Fluid and Electrolyte Management Quiz

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Questions and Answers

What percentage of an adult's weight is composed of fluid?

80%

70%

60% (correct)

50%

Which fluid compartment contains about two-thirds of body fluids?

Extracellular fluids

Interstitial fluids

Transcellular space

Intracellular fluids (correct)

What is the normal range for sodium levels in mEq/L?

125−135

135−145 (correct)

130−140

145−155

What is the primary method of fluid movement across cell membranes during osmosis?

Movement of water Signup and view all the answers

Which type of IV fluid solution is classified as isotonic?

Normal Saline (NS) Signup and view all the answers

What is the total average daily intake and output of fluids in an adult?

2600ml Signup and view all the answers

In what condition can loss of body water lead to severe consequences?

Chronic dehydration Signup and view all the answers

What type of IV fluid solution would be used to treat patients with cellular dehydration?

Hypotonic solutions Signup and view all the answers

Which treatment is recommended for managing hyponatremia?

Fluid restriction with diuretics Signup and view all the answers

What is the primary symptom of hypernatremia?

Confusion and lethargy Signup and view all the answers

What is a common contributing factor for hypokalemia?

Corticosteroid administration Signup and view all the answers

What are the symptoms commonly associated with hyperkalemia?

Bradycardia and dysarrhythmia Signup and view all the answers

What is the preferred initial treatment for a patient with hyperkalemia?

Correct underlying renal failure Signup and view all the answers

Which position should a patient be placed in if they experience shortness of breath?

Fowler's position Signup and view all the answers

Which ECG change is indicative of severe hyperkalemia?

Peaked T waves progressing to sine wave pattern Signup and view all the answers

What is the immediate treatment for hyperkalemia if serum potassium exceeds 7.5 mEq/L?

Calcium gluconate IV over 2 minutes Signup and view all the answers

Which lab value is likely to decrease due to plasma dilution?

BUN Signup and view all the answers

What is the maximum recommended rate for administering hypertonic saline to treat hyponatremia?

100 cc/hr Signup and view all the answers

Which treatment is recommended for symptomatic hypocalcemia?

IV calcium gluconate Signup and view all the answers

Which of the following conditions can lead to hypercalcemia?

Malignancy Signup and view all the answers

Which of the following is not a typical symptom of hypokalemia?

Chest pain with exertion Signup and view all the answers

What does the term 'Trousseau's sign' indicate?

Decreased calcium levels Signup and view all the answers

What treatment should be used for critical hypercalcemia (>16 mg/dL)?

Hydration with normal saline and loop diuretic Signup and view all the answers

Which of the following can cause hypocalcemia?

Hypoalbuminemia Signup and view all the answers

What is the primary characteristic that differentiates crystalloids from colloids?

Crystalloids contain small 'crystalizable' particles, while colloids contain large particles. Signup and view all the answers

When should maintenance therapy be considered for a patient?

When the patient is not expected to eat or drink normally for an extended period. Signup and view all the answers

Which factor does NOT increase water requirements according to the content?

Chronic kidney disease Signup and view all the answers

What can be a serious complication of using albumin as a colloid?

Anaphylaxis Signup and view all the answers

What does the enhancement of light diffusion during transillumination indicate?

Fluid accumulation due to infiltration. Signup and view all the answers

How much water per day is generally considered sufficient for adults?

Two liters Signup and view all the answers

Which mode of administration is used for fluids not directly administered through a vein?

Intraosseous Signup and view all the answers

What is one of the two components of fluid therapy?

Replacement therapy Signup and view all the answers

What is the maintenance IV rate for a person weighing 25 kg using the 4/2/1 rule?

70 mL/hr Signup and view all the answers

Which solution is recommended to start with for fluid replacement?

D5 1/2NS + 20 mEq K Signup and view all the answers

What adjustment should be made if the sodium level rises?

Decrease the concentration to 1/4NS Signup and view all the answers

What symptom is indicative of hypervolemia?

Weight gain Signup and view all the answers

Which of the following factors can contribute to hypovolemia?

