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Questions and Answers
The human body is composed of two main fluid compartments: the ______ and the extracellular compartments.
The human body is composed of two main fluid compartments: the ______ and the extracellular compartments.
intracellular
The intracellular compartment accounts for approximately ______ of the total body fluid.
The intracellular compartment accounts for approximately ______ of the total body fluid.
two-thirds
Fluid shifts between compartments are driven by ______ pressure.
Fluid shifts between compartments are driven by ______ pressure.
osmotic
The movement of fluids between compartments occurs through the ______ wall.
The movement of fluids between compartments occurs through the ______ wall.
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What are the 3 types of body fluids?
What are the 3 types of body fluids?
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Crystalloids are fluids and electrolytes normally found in the body without ______
Crystalloids are fluids and electrolytes normally found in the body without ______
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One indication for crystalloids is to maintain ______ volume
One indication for crystalloids is to maintain ______ volume
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Crystalloids are easily able to treat dehydration because they move easily between ______
Crystalloids are easily able to treat dehydration because they move easily between ______
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A common side effect of crystalloids is ______
A common side effect of crystalloids is ______
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Isotonic fluids have the same concentration of solutes as ______
Isotonic fluids have the same concentration of solutes as ______
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Normal saline, a common isotonic fluid, is composed of 0.9% ______
Normal saline, a common isotonic fluid, is composed of 0.9% ______
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Lactated Ringers contains Na, K, and Ca in ______
Lactated Ringers contains Na, K, and Ca in ______
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Lactated Ringers can be used to replace both fluid and ______
Lactated Ringers can be used to replace both fluid and ______
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Isotonic fluids are often used to treat low ______ or blood volume
Isotonic fluids are often used to treat low ______ or blood volume
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Hypotonic fluids have a lower concentration of ______ than blood.
Hypotonic fluids have a lower concentration of ______ than blood.
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When hypotonic fluids are administered, fluid shifts ______ the vascular space and into the tissues.
When hypotonic fluids are administered, fluid shifts ______ the vascular space and into the tissues.
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Common examples of hypotonic fluids include 0.45% or 0.25% ______.
Common examples of hypotonic fluids include 0.45% or 0.25% ______.
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Hypotonic fluids are indicated for conditions such as ______ and hypernatremia.
Hypotonic fluids are indicated for conditions such as ______ and hypernatremia.
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Hypotonic fluids are administered to treat conditions where there is a high concentration of ______ in the blood.
Hypotonic fluids are administered to treat conditions where there is a high concentration of ______ in the blood.
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Hypertonic fluids cause fluid to shift from the cell into the ______
Hypertonic fluids cause fluid to shift from the cell into the ______
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Hypertonic fluids are indicated for severe symptomatic ______
Hypertonic fluids are indicated for severe symptomatic ______
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D5W is an ______ solution that becomes hypotonic
D5W is an ______ solution that becomes hypotonic
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D5W is indicated for ______
D5W is indicated for ______
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D5W is used to provide free water for the ______
D5W is used to provide free water for the ______
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Colloids are often referred to as '________ expanders'.
Colloids are often referred to as '________ expanders'.
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Colloids contain large molecules such as albumin, globulin, and ______.
Colloids contain large molecules such as albumin, globulin, and ______.
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One indication for using colloids is in cases of ______.
One indication for using colloids is in cases of ______.
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Colloids do not contain ______ factors or carry oxygen.
Colloids do not contain ______ factors or carry oxygen.
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Dextran 40 is a type of colloid that is a ______ solution.
Dextran 40 is a type of colloid that is a ______ solution.
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Blood products increase plasma volume through ______ and hypertonic crystalloids.
Blood products increase plasma volume through ______ and hypertonic crystalloids.
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Fresh frozen plasma (FFP) contains ______ factors.
Fresh frozen plasma (FFP) contains ______ factors.
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Whole blood is given if over ______% of whole blood is lost.
Whole blood is given if over ______% of whole blood is lost.
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Packed Red Blood Cells (PRBC's) are given to increase ______ carrying capacity.
