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15 Cards in this Set
- Front
- Back
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How is sodium balance estimated?
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Sodium balance is estimated from clinical assessment of ECF volume (each liter of ECF represents ~140 mMol of Na+). Note: Serum [Na+] is NOT an indicator of Na+ balance.
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In what proportion does ECF volume loss correspond to loss of body weight? In adults, how much will the ECF volume need to decrease before the signs of dehydration become unequivocal?
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A loss of 1 kg of body weight corresponds with a loss of approximately 1 L of fluid. In adults, changes in ECF of as much as 3L may occur before presentation of unequivocal signs of dehydration.
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List several signs associated with loss of interstitial fluid volume.
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Decreased skin turgor, dry mucous membranes, and sunken eyes.
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What orthostatic changes may be associated with dehydration with respect to SBP and heart rate?
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Decreased venous return, upon standing, may result in a > 15 mmHg drop in SBP and/or a compensatory heart rate increase > 30 bpms.
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How does the ratio of BUN to creatinine change with dehydration?
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The ratio of BUN to creatinine is typically 10 to 1. But with dehydration, the ratio may go up to 20 to 1.
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What % loss of body weight represents mild dehydration and what are the clinical S&Sx?
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< 4%. Thirst, Restlessness, Decreased Tearing
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What % loss of body weight represents moderate dehydration and what are the clinical S&Sx?
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4 to 8%. Decreased skin turgor, sunken eyes, orthostatic changes, decreased urine output, dry mucous membranes, and thirst
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What % loss of body weight represents severe dehydration and what are the clinical S&Sx?
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> 8%. Decreased blood pressure and increased heart rate, even when recumbent; no urine output; altered mental status.
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What are the mild, moderate, and severe dehydration cut points for infants and young children?
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Mild is < 5%, moderate is 5 to 10%, and severe is greater than 10%.
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What are three relatively reliable indicators of moderate dehydration in infants and children?
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Decreased capillary refill, deep respirations, and decreased turgor.
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Distinguish hypertonic dehydration from hypotonic dehydration.
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Hypertonic dehydration involves relatively greater loss of water than solutes, leading to increased serum sodium, while hypotonic dehydration involves a relatively greater loss of solute than water, leading to decreased serum sodium.
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What i.v. solution and infusion rate should be used for maintenance of a patient who has no deficits?
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D5/0.2 w/ KCl 20 to 30 mEq/L at an infusion rate of 100 to 125 mL/hr (adult)
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What i.v. solution and infusion rate should be used for treatment of a patient who has ECF depletion from mild-to-moderate dehydration?
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D5/0.45 or 0.45% NaCl & KCl 20 to 40 mEq/L at an infusion rate of 125 to 500 mL/hr
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What i.v. solution and infusion rate should be used for treatment of a patient experiencing hypotension and hypoperfusion due to severe dehydration or shock?
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0.9% NaCl or Lact Ringer's (usually no KCl) at a rapid infusion rate until adequate blood pressure and urine output are achieved.
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What i.v. solution and infusion rate should be used for treatment of a patient who has severe free water deficit or Na restriction?
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D5/W w/ KCl as needed at whatever infusion rate is needed to correct the free water deficit.
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