206 week 5- fluid balance

stopped at slide 30 (got to 31 in class, finish this frid

who is the universal donor and why

type o

• no a or b antigens

what triggers EPO erythropoietin

hypoxia-

epo tries to fix the low oxygen

what are the 2 primary iv sites

medial cubital vein, external jugular vein.

what is th eprimary organ for water excreation

kidneys

how do you calculate how much urine per hour is produced

1ml/kg/hr (need to look at pt wieght)

how do you convert kg into lb

kg x 2.2 = lb

if a patient weighs 100kg what is there urine output for an hour

100ml/hr

list other organs of fluid excreation

• skin (sweat), lungs (breathing), GI tract (stool).

what percent of body fluid is water

60%

how much h20 (in %) is in the icf and ecf

icf- 40%

ecf- 20%

in the ecf what are the 2 subcategories

interstitial (16%)

plasma (45)

what do 3e

if interstitial fluid is low what do we see

pt has dry skin

where is intertitial fluid

between cells and blood

what % of the blood is plasma

55

how does fluid move between compartements (icf and ecf)

continuously

what are barorecptors and where are they

pressure sensorys thruought body

carotid sinuses (arteries), aortic arch (BP highest here, so it detects perfusion), kidneys (regulate fluid).

where is the vasomotor center

medulla

how does the vasomotor center work

signls sns to signal adrenal gland

what does adrenal medulla release

epinephrine and norepinephrine (hormones in blood). strictor.

what does norepinephrine do

vasocontrictor

what does adrenal coretx release

aldosterone

what does aldosterone do

trigger for water retention

shat does hypothalamus initiate and how

thirst

signals the posterior pituitary to secrete ADH, which retains Na and water and also vasoconstricts.

what synthesizes renin

kidney

how does raas work (renin-angiotensin-aldosteron system)

kidney syntheisze renin then angiotension 1 (from liver) → angiotensin 2 (in the lungs0

what does angiotensin 2 do

causes vasoconstriction and stimulates aldosterone

what is strict I & O

oder mans measure everything( urine, number of stools, etc)

list the body fluids in the human body

water, plasma, blood, lymph, ICF, ECF (plasma, interstitial, transcellular).

what is the recommended daily intake

2-3L/day

what patients will experience fluid balance issues and fluid loss

burns, vomiting, diarrhea, hemorrhage, fever, excess sweating, diuretic use, renal disease, NPO.

What are the s&s if fluid output exceeds intake?

• Dry mucous membranes, poor skin turgor, pale color and perfusion

• LOC changes and irritability (mentation determines LOC)

• Hypotension, tachycardia, decreased organ function (e.g., urea, creatinine)

• Patients may be hypertensive first because they are overcompensating.

what 3 solutes does osmolity depend on

sodium, glucose, urea.

why is renal function so important

primary regulator of fluid output (balances the fluid).

osmality def

how much solute per unit of water.

what is normal blood asmolity

275–295 mOsm/kg H2O.

how does wtaer move when there are chnages to osmolality

via osmosis plus aquaporin channels (facilitated transport (diffusion), water only).

what does dehydration do osmolality

↑ osmolality (too much solute for the water).

what does overhydration do osmolality

↓ osmolality (not enough solute).

define electrolytes and what they are essentila for

inorganic substances, cations (+) & anions (-), in water

cellular fx and water balance

in ecf (plasma and interstitial) what are 3 electrolytes

sodium, chloride, calcium

in icf high on what electrolytes

potassium, phosphate, magnesium.

during ap how does na and k move

na influx into icf

k efflux into ecf

how does na/k pump work

active transport so need atp

write the 4 phases of myocardial ap

• Phase 0: Na influx (voltage-gated)

• Phase 1: Na inactivation and K outward

• Phase 2: slow inward Ca

• Phase 3: Ca inactivation and K outward

what does the electrolyte panel test

CO2, chloride, potassium, sodium.

what do we need when wbc are compromised

cbc and difffrential

The differential is the WBC breakdown.

what is the ph of chloride

neutral

if chloride is low what happens to co2

high

bicarbonate

acidic or alkaline

found where

what happens if you lose to much bicarbonate

vs keep to much bicarb

at risk for metabolic acidosis (e.g., high bicarb loss through GU/GI or respiration; tachypnea; risk of acidosis).

alkalosis: body fluids (in cluding blood are too high in ph )

what is urea a waste product of

amino acid metabolism

what metabolizes the ammmonia into urea

the liver

what is the goal of iv fluid admin and how does it work

Aims to maintain homeostasis and correct fluid imbalances.

Primarily via osmosis: water moves from low solute to high solute (“dilutes”).

what are the 3 most common sites of iv

medial cubital (most common, but painful, so other veins can be used), external jugular (superficial IV), internal jugular (deep vein but risky).

what is tonicity

is a relative measurement of IV fluid’s osmolality

all ivs are dispensed according to what

their tonicity

iv fuid tonicity 2 main solutes

sodium and dextrose

what is an isotonic fluid

same as plasma

what is a hypertonic fluid

higher (more solute).

what is a hypotonic fluid

lower (less solute)

what is the plasma solute concentration in helathy

280

explian the movement of isotonic

freely moving, no net fluid change. Great for maintenance.

explain movemnet of hypertionic and when it is used

high solute. Water moves from cells and interstitial fluid into plasma (expanded plasma volume; cells shrink). Used when the patient lost a lot of solute, or to draw H2O into circulation (e.g., cerebral edema).

explain movement of hypotonic and when it is used

low solute. Water moves from plasma into interstitial fluid and cells (cells swell).

