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Questions and Answers
What percentage of total body water (TBW) is contained within the intracellular fluid (ICF)?
What percentage of total body water (TBW) is contained within the intracellular fluid (ICF)?
Which of the following is a component of extracellular fluid (ECF)?
Which of the following is a component of extracellular fluid (ECF)?
What is the primary role of colloids in fluid therapy?
What is the primary role of colloids in fluid therapy?
Which fluid would be most appropriate to administer for a patient experiencing hypovolemic shock?
Which fluid would be most appropriate to administer for a patient experiencing hypovolemic shock?
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What is a potential adverse effect of using crystalloid fluids?
What is a potential adverse effect of using crystalloid fluids?
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Which fluid is known to contain both electrolytes and small molecules but lacks proteins?
Which fluid is known to contain both electrolytes and small molecules but lacks proteins?
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Which intravenous fluid is typically used to treat dehydration and replace fluid loss?
Which intravenous fluid is typically used to treat dehydration and replace fluid loss?
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Which condition is NOT typically treated with colloids?
Which condition is NOT typically treated with colloids?
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What percentage of total body water (TBW) is represented by plasma volume in adults?
What percentage of total body water (TBW) is represented by plasma volume in adults?
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Which of the following is a key factor in determining the distribution of fluid in extracellular fluid (ECF)?
Which of the following is a key factor in determining the distribution of fluid in extracellular fluid (ECF)?
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What is a significant disadvantage of using colloids for resuscitation?
What is a significant disadvantage of using colloids for resuscitation?
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How does potassium primarily influence the body?
How does potassium primarily influence the body?
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Which condition could lead to a deficiency of potassium in the body?
Which condition could lead to a deficiency of potassium in the body?
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What is the primary use of fresh frozen plasma in clinical settings?
What is the primary use of fresh frozen plasma in clinical settings?
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What potential risk is associated with blood product transfusions?
What potential risk is associated with blood product transfusions?
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Which of the following symptoms may indicate hypernatremia?
Which of the following symptoms may indicate hypernatremia?
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What is the recommended maximum rate for IV potassium infusions?
What is the recommended maximum rate for IV potassium infusions?
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Which statement best describes the primary role of sodium in the body?
Which statement best describes the primary role of sodium in the body?
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What is a key advantage of crystalloids over colloids?
What is a key advantage of crystalloids over colloids?
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Which dietary items are rich sources of potassium?
Which dietary items are rich sources of potassium?
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What condition is indicated by hypokalemia?
What condition is indicated by hypokalemia?
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Which of the following best describes the use of packed RBCs in medical practice?
Which of the following best describes the use of packed RBCs in medical practice?
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What could be a result of excessive potassium in the bloodstream?
What could be a result of excessive potassium in the bloodstream?
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What is a common effect of administering colloids too quickly?
What is a common effect of administering colloids too quickly?
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Study Notes
Fluids and Electrolytes (Chapter 45)
-
Objectives:
- Review fluid dynamics
- Identify different forms of fluid replacement
- Identify conditions requiring fluid therapies
- Discuss potassium and sodium imbalances and their treatment
- Identify implications for client care receiving fluid and electrolyte therapies
Fluid Balance
-
Total Body Water (TBW):
- 60% of adult human body is water
-
Compartments of TBW:
- Intracellular fluid (ICF): 67%
- Interstitial fluid (IF): 25%
- Plasma volume (PV): 8%
- Extracellular fluid (ECF): 33%
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Components of ECF:
- Interstitial fluid
- Blood (plasma + cells)
- Blood constituents (plasma proteins, RBCs, platelets, WBCs)
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Distribution in ECF:
- Determined by bulk flow and Starling forces
Capillary Microcirculation
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Balance of pressures:
- Hydrostatic pressure (blood pressure)
- Colloid osmotic pressure (due to plasma proteins)
Fluid Balance
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Water balance:
