# Shared Flashcard Set

## Details

Fluid & Electrolytes
calculations etc.
103
Other
06/06/2014

Term
 Fluid Distribution: TBW males vs. females
Definition
 60% in males50% females
Term
 True or False; because fat contains little water content, obese patients will have a lower percentage of TBW?
Definition
 True
Term
 Elderly patients will have a lower percentage of total body water ____ to ___%
Definition
 46-52%
Term
 Infants have a _______ body water content about ____ to ___%
Definition
 increased, 70-80%
Term
 2/3 of the of body fluid is?
Definition
 intracellular
Term
 1/3 of body fluid is extracellular with the majority (3/4) _______ and only 1/4 in the_______ space
Definition
 intersitial, intravascular
Term
 True or False: Drug distribution is the same in elderly, adults, infants, and the obese
Definition
 false; drug distribution will differ based on fat & water content in the body
Term
 _______ is the number of impermeable particles in a solution
Definition
 Osmole
Term
 These particles determine osmotic pressure
Definition
 osmole's
Term
 Osmolality is the number of osmoles per____ of solvent
Definition
 Kg
Term
 The normal plasma osmolality is?
Definition
 290-300mosm/L
Term
 Osmolarity is the number of osmoles per ____ of _____
Definition
 liter, solvent
Term
 hyper, hypo, and isotonic are used to describe what?
Definition
 tonicity- the ability of a solution to exert an osmotic force across a membrane
Term
 Oncotic pressure is the pressure produced by what?
Definition
 proteins
Term
 What are the 3 goals of fluid and electrolyte management?
Definition
 Maintaining fluid, electrolyte, and acid base balance (homeostasis) with the end result of reduced M &M
Term
 Name the 5 components of calculating intra-operative fluid requirements
Definition
 1. hourly rate2. replacement of the NPO deficit3. Maintenance replacement4. surgical loss replacement5. insensible and sensible loss replacement
Term
 Calculating "hourly" fluid requirements is based on what rule?
Definition
 4-2-1 rule; 4ml/kg/hr 1-10kg2ml/kg/hr 11-20 kg1ml/kg/hr >21kg
Term
 Calculating NPO deficit is done by?
Definition
 Multiplying the hourly rate x the number of NPO hours
Term
 What ultimately dictates how fast the NPO deficit is replaced?
Definition
 Pt's history and co-existing conditions
Term
 Maintenance fluid is based on what? and accounts for what type of losses?
Definition
 calculations are based on the type of operationaccounts for evaporative loss and fluid redistribution out of the intravascular compartment
Term
 Maintenance fluid for procedure involving minimal tissue trauma/exposure?
Definition
 2-4ml/kg/hr
Term
 Maint. fluid for procedure involving moderate tissue trauma/exposure is?
Definition
 4-6ml/kg/hr
Term
 Maint. fluid for procedure involving severe tissue trauma/exposure?
Definition
 6-8ml/kg/hr
Term
 Maint fluid for procedure involving open chest or abdomen?
Definition
 8+ml/kg/hr
Term
 Maint for complex laceration of left hand?
Definition
 2-4
Term
 lap appendectomy maintenance fluid?
Definition
 2-4
Term
 Bunionectomy fluid maintenance?
Definition
 2-4
Term
 Total hip fluid maintenance?
Definition
 4-6
Term
 Colectomy w/invasive tumor removal and colostomy fluid maintenance?
Definition
 6-8
Term
 open bariatric rue-en-y with chole fluid maintenace?
Definition
 8+
Term
 Hysterectomy w/tumor debulking?
Definition
 6-8
Term
 T&A
Definition
 2-4
Term
 D&C
Definition
 2-4
Term
 open chest & open abd exploration s/p GSW
Definition
 8+
Term
 Cranitomy
Definition
 2-4
Term
 Crystalloid replacement of blood loss ratio is?
Definition
 3:1, 3 ml of isotonic solution for every 1ml blood loss
Term
 Describe the difference between sensible loss and insensible loss?
Definition
 Insensible loss does not contain solutes; loss of free water. Sensible losses contains solutes
Term
 Name routes of insensible loss?
Definition
 skin, respiratory tract, evaporative loss via incision (accountanted for in maintenance fluid)
Term
 Sensible loss includes:
Definition
 mucous, tears, urine, stool, sweat
Term
 Average insensible loss via the skin is ____ and ____ via the respiratory tract
Definition
 300ml/day, 400ml/day (total 700)
Term
 How does mechanical ventilation affect insensible losses?
Definition
 MV increases insensible water losses, air/oxygen/inhalation gases are dry.
Term
 What can help reduce insensible water loss due to mechanical ventilation?
Definition
 humidification- HME- reduces the KCal required to heat the inspired air, also decreases water loss
Term
 Insensible water loss is higher in neonates and is aprox?
Definition
 40ml/kg/day
Term
 Insensible loss in the neonate is inversely proportional to what?
Definition
 gestational age
Term
 Methods to reduce insensible water loss in neonates?
Definition
 Increased ambient humidity (minus 12ml/kg/day)Saran wrap/inner sheild (minus 4-12ml/kg/day)
Term
 Name 3 factors that will increase the insensible loss in neonates by 20ml/kg/day?
Definition
Term
 Fever in a neonate will increase insensible fluid loss by how much?
Definition
 40-80ml/kg/day
Term
 What condition will increase the insensible fluid loss in neonates the MOST?