Used when the patient has high solute and we want to dilute (e.g., high glucose).

what does hypertonic do to the plasma volume

expands

what does hypotomic do to the plasma volume

smaller plasma volume

does hypotonic or hypertonic have increased osmolatiyy in plasma

hyertonic

what are the 2 categories of iv fluid

colloids and Crystalloids:

what are colloids

how are they based

where do they stay

aka

Protein-based (mainly but not always).

Too large to leave circulation, so they draw H2O into circulation (hypertonic effect):

“plasma expanders.”

exmaple for when colloids are used

hypovolemic shock. Contraindicated in most other cases (no passage via capillaries, high renal workload).

what is the composition of crystalloids and how do they move thru body

• H2O + electrolytes + other solutes (e.g., glucose). Move freely between ECF and ICF. Tonicity directs fluid movement.

explain protein content tonicity in the bag vs body

and example

although maybe isotonic in the ‘bag’, will be ‘hypertonic in the body’ d/t protein content ๏e.g. Albumin 5%

explain dextrose tonicity in the bag vs body

and ex

if dextrose is the dominant solute, the body uses it quickly, so the remaining fluid becomes more isotonic or even hypotonic. E.g., D5 1/2 NS is mildly hypertonic in the bag.

define fluid maintennace and how we achieve

meeting body requirements (keeping up with normal losses)

๏oral intake (eating/tube feeding); IV infusion; SC infusion

define fluid resuscitation and what to do in minor vs concerning cases

what is the goal

replacing deficits from more severe losses (hemorrhage, high fever, vomiting)

๏PO if minor; IV if concerning

goal: adequate perfusion => rescue intravascular volume

what are normal fluid losses from respiratory and stool

r- 400ml/day

stool; 100-200ml

is fluid restriction np

iv fluid maintenance calculation for adult w good organ fx

35 mL/kg/day of water

iv fluid maintenace calculation peds (theres 3 parts)

“4/2/1” rule

▪ 4ml/kg/hr for 1st 10 kg of body weight ▪

2ml/kg/hr for 2nd 10 kg of body weight ▪

1 ml/kg/hr for the remaining kgs

how much dextrose is needed daily to avoid starvation

50–100 g/day

what does D5 mean aand how many calories are in this

50 g glucose per L; 1 L of 5% dextrose = 170 cal.

calculate iv maintenance for 25 kg child

= 40 + 20 + 5 = 65 mL/hr.

s/s of fluid overload

weight gain, peripheral edema, JVD, crackles in lungs, SOB, bounding pulse, hypertension.

s/s of hypovolemia (low circulating blood/fluid volume)

tachycardia, weak pulse, hypotension, dry mucous membranes, poor skin turgor, ↓ urine output, confused or dizzy.

whta are 2 common isotonic fluids

crystalloids

colloids

list the 5 crystalloid isotonic fluids

Normal Saline (NS) 0.9% (H2O + Na),

Lactated Ringer’s (LR/RL),

Plasma-Lyte 148

, D5W,

D5.2NS.

how do colloids show up in the body

hypertonic

list the 3 colloid isontonic soltions (hypertonic in body)

๏ 5% Albumin ๏ Dextran 40, Dextran 70 ๏ Hydroxyethyl Starch 6% (e.g. Hetastarch)

what is dextrose

r glucose = energy.

Normal Saline (NS) 0.9%:

what are the contents per l

what is the tonicity/how they move

• Na 154 mEq, Cl 154 mEq. Isotonic, freely moving.

isotonic- freely moving

what is the resuscitation fluid #1 an hw is it different in adults and peds

NS 0.9%

adults 500 mL bolus, reassess

paediatrics 15 mL/kg, reassess; switch to D5 1/2 NS

what are the side effects of prolonged use of Normal Saline (NS) 0.9%

hyperchloremia (a lot of Cl → bicarb goes down → risk of acidosis; check kidney function/GFR), low other electrolytes, no dextrose (no energy, calories, or nutrients).

Lactated Ringer’s (LR/RL) what are the contents per L (5) anmd what is tonicity

๏Na 130 mEq

Potassium 4 mEq

Calcium 2.7 mEq

Chloride 109 mEq

Sodium lactate 28 mEq (metabolized into bicarbonate)

isotonic

2 side effects of Lactated Ringer’s (LR/RL)

hyperkalemia(bood potassium to high), no dextrose.

what is a ped contraindicator for lactated ringers

high electrolytes for kids.

Plasma-Lyte 148 what are the content per liter

o Na 140 mEq

Potassium 5 mEq

Mg 3 mEq

Chloride 98 mEq (normo-chloremic)

Alkalizing agents(converts into bicarb0: 27 mEq acetate, 23 mEq gluconate

plasma-Lyte 148

calories:

when is it common choice

cautions

21

Common post-OR fluid.

: hypersensitivity reactions

Dextran 40 what is the composition and what doe sit contain

Large polysaccharide (not a protein, but a big molecule). Contains some 0.9% NS.

where does Dextran 40 go and how deos it work

stays in circulation ‘volume expander’ o binds RBCs & platelets, reduces aggregation o Anti-platelet o reduces blood viscosity o risk of bleeding