- Water intake = water loss
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Imbalances:
- Edema
- Dehydration and fluid loss
IV Fluid Administration
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Reasons for IV fluids:
- Dehydration
- Electrolyte imbalances
- Blood component deficiencies
- Nutrition
IV Fluids: Types
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Crystalloids:
- Solutions of electrolytes and small molecules
- Do not contain proteins/large molecules (colloids)
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Examples:
- Normal saline (0.9% NaCl)
- Half normal saline (0.45% NaCl)
- Hypertonic saline (3% sodium chloride)
- Lactated Ringer's
- D5W
- Normosol/Plasmalyte
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Uses of Crystalloids:
- Treat dehydration (volume loss/maintenance)
- Fluid replacement (compensate for insensible losses)
- Manage electrolyte imbalances (e.g., Ringer's lactate)
- Promote urinary flow
- Expand plasma volume (e.g., 3% NaCl)
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Indications (Crystalloids):
- Acute liver failure
- Acute nephrosis
- Burns
- Hypovolemic shock
- Renal dialysis
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Crystalloids: Adverse Effects
- Edema (peripheral or pulmonary)
- Fluid overload
- May dilute plasma proteins
- Effects may be short-lived
-
Colloids:
- Increase colloid osmotic pressure
- Move fluid from interstitial to plasma compartment
- "Plasma volume expanders"
- Restore blood pressure and initiate diuresis
- Examples:
- Dextran 40 or 70
- Hetastarch / hydroxyethyl starch (HES)
- Modified gelatin
- Albumin
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Indications (Colloids):
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Trauma, Burns, Sepsis, Hypovolemic shock
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Colloids: Adverse Effects
- Usually safe
- Concerns in renal failure
- May cause altered coagulation (bleeding)
- No oxygen-carrying capacity
Blood & Blood Products
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Characteristics:
- Most expensive and least available
- Require human donors
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Examples:
- Whole blood
- RBC products (carry oxygen)
- Clotting factors (from plasma)
- Platelets
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Indications (Blood Products):
- Increase oxygen-carrying capacity (e.g., anemia, substantial hemoglobin deficits)
- Blood loss >25%
- Increase clotting factor levels (e.g., coagulation disorders and disseminated intravascular coagulation (DIC).
-
Adverse Effects (Blood Products):
- Transfusion reactions (blood type and cross-match)
- Transmission of pathogens (hepatitis B, C, HIV)
Client Care
- Crystalloids: Administer slowly, monitor for fluid overload and possible heart failure, monitor for transfusion reactions.
-
Colloids: Administer slowly, monitor for fluid overload and possible heart failure, monitor for transfusion reactions.
- Blood products monitor for transfusion reactions.
Advantages/Disadvantages of Crystalloids and Colloids
- Crystalloids: Few side effects, low cost, widely available, short duration of action, may cause edema
- Colloids: Longer duration of action, less fluid required to correct hypovolemia, higher cost, may cause volume overload, may interfere with clotting, risk of anaphylactic reactions.
Plasma Electrolytes
- Principal ECF electrolytes: Sodium (Na+), Chloride (Cl-)
- Principal ICF electrolyte: Potassium (K+)
- Others: Calcium, magnesium, phosphorus
Plasma Potassium
- Functions: Skeletal muscle contraction, nerve impulse transmission, regulates heartbeat, acid-base balance, etc.
- Abundance: 95% of body's potassium is intracellular
- Normal ECF: 3.5 to 5 mmol/L
- Sources: Foods (fruit, fish, vegetables, etc)
- Excretion: Kidney function
- Hypokalemia: Deficiency (<3.5 mmol/L) Causes: diuretics, vomiting, diarrhea, malabsorption, etc. Symptoms: muscle weakness, lethargy, cardiac dysrhythmias, irregular pulse, paralytic ileus.
- Hyperkalemia: Excess (>5 mmol/L) Causes: K+ supplements, ACE inhibitors, renal failure, excessive K+ loss from cells, or K+-sparing diuretics. Symptoms: irregular heartbeat, cardiac arrest, muscle weakness, paralysis, paresthesia.
- Treatment: Oral or IV administration (IV given slowly, never in a bolus or as an undiluted solution)
Plasma Sodium
- Functions: Controls water distribution, fluid and electrolyte balance, osmotic pressure of body fluids, acid-base balance
- Normal concentration: 135 to 145 mmol/L
- Sources: Dietary intake of sodium chloride (salt, fish, meats, etc)
- Hyponatremia: Deficiency (<135 mmol/L) Causes include hypokalemia causes, prolonged diarrhea, vomiting, renal issues. Symptoms: lethargy, stomach cramps, hypotension, vomiting, diarrhea, seizures
- Hypernatremia: Excess (>145 mmol/L) Causes: kidney malfunction, inadequate water consumption, and dehydration. Symptoms: edema, hypertension, flushing, dry/sticky mucous membranes, elevated temp, decreased urine output.
- Treatment: Mild cases are treated with oral sodium chloride and/or fluid restriction. Severe cases need IV normal saline or lactated Ringer's.
Client Care (General)
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Monitoring:
- Serum electrolyte levels during therapy
- Infusion rate and appearance of fluid/solution
- Infusion site
- Infiltration and other IV complications
-
Therapeutic response:
- Monitoring normal lab values (RBC, WBC, Hgb, Hct, electrolytes)
- Improved fluid volume status
- Increased tolerance of activities.
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