Fluids And Electrolytes

Front 1

What are the major Functions of Calcium?

Back 1

Transmission of nerve impulses
Cardiac contractions
Blood clotting
Formation of bones and teeth
Muscle contraction

Front 2

Most common hypotonic crystalloids?

Back 2

½ NS 154
D5W 253

Front 3

Most common isotonic crystalloids?

Back 3

LR 273 mOsm/L (normal in humans is 285-295)
NS 308

Front 4

Most common hypertonic crystalloids?

Back 4

D5 ½ NS 432
D5LR 525
D5NS 586
NS 3% 1026 (hypovolemic resuscitation/hyponatremia)

Front 5

Calcium production requires?

Back 5

Vitamin D
Parathyroid Hormone (PTH)
Calcitonin (from thyroid gland)

Front 6

Estimated blood volume for adult male?

Back 6

Men 75 ml/kg

Front 7

Estimated blood volume for adult male/female?

Back 7

Adults: Men 75 ml/kg
Women 67 ml/kg

Front 8

Estimated blood volume for infants?

Back 8

Infants: 80 ml/kg

Front 9

ABL (Allowable blood loss)?

Back 9

80 kg male = 80kg x 75ml/kg = 6,000ml
EBV x (starting hct – target hct)/starting hct =
(6,000 x (39 – 25)/39=2,153 ml
ABL (allowable blood loss) = 2,153ml

Front 10

Maintenance fluids for
Peds?
Adults?

Back 10

Pediatrics
1st 10 kg: 4ml/kg/hr……….8 kg = 32 ml/hr
10-20 kg: add 2ml/kg/hr……13 kg = 46 ml/hr
Each kg >20: add 1ml/kg/hr…..27 kg = 67 ml/hr
Adults
1.5 x weight in kg….80 kg = 120 ml/hr
Above formula = 40 + 20 + 60 = 120 ml/hr

Front 11

Estimated blood volume for neonates? Premie and Full term

Back 11

Neonates
Premature: 95 ml/kg
Full-term: 85 ml/kg

Front 12

Total Body Fluid (% of body weight)

Back 12

Newborn: 70-80%
1 year: 64%
12-39: Men 60% Women 52%
40-60: Men 55% Women 47%
61+: Men 52% Women 46%
Total body Water:
ICF: 2/3 of total body volume, K+, Phosphate, Mag.
ECF: 1/3 of total body volume, Na++, Cl-
IVF: intravascular fluid, 42%
ISF: interstitial fluid, plasma,interstitial,lymph

Front 13

Cations

Back 13

Na+, K+, Ca++, Mg+

Front 14

Anions

Back 14

HCO3, Cl-, PO2-

Front 15

1 L water =

Back 15

2.2 lb or 1 kg

Front 16

Main ICF electrolyte

Back 16

K+

Front 17

Main ECF electrolyte

Back 17

Na++

Front 18

Diffusion

Back 18

High concentration to low

Front 19

Osmosis

Back 19

A solvent (water) passes through a semipermeable membrane that separates two different concentrations. Influenced by osmotic pressure

Front 20

Osmotic pressure

Back 20

The force of a solvent as it passes through a semipermeable membrane

Front 21

Osmolarity

Back 21

The concentration of osmotically active particles in a solution.

Front 22

Regulation of Water Balance

Back 22

Anti-Diuretic Hormone (ADH) from Hypothalamus and Posterior Pituitary
Adrenal Gland (glucocorticoids and mineralcorticoids)
Kidneys (urine volume)
Cardiac (vasoconstricition excretion of urine)
Gastro Intestinal Intake 2-3 L/24 hours
Insensible loss: 900 ml via lungs and skin

Front 23

Sodium (Na+) NL

Back 23

135-145 mEq/L

Front 24

Major functions of Na+

Back 24

Water balance
Transmission of nerve impulses (deficits = neurological change)
Na+ absorbed from food and eliminated via urine, sweat and feces

Front 25

Na+ >145 mEq/L Causes

Back 25

Water loss or sodium gains
Elderly patients
Na+ intake more than water intake
Diabetes Insipidus

Front 26

Na+ >145 mEq/L Manifestations

Back 26

Thirst, dry tongue
Restlessness
Weight changes

Front 27

Na+ >145 mEq/L Treatment

Back 27

Dilute Na+ and promote excretion, D5W & diuretics

Front 28

Na+ < 135 mEq/L Causes

Back 28

Water gain or sodium loss
GI loss (diarrhea, vomiting, NG suctioning)
Urine/Renal disease
Psychiatric (excessive H20 intake)
CHF

Front 29

Na+ < 135 mEq/L Manifestations

Back 29

Water excess rapid weight gain
Na+ loss  neuro symptoms (irritability)

Front 30

Na+ < 135 mEq/L Treatment

Back 30

water excess restrict fluids, hypertonic saline (3% NS)
sodium lossoral or iv sodium

Front 31

Manifestations of vital signs for fluid excess

Back 31

BP: elevated
Pulse: bounding and rapid
Respirations: increased
CVP: elevated
Lung sounds: moist, crackles, shortness of breath

Front 32

Manifestations of vital signs for fluid deficit

Back 32

BP: normal (compensatory mechanisms)
Orthostatic hypotension
Pulse: thready with severe hypotension
CVP: reduced
Respirations: increasesd (hypoxia)
Severe deficit: shock

Front 33

Potassium (K+) NL

Back 33

3.5-5.5 mEq/L

Front 34

Potassium (K+)

Back 34

Maintained by sodium-potassium pump in cells
K+ changes  altered excitability of muscles, neurons, pancreatic cells (release insulin)
Eliminated by kidneys (renal problems)
Hyperkalemia
Cause K+ to move from ECF  ICF: Insulin
Cause K+ to move from ICF  ECF: acidosis, trauma to cells and exercise

Front 35

K+ >5.5 mEq/L Causes

Back 35

Excess or rapid delivery of K+
Excessive use of salt substitutes with K+
Renal failure
Uncontrolled diabetes
Massive cell destruction
Transfusion of old blood

Front 36

K+ >5.5 mEq/L treatment

Back 36

Eliminate K+ (oral & parenteral)
Diuretics - lasix
Dialysis
Kayexalate
Increase fluids
IV Insulin
Cardiac monitor

Front 37

K+ <3.5 mEq/L Causes

Back 37

Shift from ECFICF
Abnormal loss (NG, diarrhea, vomiting)
Elevated aldosterone (diuresis)
Metabolic alkalosis

Front 38

K+ <3.5 mEq/L Manifestations

Back 38

Fatigue, muscle weakness (leg), weak, irregular pulse, arrhythmias

Front 39

K+ <3.5 mEq/L treatment

Back 39

Give Potassium Chloride (KCl)
30cc/hr urine output (minimum)
NEVER PUSH---dilute and do not give more than 20 mEq/hour IV
Prevent persons on diuretics from eathing foods high in K+

Front 40

Major Functions fo Calcium

Back 40

Transmission of nerve impulses
Cardiac contractions
Blood clotting
Formation of bones and teeth
Muscle contraction

Front 41

Calcium Requires

Back 41

Vitamin D
Parathyroid Hormone (PTH)
Calcitonin (from thyroid gland)