Definition
 Major skin defects- ie: gastroschisis (bowel is outside the body) +120ml/kg/day
Term
 sensible loss increases by what % for every degree > 38
Definition
 10%
Term
 For every degree > 37, how much sensible loss will there be?
Definition
 100 to 150 ml (in 70kg pt)
Term
 Usually sensible loss is not accounted for in hourly totals. Name 2 situations in which sensible loss should be accounted for?
Definition
 Consider sensible loss in the neonate Sensible loss should be accounted for if the patient is febrile
Term
 Osmolality of D5W is?
Definition
 hypotonic 253 mOsm/kg
Term
 Osmolality of NS
Definition
 308 - isotonic
Term
 Osmolality of LR
Definition
 273
Term
 What solution contains an electyrolyte profile most similar to plasma?
Definition
 LR- "balanced salt solution"
Term
 1 L of d5W contains how much glucose?
Definition
 5000 mg or 5gms
Term
 What type of fluid may be used for hourly in neonates?
Definition
 Dextrose solutions (neonates have limited glycogen stores)
Term
 Name the solution most physiological in large volumes
Definition
 LR
Term
 How much free water is supplied by 1 liter of LR
Definition
 100ml
Term
 Lactate is metabolized what 2 ways:
Definition
 70% via gluconeogensis into glucose30% via oxidation into bicarbonate
Term
 Intravascular 1/2 life of LR
Definition
 20-30min
Term
 What is the best solution to use for patients with neurological injuries?
Definition
 Normal saline
Term
 Patients with what 2 comorbidites may beneifit from NS over LR?
Definition
 diabetic pts & ESRD
Term
 This solution may cause hyperchloremic acidosis
Definition
 NS
Term
 Intravascular half life of NS
Definition
 15-20 minutes
Term
 For Fluid boluses, the formula used is?
Definition
 10-20 ml/kg of isotonic fluid
Term
 Fluid boluses in the neonate must be what?
Definition
 Preservative Free
Term
 Name 3 colloids
Definition
 Albumin, Dextran, & Hestastarch
Term
 Coilloids contain what?
Definition
 proteins/large molecules which create as osmotic/oncotic pull
Term
 When using COLLOIDS to replace blood loss, what is the ratio?
Definition
 1:1
Term
 When do we use Colloids?
Definition
 when crystalloid fluid admin exceeds 3-4L adjunct until blood arrivesFluid resuscitation in pts with severe protein loss
Term
 Most common plasma protein is _______, responsible for 70-80% of the oncotic pressure
Definition
 Albumin
Term
 ____% of albumin is located in the extravascular space, while ___ % is located in the intravascular space
Definition
 60% EV, and 40% IV
Term
 _________ binds and transports drugs, hormones, fatty acids, and enzymes
Definition
 Albumin
Term
 Uses for Albumin include:
Definition
 ARDS, bacterial peritonitis, toxic bilirubin levels in infants with hemolytic disease
Term
 True or False: drugs may compete for albumin binding sites
Definition
 True
Term
 How does albumin levels affect the effects of drugs?
Definition
 if a drug binds to albumin, and albumin levels are low there will be more "free drug" to produce effects.
Term
 If a pt has a low albumin level, the amount of drug given should be _______?
Definition
 reduced
Term
 If albumin levels are high, and a drug binds to albumin, the amount of drug given may need to be _______
Definition
 increased
Term
 Half life of Albumin?
Definition
 15 to 20 DAYS
Term
 For each 2.5g/dl decrease in serum albumin the risk of death increases by what?
Definition
 24-56%
Term
 What colloid may be preferred in vascular cases?
Definition
 Dextran; decreases blood viscosity
Term
 Infusions of what colloid > 200ml/kg/day can interefere with blood typing and prolong bleeding time
Definition
 Dextran
Term
 What is given to bind circulating dextran antibodies?
Definition
 Promit (dextran 1)
Term
 What colloid is antigenic?
Definition
 dextran
Term
 What colloid is completely eliminated by the kidneys ?
Definition
 Hetastarch
Term
 Benefits of using hetastarch
Definition
 less expensive than albumin, Nonantigenic
Term
 Max dose for hetastarch
Definition
 should not exceed 20ml/kg/day because of effect on coagulation and bleeding times
Term
 Hgb is aproximately ____ of the Hct in the adult?
Definition
 1/3
Term
 Hct is affected by?
Definition
 plasma volume
Term
 Total blood volume in the premature neonate is?
Definition
 90ml/kg
Term
 TBV in infant
Definition
 85ml/kg
Term
 TBV in child
Definition
 80ml/kg
Term
Definition
 75ml/kg
Term
Definition
 65ml/kg
Term
Definition
 55ml/kg
Term
 Calculating ABL is based on what formula? & is acceptable to use when?
Definition
 EBV X 20%,multiple EBL by triger hct, subtract the two, and multiply result by 2-3=allowable blood loss before transfusion use for HEALTHY pts if no hgb/hct is available
Term
 What is the transfusion trigger for most healthy patients
Definition
 7-8g/dl /hct 21-24%
Term
 Transfusion trigger in elderly pts with pulmonary disease and cardiac disease is?
Definition
 hgb 10gd/dl (30% hct)
Term
 The universal blood donor is?
Definition
 type O
Term
 Universal blood recipient
Definition
 AB
Term
 Universal PLASMA donor
Definition
 AB
Term
 Universal PLASMA recipient
Definition
 O
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