Packed Red Blood Cells (PRBC's) are given to increase ______ carrying capacity.
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Cryoprecipitate is high in clotting factors and ______.
Cryoprecipitate is high in clotting factors and ______.
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Blood donations must be type and ______ matched to prevent anaphylaxis.
Blood donations must be type and ______ matched to prevent anaphylaxis.
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Blood products can only be administered with ______.
Blood products can only be administered with ______.
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Fresh frozen plasma (FFP) is indicated for ______ of clotting factors.
Fresh frozen plasma (FFP) is indicated for ______ of clotting factors.
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Cryoprecipitate is indicated for ______ bleeding.
Cryoprecipitate is indicated for ______ bleeding.
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Anemia, low H&H, and low blood volume are all indications for ______.
Anemia, low H&H, and low blood volume are all indications for ______.
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Cryoprecipitate is high in clotting factors and ______.
Cryoprecipitate is high in clotting factors and ______.
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Potassium is responsible for ______ contraction.
Potassium is responsible for ______ contraction.
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Only ______% of potassium is in the blood.
Only ______% of potassium is in the blood.
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Normal K+ levels are between ______-5.
Normal K+ levels are between ______-5.
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Hyperkalemia can be caused by taking ______ diuretics.
Hyperkalemia can be caused by taking ______ diuretics.
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Treatment of severe hyperkalemia may involve administration of ______ bicarbonate.
Treatment of severe hyperkalemia may involve administration of ______ bicarbonate.
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In severe cases of hyperkalemia, ______ may be necessary to remove excess potassium.
In severe cases of hyperkalemia, ______ may be necessary to remove excess potassium.
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Potassium is responsible for muscle and ______ function.
Potassium is responsible for muscle and ______ function.
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A common source of potassium is ______.
A common source of potassium is ______.
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Mild hyperkalemia can be treated by restricting dietary intake of ______.
Mild hyperkalemia can be treated by restricting dietary intake of ______.
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ACE inhibitors can lead to ______.
ACE inhibitors can lead to ______.
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One cause of hypokalemia is the use of ______ diuretics.
One cause of hypokalemia is the use of ______ diuretics.
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Common symptoms of hypokalemia include ______ and confusion.
Common symptoms of hypokalemia include ______ and confusion.
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The maximum rate of potassium administration should not exceed ______ mEq per hour.
The maximum rate of potassium administration should not exceed ______ mEq per hour.
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A common side effect of potassium chloride is ______.
A common side effect of potassium chloride is ______.
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Patients may experience cardiac ______ as a sign of hypokalemia.
Patients may experience cardiac ______ as a sign of hypokalemia.
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Loop diuretics, Thiazide diuretics, and Corticosteroids are common causes of ______.
Loop diuretics, Thiazide diuretics, and Corticosteroids are common causes of ______.
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One of the signs and symptoms of ______ is hypotension.
One of the signs and symptoms of ______ is hypotension.
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The treatment of ______ often involves the administration of potassium chloride.
The treatment of ______ often involves the administration of potassium chloride.
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Giving potassium chloride through ______ is not recommended.
Giving potassium chloride through ______ is not recommended.
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A possible side effect of potassium chloride is ______.
A possible side effect of potassium chloride is ______.
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IV potassium chloride should be given _______.
IV potassium chloride should be given _______.
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Sodium is responsible for maintaining __________ balance.
Sodium is responsible for maintaining __________ balance.
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A normal level of sodium in the body is between __________.
A normal level of sodium in the body is between __________.
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Sodium can be found in sources such as __________ and fish.
Sodium can be found in sources such as __________ and fish.
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Hyponatremia can cause symptoms such as __________ and stomach cramps.
Hyponatremia can cause symptoms such as __________ and stomach cramps.
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Treatment for severe hyponatremia may involve administration of __________ normal saline or lactated ringers.
Treatment for severe hyponatremia may involve administration of __________ normal saline or lactated ringers.
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Oral sodium chloride tablets are used to treat mild hyponatremia with levels between ______.
