation- bigger tank
    • 2. Stress of Surgery and the Anesthesia: increases ADH and Aldosterone secretion
    • 3. Mechanical Ventilation decreases ANP and causes the kidneys to conserve Na
  116. The average person requires:
    ___Na every day
    ___K every day
    • 75 mEq Na qday
    • 40 mEq K qday
  117. What are some advantages of colloids?
    • -smaller infused volume
    • -prolonged increased PV time
    • -less peripheral edema
  118. What are some disadvantages of colloids?
    • -coagulopathy [Dextran>Hespan]
    • -Pulmonary Edema
    • -Decreased GFR
    • -Osmotic Diuresis [with Dextran40]
    • -Increased duration of excessive volume duration
  119. What are some advantages to crystalloids?
    • -CHEAP!
    • -greater urine flow
    • -interstitial fluid replacement
  120. What are some disadvantages to crystalloids?
    • -Transient increased intravascular volume
    • -Transient hemodynamic improvement
    • -Peripheral Edema (d/t protein dilution)
    • -Pulmonary Edema (d/t protein dilution)
  121. Which patients have better statistical outcomes:
    -with colloids?
    -with crystaolloids?
    • Colloids: Sepsis
    • Crystalloid: Trauma
  122. What colloid is most commonly used?
    Hetastarch/Hespan specifically
  123. True or False:
    When decided between a colloid or a crystalloid, the decision really should come down to the patient population and the end game.

    Taper treatment to the patient you're taking care of!
  124. Studies suggested the estimated loss from bowel prep is:
    2 L
  125. To calculate maintenance fluid during a case:
    • First 4ml/kg for first 10 kg
    • Second 2 ml/kg for next 10 kg
    • Lastly, 1 ml/kg for rest of kg's

    Add together to get ml/hr
  126. To calculate an NPO deficit for fluid replacement:
    Multiple the maintenance fluid dose by the number of hours the patient has been NPO
  127. Replace for third spacing (AKA tissue trauma) by:
    • *based on tissue trauma, values vary depending on source
    • 4-6 ml/kg/hr for mimimal tissue trauma
    • 6-8 ml/kg/hr for moderate tissue trauma
    • 8-12 ml/kg/hr for severe tissue trauma
  128. To calculate the amount of fluid to replace blood loss:
    Use the 3:1 Rule.

    For every one ml of blood lost, replace with 3 ml of isotonic fluid
  129. What other considerations can we think of when calculating third space losses?
    • -Evaporation from the field
    • -Surgical Loss
    • -Loss from bowel prep
  130. What is the ratio for cell replacement for blood loss?
    • 1:1 !
    • For every one ml of blood lost, replace with 1 ml of cell replacement!
Card Set:
Fluid and Electrolytes Part One
2013-04-02 14:28:04

Fluid and Electrolyte Cards over first half of the lecture for Quiz
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