Fluid therapy 1&2

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Questions and Answers

What is the most common electrolyte disturbance due to fluid loss

Hyperkalemia

Hypokalemia

Hyponatremia (correct)

Hypernatremia

What is the most common cause of volume loss

Diuretics

Cerebral edema

Vomiting (correct)

Diarrhea (correct)

Other causes of volume loss are

Diuretics (correct)

Renal disease (correct)

Addison's disease (correct)

Cerebral edema (correct)

Clinical signs of hyponatremia

Lethargy Signup and view all the answers

Changes in potassium are particularly serious because of the clinical signs that can be seen, for example:

Bradycardia Signup and view all the answers

Serum levels begin to _____ when k+ is driven into the cells

drop Signup and view all the answers

Serum potassium will decrease only after a considerable loss of total body k+ loss, when serum potassium concentration is _____.

< 3.5 mEq/L Signup and view all the answers

Clinical signs of hypokalemia

Muscle weakness Signup and view all the answers

Regarding abnormal serum concentrations of K+, which one is most commonly seen

Hypokalemia Signup and view all the answers

Common causes of hypokalemia

Anorexia Signup and view all the answers

Less commonly encountered abnormal serum concentration of K+ is

Hyperkalemia Signup and view all the answers

Causes of hyperkalemia

Urinary obstruction or Trauma to the renal system (ureter, bladder, etc) Signup and view all the answers

K+ is normally excreted by the kidneys. Acidosis -> K+ being driven out of the cell which can cause which of the following

Arrhythmia Signup and view all the answers

Match the electrolyte with its primary function

Water balance and volume within the ECF = Sodium Resting cell membrane potential = Potassium Osmolality and acid/base regulation = Chloride Acid/bae regulation and fluid pH = Bicarbonate Signup and view all the answers

Match the electrolyte to its primary function

Support, muscle contractions, hormone signaling, blood clotting, and nerve function = Calcium Primary component of ATP, energy source = Phosphorus Cofactor in many enzymatic processes = Magnesium <ul> <li>= -</li> </ul> Signup and view all the answers

Match

Movement of molecules; mores the electrolytes and proteins down the concentration gradient (high to low) = Diffusion Movement of water across the membrane = Osmosis Moves electrolytes or proteins against the concentration gradient = Active transport <ul> <li>= -</li> </ul> Signup and view all the answers

What is the cell membrane and what is its function

Semi-permeable membrane that restricts movement of electrons and proteins Signup and view all the answers

The pumping of ____ against its concentration gradient is used for transmitting electrical signals within nerve cells

sodium Signup and view all the answers

Na+/K+ pump, generate action potentials that are responsible for

Heart contraction Signup and view all the answers

Osmoreceptors in the hypothalamus detect an increase in plasma concentration which stimulates thirst and the release of _____

ADH Signup and view all the answers

Causes the reabsorption of water

ADH Signup and view all the answers

Match Renal hypoperfusion

Stimulates the release of renin from the juxtaglomerular cells = 1 Renin acts of angiotensinogen in the plasma which converts to angiotensin I then angiotensin II = 2 Stimulates release of aldosterone from the adrenal cortex = 3 Promotes reabsorption of sodium from the DCT = 4 Signup and view all the answers

Fluid losses happen

During periods of food and water restriction Signup and view all the answers

What is dehydration

Net reduction in the free water content of the body Signup and view all the answers

Indications for use of fluid therapy (7)

Maintenance of fluid volume, dehydration, shock, systemic disease, diuresis, hypoproteinemia, anesthesia Signup and view all the answers

Assessment of fluid and electrolyte imbalance involves what 3 things

History, physical exam, laboratory tests Signup and view all the answers

Match the estimates of dehydration with the clinical signs

5-6 = skin sly, doughy, inelastic 6-8 = skin inelastic, eyes slightly sunken in orbits 10-12 = marked increased skin turgor, eyes sunken, prolonged CRT, dry mm, early sings of shock 12-15 = all signs plus muscle weakness, collapse, shock, weak pulse, cool extremities, decreased urine production, increase in temperature, imminent death Signup and view all the answers

A pound is a

Pint Signup and view all the answers

Fluid therapy can play a vital role in the stabilization and recovery of an ill patient. It is used in clinical medicine to: (5)

Replace hydration deficits, maintain normal hydration status, replace electrolytes, nutrients, and serve as a vehicle for infusing certain IV drugs Signup and view all the answers

Which of the following is accurate of crystalloids

Water-based solutions containing electrolytes and non electrolytes that are permeable to the capillary membrane Signup and view all the answers

Colloids contain molecules that can cross cell membranes and enter all fluid compartments

False Signup and view all the answers

Colloids remain in the intravascular space longer because the pressure is greater than in the tissue

True Signup and view all the answers

Hetastarch can reduce the amount of crystalloids needed for volume resuscitation by 60-100%

False Signup and view all the answers

Colloid properties remain active for approximately 24-48 hours.