Oral sodium chloride tablets are used to treat mild hyponatremia with levels between ______.
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IV normal saline or lactated ringers is indicated for ______ hyponatremia.
IV normal saline or lactated ringers is indicated for ______ hyponatremia.
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Hypotonic fluids are administered to treat conditions where there is a high concentration of ______ in the blood.
Hypotonic fluids are administered to treat conditions where there is a high concentration of ______ in the blood.
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Treatment of severe hyperkalemia may involve administration of ______ bicarbonate.
Treatment of severe hyperkalemia may involve administration of ______ bicarbonate.
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The normal range for magnesium is between 1.5 and ______.
The normal range for magnesium is between 1.5 and ______.
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A normal ______ level falls between 3.5 and 5.
A normal ______ level falls between 3.5 and 5.
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The normal range for ______ is 8.5 to 10.
The normal range for ______ is 8.5 to 10.
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Sodium levels should be between 135 and ______.
Sodium levels should be between 135 and ______.
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The normal phosphate level is _______.
The normal phosphate level is _______.
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When replacing K and Mg, always replace ___ first.
When replacing K and Mg, always replace ___ first.
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Study Notes
Body Compartments
- The body is divided into two main compartments: intracellular and extracellular.
- The intracellular compartment makes up 2/3 of the body's fluid, while the extracellular compartment makes up 1/3.
Fluid Shifts
- Fluid shifts occur between the two compartments due to osmotic pressure.
- Fluid shifts occur through the cell wall, from an area of high concentration to an area of low concentration.
Maintaining Homeostasis
- The goal is to maintain homeostasis, which requires monitoring input and output (I&O's).
Types of Fluids
- There are three main types of fluids: crystalloids, colloids, and blood products.
Types of IV Fluids
- Isotonic fluids have the same osmotic pressure as blood plasma and are used to replace lost fluids, electrolytes, and blood volume, with examples including 0.9% Sodium Chloride (normal saline) and Lactated Ringer's solution.
- Hypotonic fluids have lower osmotic pressure than blood plasma and are used to provide free water and treat dehydration, with an example being 0.45% Sodium Chloride.
- Hypertonic fluids have higher osmotic pressure than blood plasma and are used to treat severe hyponatremia, cerebral edema, and increased intracranial pressure, with examples including 3% Sodium Chloride and 7.5% Sodium Chloride.
Components of IV Fluids
- Electrolytes in IV fluids include Sodium (Na+), Potassium (K+), Calcium (Ca2+), and Magnesium (Mg2+).
- Buffering agents in IV fluids include Bicarbonate (HCO3-) and Phosphate (PO42-).
- IV fluids can contain energy sources like Dextrose (glucose).
Indications for IV Fluid Administration
- IV fluids are used for fluid resuscitation in cases of hypovolemic shock, burns, and trauma.
- IV fluids are used for electrolyte replacement in cases of diarrhea, vomiting, and diuretic therapy.
- IV fluids are used for medication administration, such as pain management, antibiotics, and chemotherapy.
Complications of IV Fluid Administration
- Fluid overload can lead to pulmonary edema and heart failure.
- Electrolyte imbalance can occur due to IV fluid administration, resulting in hypernatremia, hyponatremia, hypokalemia, and hyperkalemia.