Vomiting and diarrhea Signup and view all the answers

When using the 4/2/1 rule, what is the rate of fluid administration per hour for a patient weighing 30 kg?

100 mL/hr Signup and view all the answers

If plasma potassium levels start to fall, what is the recommended action?

Add more potassium to the IV Signup and view all the answers

What is the maximum IV rate limit set in the 4/2/1 rule?

120 mL/hr Signup and view all the answers

What is the primary treatment approach for hypomagnesemia?

IV replacement of 2-4 gm of MgSO4 per day or oral replacement Signup and view all the answers

Which condition is NOT associated with hypomagnesemia?

Iatrogenic causes Signup and view all the answers

What symptoms are associated with hypermagnesemia?

Nausea and vomiting Signup and view all the answers

Which of the following IV solutions is considered hypertonic?

D5% NS (Dextrose 5% in Normal Saline) Signup and view all the answers

What is the main complication associated with the use of hypotonic solutions?

Cerebral edema Signup and view all the answers

In which case would phosphate-binding antacids be commonly used?

Hyperphosphatemia Signup and view all the answers

Which solution is recommended for cellular dehydration?

0.45% saline Signup and view all the answers

What biochemical change is characteristic of metabolic acidosis?

Decreased pH and decreased HCO3 Signup and view all the answers

Study Notes

Fluid and Electrolyte Imbalance

Fluid and electrolyte balance is a complex process.
Electrolyte is a substance containing free ions, acting as an electrically conductive medium.
Osmosis is the net movement of the solvent across a semi-permeable membrane from a high solute potential to a low solute potential.
Body fluids are distributed in two compartments: intra- and extra-cellular.

Movement of Body Fluids

Diffusion
Osmosis
Active transport

Fluid and Electrolyte Disturbance

Approximately 60% of an adult's weight is fluid (water and electrolytes).
Intracellular fluids (ICF) make up 2/3 of body fluid.
Extracellular fluids (ECF) make up 1/3 of body fluid.
- Intravascular fluids= plasma
- Interstitial fluids surround cells
- Trancellular fluids (e.g., cerebrospinal, pericardial, synovial)
Total body water (TBW): 42 L. 60% of body weight
Extracellular fluid (ECF): 14 L, 1/3 TBW.
Intracellular fluid (ICF): 28 L, 2/3 TBW.
Interstitial fluid: 80% of ECF = 11 L
Plasma: 20% of ECF = 3 L

Average Daily Intake and Output in an Adult

Intake:
- Oral liquids: 1300 mL
- Water in foods: 1000 mL
- Water by metabolism: 300 mL
- Total Intake: 2600mL
Output:
- Urine: 1500 mL
- Stool: 200 mL
- Insensible loss through lungs: 300 mL
- Insensible loss through skin: 600 mL
- Total Output: 2600 mL

Normal Lab Results

Na+: 135-145 mEq/L
K+: 3.5-5.5 mEq/L
Ca²⁺: 8.5-10.5 mEq/L
Cl⁻: 96-106 mEq/L
Mg²⁺: 1.5-2.5 mEq/L

Importance of Fluid Balance

Fluid management is crucial in hospitalized patients.
Fluid imbalances (loss or gain of body water) can cause serious problems, ranging from lightheadedness to convulsions, coma, and death.
Fluid therapy can be life-saving but is not without risk.

Types of IV Fluids

Hypotonic (1/2 NS)
Isotonic (NS, LR, Albumen)
Hypertonic (Hypertonic saline)
Crystalloids
Colloids

Crystalloid vs Colloid

Crystalloids have small particles (e.g., NaCl).
Colloids have large particles (e.g., albumin).
Colloids stay longer in circulation.
Smaller amount of colloids is needed compared to crystalloids to achieve the same volume expansion. (250 ml albumin = 4 L NS)

IV Modes of Administration

Peripheral IV
PICC
Central line
Intraosseous

IV Problem: Extravasation/Infiltration

Visual inspection with a penlight is the most sensitive indicator of extravasation.
Assessing the infusion flow rate doesn't indicate fluid distribution.

