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20 Cards in this Set
- Front
- Back
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Where is fluid loss that is accounted to being "insensible" loss?
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skin and lungs
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How much water is lost per day to insensible loss normally?
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500ml
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What does ADH cause?
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Re-absorption of pure water
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Where does ADH come from?
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posterior pituitary
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What does the acronym ADH mean?
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anti-diuretic hormone
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What would a rise in plasma osmolality do to ADH secretion?
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increase ADH secretion
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What would a fall in plasma osmolality do to ADH secretion?
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decrease ADH secretion
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In the rules of fluid replacement, you replace blood with?
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blood
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In the rules of fluid replacement, you replace plasma with?
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colloid
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In the rules of fluid replacement, you resuscitate with?
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0/9% sodium chloride
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In the rules of fluid replacement, you replace ECF depletion with?
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saline
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In the rules of fluid replacement, you rehydrate with?
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dextrose
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With 30L intracellularly, 9L interstitially, and 3L intravascularly, you give a pt 2L of blood. How does this change the fluid distribution?
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Increases their intravascular compartment to 5L
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With 30L intracellularly, 9L interstitially, and 3L intravascularly, you give a pt 2L of colloid. How does this change the fluid distribution?
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Immediate expansion of the intravascular compartment by 2L yielding 5L with an increase in oncotic pressure. This causes water to be drawn into the vascular space from the interstitial and intracellular reservoirs. Final result is 29L intracellularly, 8L Interstitially, and 7L intravascularly
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With 30L intracellularly, 9L interstitially, and 3L intravascularly, you give a pt 2L of 0.9% saline. How does this change the fluid distribution?
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Immediate result leads to 5L of intravascular fluid. Final result leads to 29L of intracellular, 10.5L of interstitial, and 4.5L of intravascular fluid. Saline being a crystalloid, does not remain within the vascular space, but will diffuse into the interstitial space. The sodium it carries will not enter the intracellular space however, because of active sodium extrusion from the cell. Saline will therefore cause immediate expansion of the intravsacular volume, followed by equilibration between the vascular and interstitial spaces, the osmolality of which are equal, but are now slightly greater than that of the intracellular space, due to the increased sodium load. This results in water movement from the intracellular space in order to equalise osmolality throughout all three compartments
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With 30L intracellularly, 9L interstitially, and 3L intravascularly, you give a pt 2L of 5% dextrose. How does this change the fluid distribution?
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5 Dextrose is isotonic to plasma. Giving 2 litres of 5% dextrose will cause the immediate expansion of the vascular compartment but, as its glucose content is rapidly metabolised, the remaining water will distribute itself between all compartments and very little will remain within the blood space. For this simple reason, dextrose is not a fluid of resuscitation. Final result: 31L intracellular, 9.7L interstitial, 3.3L intravascular
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What are the signs of volume depletion?
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Postural hypotension, tachycardia, absence of JVP @ 45*, decreased skin turgor, dry mucosa, supine hypotension, oliguria, organ failure
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What are the signs of volume overload?
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hypertension, tachycardia, Raised JVP/gallop rythm, edema, pleural effusions, pulmonary edema, ascites, organ failure
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What is the tx for Hyperkalemia?
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1. Calcium Gluconate
2. Sodium Bicarbonate 3. Insulin + Dextrose 4. Kayexelate |
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What is the tx for Diabetic Ketoacidosis?
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1. Normal Saline 1 liter over 1 hour
2. NS 2nd liter over 2 hours 3. Start Insulin drip 4. When serum glucose 250 mg/ml, switch to D5-1/2NS with KCl 20 mEq at 250 ml/hr 5. Continue insulin drip until acidosis resolves – occurs after glucose normal |