Crystalloids
- Definition: Fluids and electrolytes normally found in the body without proteins
Indications
- Maintenance of fluid volume
- Treatment of dehydration, as they can move easily between compartments
- Volume replacement
- Management of acute liver failure
- Burns
- Dialysis
Side Effects (SE)
- Edema
- Peripheral edema
- Pulmonary edema
Isotonic Fluids
- Have the same concentration of solutes as blood
- Examples of isotonic fluids:
- Normal saline (0.9% NaCl)
- Lactated Ringers
- Lactated Ringers composition:
- Sodium (Na)
- Potassium (K)
- Calcium (Ca) in water
- Function of Lactated Ringers:
- Replaces fluids and electrolytes
- Used in cases of:
- Low blood pressure (BP)
- Low blood volume
- Indications:
- Burn patients
- Trauma patients
- Malnourished patients
Hypotonic Fluids
- Have a lower concentration of solutes compared to blood
- Cause fluid to shift out of the vascular system and into the tissues
- Examples of hypotonic fluids include:
- 0.45% sodium chloride
- 0.25% sodium chloride
- Indications for use:
- Diabetic ketoacidosis (DKA)
- Hypernatremia
Hypertonic Fluids
- Characterized by fluid shift from cells into the vascular compartment
- Examples include 3% or 5% sodium chloride solutions
- Indicated for severe symptomatic hyponatremia
D5W Solution
- Initially an isotonic solution due to dextrose content
- Becomes hypotonic once glucose is metabolized, leaving behind hypotonic solution
- Characterized by fluid shift from vascular into tissues
- Indicated for:
- Hypernatremia treatment
- Providing free water for kidney hydration
Colloids as Plasma Expanders
- Colloids move fluid from cells to the vascular space by containing large molecules that cannot pass through, including albumin, globulin, and fibrinogen (three blood proteins in the body).
- Compared to crystalloids, colloids require less fluid to cause a fluid shift.
Indications for Colloid Use
- Shock
- Burns
- Plasma volume expansion is needed
Characteristics of Colloids
- Usually well-tolerated without problems
- Do not contain clotting factors or carry oxygen
Side Effects of Colloids
- Bleeding possibility due to dilution of clotting factors with added fluid
Types of Colloids
- Albumin (5% or 25%): naturally produced, requiring human donors
- Dextran 40: a glucose solution
Blood Products
- Increase plasma volume through colloids and hypertonic crystalloids, causing fluid shifts from cells into vascular.
- Donated blood products require type and cross-matching to prevent anaphylaxis.
Administration
- Administer blood products intravenously (IV) using a pump.
- Can only be administered with normal saline.
Types of Blood Products
Fresh Frozen Plasma (FFP)
- Contains clotting factors.
- Indicated for increasing clotting factors, particularly for prevention of bleeding.
Cryoprecipitate
- High in clotting factors and fibrinogen.
- Indicated for acute bleeding, especially with 25% blood loss rapidly or 50% slowly.
- Check hemoglobin and hematocrit (H&H) levels before administration, and consider its use when blood clotting is necessary.
Packed Red Blood Cells (PRBC's)
- Does not contain plasma.
- Indicated for increasing oxygen-carrying capacity, particularly for:
- Anemia
- Low H&H
- Low blood volume
- Blood loss up to 25%
Whole Blood
- Contains plasma, protein, and red blood cells.
- Indicated when more than 25% of whole blood is lost.
Blood Product Administration
- Blood products can only be administered using an IV pump.
- Normal saline is the only compatible solution for blood product administration.
Types of Blood Products
-
Fresh Frozen Plasma (FFP)
- Contains clotting factors
- Indicated for increasing clotting factors
- Used for bleeding prevention
-
Cryoprecipitate
- High in clotting factors and fibrinogen
- Indicated for acute bleeding
- Used when there is 25% blood loss rapidly or 50% slowly
- Check if H&H is low or if blood clotting is necessary
-
Packed Red Blood Cells (PRBC's)
- Does not contain plasma
- Indicated for increasing oxygen carrying capacity
- Used for anemia, low H&H, low blood volume, or blood loss up to 25%
-
Whole Blood