Components of Fluid Therapy

Maintenance therapy replaces ongoing losses.
Replacement therapy corrects existing deficits in water and electrolytes.

Maintenance Therapy

Usually used when a patient is not expected to eat or drink normally for an extended period (e.g., surgery, ventilator).
Many patients are NPO (nothing by mouth) for 12 hours.
Patients who are not eating for one to two weeks benefit from parenteral or enteral nutrition.
Maintenance requirements are broken down into water and electrolyte requirements.

Water Requirements

Two liters of water per day are generally sufficient for adults
Most water intake comes from food and oxidation reactions (not external liquid consumption).
In healthy patients, minimal water needs only 500 mL daily with regular diet.
Water needs in patients not eating must be supplemented through maintenance fluids.
Water requirement increases due to elevated body temperature and ongoing fluid losses (e.g., fever, sweating, burns, surgical drains).

4/2/1 Rule (Weight + 40)

This formula is used to calculate maintenance fluid rates.
4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the next 10 kg, and 1 mL/kg/hr for any kg above 20
This rule is comparable to the pediatric formula.
This method equates to 60 mL/hr for the first 20 kg, then plus an additional 1 mL/kg/hr for any subsequent weight.
(Weight in kg + 40) = Maintenance IV rate/hour

What to Put in Fluids

D5 1/2NS + 20 mEq K @ WT+40/hr: A practical starting point for maintaining fluid balance
Dextrose (D5) added for calories when patients aren't eating.

Start D5 1/2NS + 20 mEq K, Then Adjust:

Adjust solution concentration according to sodium levels, either increasing or decreasing proportionally.
Increase potassium if plasma potassium levels are falling. Keep the current rate if everything is proceeding as expected.

###Assessment and Diagnostic Evaluation

Health history and physical exam
Serum BUN and creatinine
Hematocrit (should be high)
Urine specific gravity
Serum electrolytes level (assessing hypo/hyperkalemia, natremia, etc)

Fluid Volume Disturbance: Hypovolemia

Contributing factors: loss of water and electrolytes (vomiting, diarrhea, burns), decreased intake (anorexia, nausea, inability to access fluids), some disease (DM, Diabetes Insipidus)
Symptoms: weight loss, general weakness, dizziness, increased pulse.

###Kidney Function Control

Adrenocorticotropic hormone (ADH) regulates urine concentration and volume.
ADH release is stimulated by decreasing water concentration or decreased blood volume.
ADH promotes water reabsorption in the kidneys, concentrating urine and decreasing urine volume.

Regulation of Sodium Ion Levels in the Extracellular Fluids

Renin-angiotensin-aldosterone system (RAAS) controls sodium reabsorption and water reabsorption in response to low blood pressure.

Fluid Volume Disturbance: Hypervolemia

Contributing factors: compromised regulatory mechanism (renal failure, congestive heart failure, cirrhosis), excess administration of fluids containing sodium, prolonged corticosteroid therapy, increased fluid intake.
Symptoms: weight gain, increased blood pressure, edema, shortness of breath.

Assessment and Diagnostic Evaluation (Hypervolemia)

Decreased BUN, creatinine, serum osmolality, and hematocrit (due to plasma dilution).
Increased urine sodium if kidneys are excreting excess fluid.
Chest X-Ray (CXR) may show pulmonary congestion.

Electrolyte Imbalance: Hyponatremia

Contributing factors: use of diuretics, loss of GI fluids, gain of water.
Symptoms: anorexia, nausea, vomiting, headache, lethargy, confusion, seizures.

Hyponatremia Continued

Treatment: correct underlying disorder, fluid restriction, diuretics, hypertonic saline to increase sodium level.

Electrolyte Imbalance: Hypernatremia

Contributing factors: water deprivation, hypertonic tube feeding, diabetes insipidus.
Symptoms: thirst, hallucination, lethargy, restlessness, pulmonary edema.

