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3% NaCl is classified as having what type of tonicity?
Hypertonic
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0.45% NaCl is classified as having what type of tonicity?
Hypotonic
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What solutions are classified as isotonic?
0.9% NaCl, LR, R, D5W
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Would you expect a shift of fluids between the ICF and ECF with administration of an isotonic solution?
No
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Would you expect a shift of fluids between the ICF and ECF with administration of a hypertonic solution, why?
Yes, because it has a greater tonicity than the ICF, so fluid flows from the ICF to the ECF
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Would you expect a shift of fluids between the ICF and ECF with administration of a hypotonic solution, why?
Yes, because it has a lower tonicity than the ICF, so fluid flows from the ECF to the ICF
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What are the main crystalloid solutions used in practice?
NS, 1/2 NS, 3% NaCl, LR and R
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The plasma volume expanding capability of crystalloids is directly related to its _________ Concentration.
Na
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When you give D5W, it will distribute in what way?
As free water, 2/3 to ICF, 1/3 to ECF
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Crystalloid or Colloids require more volume to achieve the same effect.
Crystalloids
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Would a higher or lower Na conc. Crystalloid solution cause a greater expansion on the volume of plasma?
Higher
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The Na portion of NS contributes what tonicity to the solution?
154 mEq/L
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The Cl portion of NS contributes what tonicity to the solution?
154 mEq/L
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Would you potentially use NS for metabolic alkalosis?
Yes
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What are the main uses for NS?
Peri/post operation, shock, hemorrhage, w/ a blood transfusion, burns, fluid challenge, hyponatremia
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Would you use NS to treat hyponatremia?
Yes
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What group of patients might experience fluid overload when given NS?
CHR and renal failure
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Can NS be given for EFV replacement from any cause?
Yes
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You have an increased concentration of _________ during metabolic alkalosis.
Bicarbonate (HC03)
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Describe how metabolic alkalosis occurs:
NaCl is leaving the patient, creating a Cl- deficit, so HCO3- enters the blood to balance the loss, causing metabolic alkalosis
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When treating metabolic alkalosis with NS, is the Na or Cl the important ion in correcting the problem?
Cl
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What is a fluid challenge?
Giving fluid more rapidly than normal to raise low blood pressure
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If you give too much NS, what type of pH imbalance can you create?
Non-gap metabolic acidosis
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After giving too much NS, a patient develops non-gap metabolic acidosis, what ion is this contributed to?
-
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What type of saline solution provides both free water and Na?
0.45% NaCl solution
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What type of ECFV depletion state can be treated with 0.45% NaCl?
Hypertonic
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What are potential adverse effects of 0.45% NaCl solutions and how can they be avoided?
Hyponatremia, closely monitor serum Na
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A patient has high and and TBW depletion, what NaCl would be appropriate to give?
1/2NS
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What state is 3% NaCl used to treat?
Severe, symptomatic hyponatremia
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(True/False) 3% NaCl should be infused slowly or rapidly?
Slowly
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What are the potential adverse effects of administering 3% NaCl?
ECFV overload and Hypernatremia
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If you want to raise the patient Na Osmolality in the blood, what type of NaCl solution might you give?
3% NaCl
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In the event of a traumatic brain injury, intracranial pressure increases, what solution should you give to lower this pressure?
Hypertonic saline
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What are the potential adverse effects of IV hypertonic saline administration?
HYPERosmolality, HYPERnatremia, CHF, HYPOkalemia, HYPERchloremic acidosis, coagulopathy, phlebitis and renal failure
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What are the potential CNS adverse effects of hypertonic saline?
Decreased level of consciousness, rebound intracranial hypertension, seizres, central pontine myelinolysis, subdural and intraparenchymal hemorrhage
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What is another term for hyperchloremic acidosis?
Non-gap acidosis
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Why can Hypertonic saline cause coagulopathy?
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By dilution of clotting factors
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Describe the electrolyte composition of lactated ringers:
Closely resembles the electrolyte composition of normal blood serum
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What causes of ECFV is Lactated Ringer’s solution usually used for?
Burns, dehydration, lower GI fluid loss, mild metabolic acidosis
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Would you use LR as a perioperative fluid?
Yes
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What ions does LR replace?
Na, Cl, K, lactate and Ca
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Does LR contain Mg or PO4?
No
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In what group may LR cause fluid overload in?
CHR and renal failure
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Can you use LR for brain trauma?
No, may worsen pressure
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What is the acid/base effect of lactate in LR?
Works as a buffer to increase the pH
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What group of patients might be at risk of metabolic alkalosis when they receive large volumes of LR?
Liver disease patients
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What group of patients might be at risk of lactic acidosis when they receive large volumes of LR?
Liver disease patients
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Should you use LR in patients with liver disease?
No, could cause lactic acidosis or metabolic alkalosis
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What makes LR useful in patients with metabolic acidosis?
Low Cl content
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If a patient is showing accumulation of Cl, but they need more volume, what fluid might be a good choice?
LR
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