- Containing plasma, protein, and red blood cells
- Indicated when over 25% of whole blood is lost
Blood Products and Indications
- Cryoprecipitate is indicated in acute bleeding cases where: • 25% blood loss occurs rapidly • 50% blood loss occurs slowly
Packed Red Blood Cells (PRBC's) Indications
- PRBC's are given to increase oxygen carrying capacity in: • Anemia cases • Low Hemoglobin and Hematocrit (H&H) levels • Low blood volume situations
Electrolytes: Potassium
- Responsible for muscle contraction, cardiac function, acid-base balance, and nerve impulse transmission
- Given when levels are low due to inadequate diet or loss caused by medications
- 95% of potassium is found inside cells, with only 5% in the blood
- Food sources: fruit, fish, veggies, meats, and dairy products
- Normal potassium levels: 3.5-5 mmol/L
Hyperkalemia
- Causes:
- K+ sparing diuretics
- ACE inhibitors
- K+ supplements
- Signs and symptoms:
- Muscle weakness
- Paresthesia
- Ventricular fibrillation (V-fib)
- Cardiac arrest
- Treatment of Mild Hyperkalemia:
- Restrict dietary intake of potassium
- Treatment of Severe Hyperkalemia:
- IV sodium bicarbonate: increases pH level while removing potassium
- IV calcium: reduces risk of ventricular fibrillation
- IV insulin with dextrose: moves glucose into cells, taking potassium with it
- IV diuretic: if blood pressure is high enough
- Sodium polystyrene sulfonate (Kayexalate): slow, oral, or rectal administration
- Hemodialysis: fast and effective
Electrolytes: Potassium
- Potassium is responsible for maintaining:
- Cardiac function
- Acid-base balance
- Nerve impulse transmission
Sources of Potassium
- Food sources of potassium include:
- Fruit
- Fish
- Vegetables
- Meats
- Dairy products
Hyperkalemia (High Potassium Levels)
- Hyperkalemia can be caused by:
- ACE inhibitors
- Potassium supplements
Signs and Symptoms of Hyperkalemia
- Symptoms of high potassium levels include:
- Muscle weakness
- Paraesthesia (abnormal sensations)
- Ventricular fibrillation (V-fib)
- Cardiac arrest
Treatment of Mild Hyperkalemia
- Treatment for mild hyperkalemia involves:
- Restricting dietary intake of potassium
Causes of Hypokalemia
- Loop diuretics can cause hypokalemia
- Thiazide diuretics can also lead to hypokalemia
- Corticosteroids are another potential cause of hypokalemia
- Vomiting and diarrhea can cause hypokalemia due to potassium loss
- Crash diets with little to no nutrition can lead to hypokalemia
- Consuming large amounts of licorice can cause hypokalemia
Symptoms and Signs of Hypokalemia
- Hypotension is a symptom of hypokalemia
- Lethargy is a common sign of hypokalemia
- Confusion can occur in individuals with hypokalemia
- Cardiac dysrhythmias are a potential symptom of hypokalemia
- Neuropathy can be a sign of hypokalemia
Treatment of Hypokalemia
- Potassium chloride is used to treat hypokalemia
- Potassium chloride can be administered orally (PO) or intravenously (IV)
- IV potassium chloride should be given via IVPB (intravenous piggyback)
- IV potassium chloride should never be given as an IV bolus or undiluted
- When administering IV potassium chloride, it should be done slowly using a pump
- The maximum rate of IV potassium chloride administration is 10mEq per hour
Side Effects of Potassium Chloride
- Nausea, vomiting, and diarrhea are potential side effects of potassium chloride
- Gastrointestinal bleeding is a possible side effect of potassium chloride
- Hyperkalemia is a potential side effect of potassium chloride administration
Causes of Hypokalemia
- Loop diuretics and thiazide diuretics can cause hypokalemia due to potassium loss
- Corticosteroids can lead to potassium depletion
- Vomiting and diarrhea can cause hypokalemia due to potassium loss through gastrointestinal fluids
- Crash diets with little to no nutrition can lead to potassium deficiency
- Consuming large amounts of licorice can cause hypokalemia due to its potassium-lowering effects
Signs and Symptoms of Hypokalemia
- Hypotension is a common symptom of hypokalemia
- Neuropathy can occur as a result of potassium deficiency
Treatment of Hypokalemia
- Potassium chloride is used to treat hypokalemia