True Signup and view all the answers

Adverse effects of colloids

Bleeding problems Signup and view all the answers

First choice for resuscitation

Crystalloids Signup and view all the answers

Commonly used for rehydration and maintenance needs

Crystalloids Signup and view all the answers

Lower osmotic pressure relative, which causes fluid shift into the cells, causing swelling of the cells

Hypotonic crystalloids Signup and view all the answers

When dextrose is metabolized it results in a hypotonic solution

True Signup and view all the answers

Similar osmotic pressure to the fluids of plasma and cell, the solutions evenly distribute in the extravascular space when given IV

Isotonic crystalloids Signup and view all the answers

50% of isotonic fluid will remain in the intravascular space of the ECF after one hour

False Signup and view all the answers

Which of the following is accurate of isotonic crystalloids

Inexpensive, readily available and a good replacement fluid for dehydration Signup and view all the answers

Most common example of an isotonic crystalloid

Lactated Ringers Solution Signup and view all the answers

Do not use LRS while giving a blood transfusion because the fluids containing calcium may overcome the anticoagulant properties of citrate, resulting in coagulation of the blood

True Signup and view all the answers

Have higher osmotic pressure which causes movement of water out of the cell

Hypertonic crystalloids Signup and view all the answers

Which of the following are accurate of hypertonic crystalloids

Used for rapid volume expansion Signup and view all the answers

If using hypertonic solutions one must use caution and be vigilant of hypernatremia or increased bleeding

True Signup and view all the answers

Which of the following can occur if hypertonic solutions are given too quickly

Bradycardia Signup and view all the answers

Example of hypertonic solutions

7% saline Signup and view all the answers

For transfusions, solutions such as 5% dextrose are hypotonic and may induce hemolysis

True Signup and view all the answers

Which of the following is an example of colloid solutions

Hetastarch Signup and view all the answers

Which of the following are examples of blood products

Plasma Signup and view all the answers

Maintenance solutions are used to replace fluid and/or electrolyte deficits

False Signup and view all the answers

Which of the following is an example of replacement solutions

LRS Signup and view all the answers

Maintenance solutions are used to maintain hydration and electrolyte levels within the body

True Signup and view all the answers

It is rare that maintenance solutions contain dextrose

False Signup and view all the answers

Which of the following is an example of a maintenance solution

Normosol M with dextrose Signup and view all the answers

Potassium (K+) is necessary for the maintenance of several body functions most notably electrical potential in muscles and nerves

True Signup and view all the answers

Maximum rate of K+

0.5mEq/kg/hr Signup and view all the answers

Volume of fluid and amount of electrolytes needed normally in a 24hr period is

40-60mL/kg/day Signup and view all the answers

Dehydration correction comes with 3 requirements, #1 is the volume of fluid needed to ______ the patient

Rehydrate Signup and view all the answers

Dehydration correction comes with 3 requirements, #2 is the volume of fluid needed for ______ requirements

Maintenance Signup and view all the answers

Dehydration correction comes with 3 requirements, #3 is the volume of fluid needed to correct __________

ongoing losses Signup and view all the answers

Routes for fluid administration

Oral Signup and view all the answers

What are SubQ fluids used for

Mild dehydration Signup and view all the answers

When administering SubQ fluids the areas where the limbs join the trunk should be used

False Signup and view all the answers

Do not give 5% dextrose SQ because it will cause necrosis

True Signup and view all the answers

How long does it usually take for SubQ fluids to be absorbed

6-8 hours Signup and view all the answers

Subcutaneous fluid administration cannot be used in animals that

Require large replacement volumes Signup and view all the answers

Most common sites of IV catheter placement

Medial femoral and saphenous veins Signup and view all the answers

Rate of fluid flow through the catheter is controlled by which of the following

Patient blood pressure Signup and view all the answers

How often should a catheter be flushed if its not being used

4-6 hours Signup and view all the answers

Complications of IV catheterization include

Phlebitis Signup and view all the answers

What to monitor during fluid therapy

Temperature Signup and view all the answers

Signs of fluid overload

Serous nasal discharge Signup and view all the answers

Neonatal fluid replacement includes

Multiple electrolyte solutions supplemented with 5% dextrose Signup and view all the answers

Fluid therapy in clinical situations - acute

Hypovolemic patients Signup and view all the answers

Fluid therapy in clinical situations - chronic

Dehydrated but not seriously hypovolemic Signup and view all the answers

A number of diseases can affect the bodies ability to stay in equilibrium. Fluid is used:

To correct dehydration deficit Signup and view all the answers

Clinical syndrome in which the peripheral blood flow is inadequate to return sufficient blood to the heart for normal function

Shock Signup and view all the answers

What is the main treatment for all types of shock

Fluid therapy Signup and view all the answers

Hypoproteinemia is when

Total protein levels are less than 3.5g/dL Signup and view all the answers

When is it best to use colloids

When total protein levels are less than 3.5g/dL Signup and view all the answers

Assists the body in eliminating substances that can be excreted by the kidneys (one word)

Diuresis Signup and view all the answers

Which of the following is an indication for the use of diuresis

Renal failure Signup and view all the answers

Which of the following is accurate of IV fluids during anesthesia

Helps maintain homeostasis Signup and view all the answers

Study Notes

Electrolyte Disturbances

Hyponatremia is the most common electrolyte disturbance due to fluid loss.
Volume depletion is the most common cause of fluid loss.
Other causes of volume loss:
- Gastrointestinal: vomiting, diarrhea, malabsorption
- Renal: diuretics, diabetes insipidus
- Skin: sweating, burns
- Third spacing: ascites, pleural effusion
Clinical signs of hyponatremia:
- Headache
- Nausea and vomiting
- Confusion
- Lethargy
- Seizures
- Coma

Potassium Disturbances

Changes in potassium are particularly serious because of the clinical signs that can be seen.
Serum levels begin to decrease when K+ is driven into the cells.
Serum potassium will decrease only after a considerable loss of total body K+ loss, when serum potassium concentration is below 2.5 mEq/L.
Clinical signs of hypokalemia:
- Muscle weakness
- Fatigue
- Constipation
- Arrhythmias
- Respiratory distress
Hypokalemia is the most commonly seen abnormal serum concentration of K+.
Common causes of hypokalemia:
- Diuretics
- Vomiting
- Diarrhea
- Renal insufficiency
Hyperkalemia is a less commonly encountered abnormal serum concentration of K+.
Causes of hyperkalemia:
- Renal failure
- Acidosis
- Medications
- Trauma
- Rhabdomyolysis
K+ is normally excreted by the kidneys.
Acidosis -> K+ being driven out of the cell which can cause hyperkalemia.

Electrolyte Functions

Sodium (Na+) : Primary function is to maintain fluid balance and regulate blood pressure.
Potassium (K+) : Primary function is to maintain nerve and muscle function.
Calcium (Ca2+) : Primary function is to strengthen bones and teeth and regulate muscle contraction.
Magnesium (Mg2+) : Primary function is to support nerve and muscle function and regulate blood sugar.
Chloride (Cl-) : Primary function is to maintain fluid balance and acid-base balance.
Phosphorous (P) : Primary function is to build strong bones and teeth and produce energy in the body.

Cell Membrane & Action Potentials

The cell membrane is a thin, flexible barrier that surrounds all cells and controls what enters and exits the cell.
The pumping of Na+ against its concentration gradient is used for transmitting electrical signals within nerve cells.
Na+/K+ pump, generate action potentials that are responsible for nerve impulse transmission.

Osmoregulation

Osmoreceptors in the hypothalamus detect an increase in plasma concentration which stimulates thirst and the release of antidiuretic hormone (ADH).
Antidiuretic hormone (ADH) causes the reabsorption of water in the kidneys.

Renal Hypoperfusion & Fluid Losses

Renal hypoperfusion refers to decreased blood flow to the kidneys.
Fluid losses can occur through various routes, including:
- Gi tract: vomiting, diarrhea
- Skin: sweating, burns
Dehydration is a condition in which the body lacks sufficient water.
Clinical signs of dehydration:
- Dry mouth
- Thirst
- Decreased urine output
- Fatigue
- Dizziness
- Sunken eyes

Fluid Therapy

Indications for use of fluid therapy:
- Dehydration
- Volume depletion
- Electrolyte imbalance
- Shock
- Trauma
- Surgery
Assessment of fluid and electrolyte imbalance involves:
- History and physical examination
- Laboratory tests
- Imaging studies

Dehydration Estimates

Estimates of dehydration with clinical signs:
- 1-2% dehydration: Mild thirst
- 3-5% dehydration: Moderate thirst, sunken eyes
- 6-8% dehydration: Severe thirst, sunken eyes, lethargy
- 9-12% dehydration: Critical dehydration, shock
A pound is a unit of weight, approximately equal to 0.45 kilograms.

Fluis Therapy Clinical Uses

Fluid therapy can play a vital role in the stabilization and recovery of an ill patient.
It is used in clinical medicine to:
- Replace lost fluids and electrolytes
- Maintain fluid balance
- Improve blood pressure
- Support organ function
- Deliver medications

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