Fluid/electrolytes (part 2)

Normal anion gap without potassium

8-12

Normal anion gap with potassium

12-18

What does an anion gap >12 indicate?

Metabolic acidosis

what does a low anion gap indicate

hypoproteinemia

What can cause an increased anion gap

• DKA

• Lactic acidosis

• Aspirin poisoning

• Uremia

• Methanol

• Ethylene glycol

Hypotonic solution

Solution with a lower concentration of dissolved particles than the inside of a cell

Hypertonic solution

Solution with a higher concentration of dissolved particles than the inside of a cell

Isotonic solution

Solution with an equal concentration of dissolved particles compared to the inside of a cell

________ solutions expand the plasma volume of the blood

Isotonic

_________ solution infusions can be used to move water from the ECF into the ICF

Hypotonic

_______ solution can be infused into the bloodstream to pull water from the ICF into the ECF (causes dehydration of cells)

Hypertonic

Examples of isotonic IV solutions

• Normal Saline (0.9% NaCl)

• Lactated Ringer’s

• 5% Dextrose in Water (D5W)

Examples of hypertonic IV solutions

• 3% NaCl

• 10% Dextrose in Water (D10W)

• 5% Dextrose in NS (D5NS)

Examples of hypotonic IV solutions

• 0.45% NaCl

• 0.33% NaCl

Where does water move with a hypotonic solution

ECF —> ICF

What do hypotonic solutions do to cells?

Water rushes into the cells (via osmosis)

What electrolyte imbalance can hypotonic solutions treat?

Hypernatremia (high blood sodium levels)

What happens to plasma volume with isotonic solutions?

Increases by expanding ECF

Common uses of hypotonic solutions

• Fluid loss from surgery

• Gastric fluid loss from NG drainage or vomiting

Common uses of isotonic solutions

• Shock

• Blood transfusions

• Hyponatremia

• Resuscitation

Colloid solutions

Highly hypertonic solutions

What do colloids do

Pull fluid into the plasma

Complications of IV therapy

• Infiltration

• Air embolism

• Extravasation

• Phlebitis

• Fluid overload

• Infection

What are packed RBC’s used to treat?

Severe/symptomatic anemia and acute blood loss

By how much does 1 unit of packed RBC’s typically increase hemoglobin (in g/dL)

About 1g/dL

By how much does 1 unit of packed RBC’s typically increase hematocrit (in %)

About 3%

About how much blood loss does 1 unit of packed RBC’s replace?

About 500mL

How long can packed RBCs be stored

Up to 35 days

How are platelets prepared

From fresh, whole blood

What are platelets used to treat

• Bleeding caused by thrombocytopenic purpura

• heparin-induced thrombocytopenia

What is FFP (fresh frozen plasma)

The liquid portion of whole blood- separated from cells and frozen

How much plasma does one unit of FFP contain?

200-250mL

What is FFP rich in?

Proteins and clotting factors, but no platelets

What is FFP used for

• Vitamin K deficiency

• Clotting-factor deficiency

• Hemorrhage

What is albumin prepared from

Plasma

What type of protein is albumin

Plasma protein

When is albumin administered

• Hypovolemic shock

• Low albumin levels

What does albumin do

• Maintains fluid balance

• Transports important substances

• Increases vascular volume

Recommended catheter size for blood administration

18-20g

What tubing can be used for blood administration

• Y tubing

• Straight tubing

• Pump tubing

Why may diphenhydramine be given before transfusion?

To decrease probability of a transfusion reaction

Diphenhydramine

First-generation antihistamine

When to take vital signs during a blood transfusions

• Before (baseline vitals)

• 5-15 minutes after starting

• End of transfusion

• Frequency depends on site policy

How quickly must a transfusion be completed

Within 4 hours

What causes an acute transfusion reaction

ABO incompatibility (mismatched blood types)

How long after a blood transfusion can an acute ABO incompatibility reaction occur

Within 15 minutes of starting the transfusion

What happens in the body during an acute ABO incompatibility transfusion reaction?

The body develops antibodies that attack the transfused RBCs, causing RBC breakdown

S/s of acute blood transfusion reaction

• Fever/chills

• Low back pain

• SOB

• Tachycardia

• Hives

• Hypotension

treatment for an acute blood transfusion reaction

• Diuretics

• IV fluids (maintains renal perfusion)

What should be sent to the lab after an acute blood transfusion reaction?

• Blood + tubing

• Urine myoglobin (measure cell lysis)

Normal blood pH

7.35-7.45

What blood pH indicates acidosis

Less than 7.35

What blood pH indicates alkalosis

More than 7.45

Which organ system regulates bicarbonate

Kidneys

Normal blood bicarbonate range

22-26 mEq/L

Normal PaCO2 range

35-45 mmHg

Normal PaO2 range

80-100 mmHg

What causes metabolic acidosis

• DKA

• Renal failure

• Lactic acidosis (lactic acid buildup)

S/s of metabolic acidosis

• Headache

• Confusion

• Increased RR / Kussmaul respirations

How is metabolic acidosis treated

• Address underlying problem

• Bicarbonate administered if pH < 7

ABG findings for metabolic alkalosis

• pH > 7.45

• HCO3- > 26mEq/L

What causes metabolic alkalosis

• Nausea/vomiting

• Long term diuretic use

• Hypokalemia

How is metabolic alkalosis treated

• Address initial cause

• Give IV NS

ABG findings for respiratory acidosis

• pH < 7.35

• PaCO2 > 42 mmHg

What causes respiratory acidosis

Poor CO2 exchange

S/s of respiratory acidosis

• Increased pulse

• Sudden changed in RR/BP

• Mental status changes

How is respiratory acidosis treated

Improve ventilation

ABG findings for respiratory alkalosis

• pH >7.45

• PaCO2 < 35 mmHg

What causes respiratory alkalosis

Hyperventilation

S/s of respiratory aklalosis

• Numbness

• Tingling

• Loss of consciousness

• Lightheadedness

Universal blood donor

O-

Universal blood recipient

AB+