- It is administered via IVPB (intravenous piggyback) to prevent rapid increases in potassium levels
- It should never be given as an IV bolus, IVP, or undiluted to avoid adverse effects
Side Effects of Potassium Chloride
- Nausea, vomiting, and diarrhea are common side effects of potassium chloride administration
- Gastrointestinal bleeding is a potential side effect of potassium chloride
- Hyperkalemia can occur as a result of excessive potassium administration
Sodium Functions
- Responsible for water distribution and fluid/electrolyte balance
- Plays a crucial role in maintaining acid-base balance
Normal Sodium Level
- Normal sodium level is between 135-145 mmol/L
- Sodium is the most abundant electrolyte in extracellular fluid
Sodium Sources
- Common sources of sodium include:
- Salt
- Fish
- Meat
- Seasonings
Hyponatremia
- Hyponatremia is a condition characterized by low sodium levels
- Symptoms of hyponatremia include:
- Lethargy
- Hypotension
- Stomach cramps
- Seizures
- Vomiting and diarrhea
- Treatment of hyponatremia depends on severity:
- Mild hyponatremia (130-135 mmol/L):
- Oral sodium chloride tablets
- Restrict fluid intake
- Moderate hyponatremia (125-129 mmol/L):
- IV normal saline or lactated ringers
- Severe hyponatremia (less than 125 mmol/L):
- Requires urgent medical attention
- Mild hyponatremia (130-135 mmol/L):
Treatment of Hyponatremia
- Mild hyponatremia (130-135 mmol/L) is treated with: • Oral sodium chloride tablets • Restricting fluid intake
Moderate Hyponatremia
- Moderate hyponatremia (125-129 mmol/L) is treated with: • IV administration of normal saline • IV administration of lactated Ringer's solution
Fluids and Electrolytes
Hypotonic Fluids
- Lower concentration of solutes than blood
- Fluid shifts out of the vascular and into the tissues
- Examples: 0.45% or 0.25% sodium chloride
- Indications: DKA, hypernaturemia
Hypertonic Fluids
- Higher concentration of solutes than blood
- Fluid shifts from cells into the vascular
- Examples: 3% or 5% sodium chloride
- Indications: severe symptomatic hyponaturemia
Isotonic Fluids
- Same concentration of solutes as blood
- Examples: 0.9% sodium chloride (normal saline), lactated Ringer's solution
- Indications: maintenance of fluid volume, dehydration, volume replacement, acute liver failure, burns, dialysis
Colloids (Plasma Expanders)
- Moves fluid from cells to the vascular
- Contains large molecules that cannot pass through cell membranes
- Examples: albumin, globulin, fibrinogen (3 blood proteins in the body)
- Indications: shock, burns, plasma volume expansion needed
- Advantages: does not have to give as much fluid to cause fluid shift (compared to crystalloids)
Blood Products
- Increases plasma volume
- Fluid shifts from cells into vascular
- Examples: fresh frozen plasma (FFP), cryoprecipitate, packed red blood cells (PRBC's), whole blood
Electrolytes
Potassium (K+)
- Responsible for: muscle contraction, cardiac function, acid-base balance, nerve impulse transmission
- Normal level: 3.5-5
- Sources: fruit, fish, veggies, meats, dairy
- Hyperkalemia: ACE inhibitors, K+ supplements, symptoms include muscle weakness, parasthesia, v-fib, cardiac arrest
- Treatment of hyperkalemia: restrict dietary intake of K+, IV sodium bicarbonate, IV calcium, IV insulin with dextrose, IV diuretic, sodium polystyrene sulfonate (Kayexalate), hemodialysis
Sodium (Na+)
- Responsible for: water distribution, fluid/electrolyte balance, acid-base balance
- Normal level: 135-145
- Sources: salt, fish, meat, seasonings
- Hyponaturemia: symptoms include lethargy, hypotension, stomach cramps, seizures, V/D; treatment includes oral sodium chloride tablets, IV normal saline or lactated ringers, restricting fluid intake
Magnesium (Mg2+)
- Normal level: 1.5-2.5
Phosphate (PO42-)
- Normal level: 2.5-4.5
Calcium (Ca2+)
- Normal level: 8.5-10
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Description
Learn about the two main body compartments, fluid shifts between them, and how they maintain homeostasis. Understand the role of osmotic pressure and concentration gradients.
