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20 Cards in this Set

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Which patients have low total body water (TBW)? high total body water?
• TBW is lowest in aged & obese
• TBW is highest in very lean & young
What are the 2 spaces of the extracellular compartment?
• intravascular plasma space (4%)
• interstitial space (16%)
What are causes of volume depletion?
• diarrhea
• external drainage from enteric, biliary, or pancreatic fistulas
• nasogastric suction
• vomiting
What is the most common cause of volume depletion in surgical patients?
GI loss (N/V/D)
What are causes of volume depletion in 3rd space losses?
• acute hemorrhagic pancreatitis
• burns
• crush injuries
• intestinal obstruction
• large areas of soft tissue infection
• long bone fractures
• periotonitis
• pleural effusions
• trauma or surgery
What are causes of excessive urinary loss that can also cause volume depletion?
• diuretic therapy
• high output renal failure
• osmotic diuresis (caused by glucose, mannitol, or angiographic contrast media)
What is the most common cause of osmotic diuresis?
DKA
What are causes of water loss that can also cause volume depletion?
• increased evaporated losses from burned surfaces
• increased sweating and evaporative losses from skin and respiratory tract in febile patients
• nephrogenic causes of diabetes insipidus
• primary deficiency of ADH
What is the number one way to monitor fluid status?
urine output
What are the electrolytes found in normal saline and what are their concentrations?
• Na: 154
• Cl: 154

*units are mEq/L
What are the electrolytes found in Ringer's Lactate and what are their concentrations?
• Na: 130
• K: 4.0
• Cl: 109
• Lactate: 28
• Ca: 3.0
How much fluid bolus can you give to an infant, adolescent, adult, and geriatric patient?
• infant: 20 cc
• adolescent: 250 cc
• adult (< 35 y/o): 500cc - 1 liter
• geriatric: 250 cc
What fluid can you give as a bolus?
• normal saline
• lactated ringer
• blood
• albumin
A fluid bolus should be given over what amount of time?
30 mins - 3½ hours
What are signs and symptoms of hyponatremia?
CNS dysfunction

• fatigue
• hyperactive DTRs
• muscle twitches
• weakness
What are causes of hypokalemia due to GI loss?
• diarrhea
• fistulas
• nasogastric suctioning
• obstruction
• vomiting
What are renal causes of hypokalemia?
• alkalosis
• diuresis
• elevated aldosterone
• elevated cortisol
• hypochloremia
• hypomagnesmia
• medications
• nephropathy
What are causes of hypokalemia due to intracellular shifts?
• alkalosis: K+ exchange for H+ ion
• insulin
• TPN (causes increases intracellular needs for potassium)
Why do you not use a glucose-based solution when giving IV K+ to treat hypokalemia?
• glucose will increase endogenous insulin levels
• can induce movement of dextrose and K+ into the cell causing K+ to drop further
What are signs and symptoms of hyperkalemia?
• muscle weakness
• cardiotoxicity