Hypernatremia Continued

Treatment: correct underlying disorder, free water replacement (0.6 * kg BW * [(Na/140)-1]), slow infusion of D5W, rest over 16-24 hrs to avoid cerebral edema

Electrolyte Imbalance: Hypokalemia

Contributing factors: diarrhea, vomiting, gastric suction, corticosteroid administration, diuretics.
Symptoms: fatigue, anorexia, nausea, vomiting, muscle weakness, ECG changes (flat T waves, ST depression, U waves)

Hypokalemia Continued

Treatment: check renal function, treat alkalosis, decrease sodium intake, PO or IV potassium supplements.

Electrolyte Imbalance: Hyperkalemia

Contributing factors: renal failure, crush injury, burns, blood transfusion, IV potassium administration.
Symptoms: bradycardia, arrhythmias, anxiety, irritability, ECG changes (peaked T waves, widened QRS, progressing to sine waves or V-fib).

Hyperkalemia Continued

Treatment: remove iatrogenic causes, Acute: Ca-gluconate (IV), Sodium bicarbonate (IV), D50W (IV) and (IV) regular insulin, emergent dialysis, hydration, diuresis, kayexalate.

Calcium Imbalances

Hypocalcemia: Often seen in hypoalbuminemia. Ionized calcium is measured. Symptoms are often not evident until Ca levels are very low. Possible causes include low Mg levels, high pancreatitis activity, hyper-PO4 levels. Check for secondary causes. Symptoms include paresthesia, numbness, tingling, circumoral numbness, tetany, seizures, trousseau's sign, chvostek's sign, EKG change that shows a prolonged QT interval.
Hypercalcemia: Usually caused by hyperparathyroidism or malignancy, thiazides, chronic kidney problems, milk alkali syndrome, acute adrenal insufficiency. Symptoms include nausea, vomiting, abdominal pain, confusion, lethargy, and mental status changes ("bones, stones, abdominal groans, and psychic overtones").

Calcium Continued

Treatment (for hypocalcemia): Acute: IV Calcium chloride or gluconate, chronic: Oral Calcium carbonate, Vitamin D.
Treatment (for hypercalcemia): hydration, loop diuretics, steroids, mitrocyamin, calcitonin, managing underlying cause and treating the immediate issues.

Magnesium Imbalances

Hypomagnesemia: Contributing factors include malnutrition, burns, pancreatitis, SIADH, parathyroid surgery, and primary hyperaldosteronism. Symptoms include weakness, fatigue, MS changes, hyperreflexia, seizures, arrhythmias. Treatment: IV or oral magnesium replacement.
Hypermagnesemia: Contributing factors include renal insufficiency, antacid abuse, adrenal insufficiency, hypothyroidism, and iatrogenic. Symptoms include nausea, vomiting, weakness, hyporeflexia, paralysis of voluntary muscles, EKG changes (AV block, prolonged QT). Treatment: discontinue magnesium source, IV Ca Gluconate for acute episodes, and hemodialysis.

Phosphate Imbalances

Hyperphosphatemia: Contributing factors include renal insufficiency, hypoparathyroidism. Treatment includes restricting phosphate, and administering phosphate-binding antacids (e.g., amphogel).

Acid-Base Disturbances

Normal values for pH, PCO2, PO2, and HCO3
Various acid-base imbalances with corresponding interpretations.

Types of IV Solutions

Isotonic (NS, LR, D5W): Does not change osmolarity, increases TBW, used to increase intravascular space. Complications are circulatory overload.
Hypotonic (0.45% saline): Decreases intravascular osmolarity; results in intracellular expansion; used in cellular dehydration; complications include shock, increased ICP, contraindicated in cerebral edema and hypotension.
Hypertonic (D5%.45%, D5%/NS, D5%/LR): Increases intravascular osmolarity; results in intracellular and interstitial dehydration; used for intracellular expansion; complications include circulatory overload; contraindicated for intracellular dehydration and hyperosmolar states.

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Test your knowledge on fluid and electrolyte management in adults. This quiz covers essential topics such as normal fluid composition, IV solutions, and treatment of electrolyte imbalances. Perfect for healthcare professionals and students studying nursing or related fields.