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. What would you like to do?
What percent of the body is water? What percent is Extra-cell/Intra-cell?
If you insert sodium chloride (saline) in the body, where does it like to go? Extra-cellular fluid or the intra-cellular fluid?
How is dextrose in water divided in the body?
If you want to replace fluid in the body, what is better?
Dextrose or Sodium Chloride
Sodium Chloride because it likes the ECF.
What are crystalloids?
- Fluids that supply water and sodium.
- PV expanders bc of Na+.
- No protien.
What is better in treating dehydration? Crystalloids or PV expanders?
What is crystalloids used for?
- Replace fluid
- Promote urine
- Manage fluid disturbances
Side effects of crystalloids?
- decrease COP
- effects last short
What are colloids?
PV expander. They move fluid from interstitial to plasma.
What is Dextran 40?
What is Dextran 70?
What is Hetastarch?
Synthetic colloid. From cornstarch.
What is albumin?
Colloid. (human donation)
What's better in PV expansion? Colloids or crystalloids?
Side effects of Colloids?
- May affect coagulation = bleeding.
- no clotting
- no carry O2
What are blood products?
- O2 carrying resuscitation fluid
- Only ones that can carry O2
What are blood products for?
- Increase O2
- Increase PV
- Pull fluid from ECF to ICF. Increase body's supply of hemoglobin, clotting factors.
Why are blood products rare and expensive?
Require human donors.
How do you manage acute bleeding?
How do you combat anemia?
*remember is restores hemoglobin.
Side effects of blood products?
- Transfusion reaction.
- Transmissions of shit from donor to recipient.
What is hypernatremia? What is normal sodium levels? What is high sodium blood levels?
High sodium blood level.
- Normal 135-145
- Hypernatremia 145+
Symptoms you have too much salt in you?
Dehydrated maybe, the blood isn't circulating good. Hypertension.
What do you do to fight hypernatremia (too much salt)?
There are two reasons why you get too much salt. Too much salt or too little H2O. Too much salt? Dial back the salt. Too much H2O? You're dehydrated. Use D5W to replace water.
What is Hyponatremia? What may cause it?
Too little salt. below 135. Too much sweating. Too much vomit. Renal disorder.
How do you treat hyponatremia?
Diuretics to relieve water.
What is hyperalema? What may cause it? What are some symptoms?
Too much K+. Normal is 3.5-5.
ACE inhibitors, hemolysis, crush injury
Arrhythmia, EKG change.
How do you treat hyperalemia?
- Calcium I.V.
- Onset: 1-3 min.
- Duration: 30-60 min.
- Sodium bicarbonate
- Onset: 30 min.
- Watch sodium content
- Onset: 1 hr.
- Duration: Several hrs.
Kayexalate + sorbitol is another way to treat hyperalemia. How does it work. What do you need to watch for?
Oral. SLOW onset: 4-6 hrs. It decreases the body's stores of K+.
What is hypoalemia? Symptoms? Treatment?
K+ less than 3.5
EKG change, arrhythmia. Same as hyperalemia.
K+ replacement. IV no faster than 10 meq/hr
What is enteral nutrition?
Nutrients through GI tract. Safe.
What is gastronomy?
Feeding tube surgically inserted through stomach.
What is jejunostomy?
Feeding tube surgically inserted to jejunum.
What is nasoduodenal?
Feeding tube from nose to duodenum.
What is nasjoejunal?
Feeding tube from nose to jejunal.
What is the nasogastric route to feed?
Feeding tube from mouth to stomach.
What is parenteral nutrition?
Nutrients given IV. Passes GI system so no need to wait to absorb, metabolize or excrete.
Central TPN is delivered where?
Through a large vein. sublcavian or internal jugular.
What's being given in TPN?
Dex, Fats and protein.
Some disadvantages with TPN?
Risks associated with line insertion, infection, use, maintenance.
Who needs TPN?
- nutritional support 7-10 days
- large nutritional requirements
- unable to tolarate large fluid loads
What is peripheral parenteral nutrition?
supplmentation for less than a week. Dex is 10% vs 25% in central.
Parental Nutrition titration
Start TPN at 40-50 ml/hr x24hrs to 25-50 ml/hr
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