Fluid and Electrolytes Part One

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 Author: Merrittk ID: 210365 Filename: Fluid and Electrolytes Part One Updated: 2013-04-02 10:28:04 Tags: BC CRNA Folders: Description: Fluid and Electrolyte Cards over first half of the lecture for Quiz Show Answers:

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1. ____% of our Bodies are Water.
60%
2. ___% : Plasma
8%
3. ___%: Interstitial Fluid
25%
4. ___%: Minor components
3%
5. ___%: Intracellular Fluid
64%
6. Total Body Water for Average 70kg Male:
___L
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
28-30L
9. What fraction of total body water is Intracellular Fluid?
2/3
10. Total Body Water:
Extracellular Fluid ___L
14 L
11. What fraction of total body water is Extracellular Fluid?
1/3
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=

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

Equivalent Weight of Calcium=
18. True or False:
It is important to know the difference between reported units of electrolytes.
TRUE.
19. Name the components found at higher concentration in the extracellular fluid. [4 Things]
• 1. Sodium []
• 2. Chloride []
• 3. Bicarbonate []
• 4. Calcium []
20. Name the components found at higher concentration in the intracellular fluid. [Five things]
• 1. Potassium []
• 2. Organic Acids [ pyruvate and lactate]
• 3. Phosphate []
• 4. Magnesium []
• 5. Protein
21. Sodium []  Concentration in
1. Plasma
2. Interstitial
3. ICF
• 1. Plasma: 140
• 2. Interstitial: 142
• 3. ICF: 10
22. Potassium []  Concentration in
1. Plasma
2. Interstitial
3. ICF
• 1. Plasma: 4
• 2. Interstitial: 4
• 3. ICF: 150
23. Magnesium [] Concentration in:
1. Plasma
2. Interstitial
3. ICF
• 1. Plasma: 2
• 2. Interstitial: 2
• 3. ICF: 40
24. Calcium [] Concentration In
1. Plasma
2. Interstitial
3. ICF
• 1. Plasma: 5
• 2. Interstitial: 3
• 3. ICF: 1
25. Chloride [] Concentration In
1. Plasma
2. Interstitial
3. ICF
• 1. Plasma: 103
• 2. Interstitial: 117
• 3. ICF: 10
26. Bicarbonate [] Concentration in:
1. Plasma
2. Interstitial
3. ICF
• 1. Plasma: 25
• 2. Interstitial: 27
• 3. ICF: 7
27. Phosphate [] 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)
60%

1000mL
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?

• Example
• 292 is average normal osmolarity
53. Density of Water is approximately ____; which makes osmolarity and osmolality:
1

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:

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

MW:

*osmoles x2 because NaCl has 2 ions

OR
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.
59. True or False:
In regard to things crossing the membrane, water is the only thing crossing: NOT electrolytes.
TRUE!
60. Describe the cell placed in isotonic solution. (280 mOsm/L)
61. Describe the cell placed in hypotonic solution. (200mOsm/L)
62. Describe the cell place in hypertonic solution. (360mOsm/L)
63. The cell changes tonicity in an attempt to:
Equilibrate
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)
Isotonic
71. ___% of isotonic fluid will move into the interstitial space.

__% of isotonic fluid will move into the intravascular space.
75-80%

20-25%

*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?
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:
Bicarbonate
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?

**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.
True!

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.
True
92. Albumin expands plasma volume ____x its normal value.
4-5x
93. True or False:
Albumin is generally safe at normal values.
True.
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.
FALSE!

Higher doses can lead to a decreases in vWb factor, decrease in fibrinogen, and decreased platelet aggregation
100. Limit use of Hetastarch to:
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?
Dextran

1:3000 administrations

caused by IgE antibodies most of us already have
106. Which colloid has robust anticoagulant properties?
Dextran
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?
Dextran70

• -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.
True.

-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.
True
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?
• -EXPENSIVE!
• -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.
TRUE!

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!

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