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Clin Lab Med Unit 2 > 4 IV Fluids > Flashcards

4 IV Fluids Flashcards

1
Q

Three main types of replacement IVF

A

Crystalloids (most common) - solutions that contain SODIUM as the main osmotically active particle

Colloids - solutions that contain high-molecular weight substances that do not migrate easily across capillary walls (more likely to stay in vascular compartment)

Blood and blood products

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2
Q

Solutions with the same salt concentrations as normal cells of the body

A

Isotonic crystalloids

Normal saline (0.9% NS)
Lactated Ringer (LR)
Plasma-lyte
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3
Q

A solution with higher salt concentration than normal cells of the body and blood (3% NS)

A

Hypertonic crystalloids

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4
Q

Solutions with lower salt concentration than normal cells of the body

A

Hypotonic crystalloids

  1. 5% NS
  2. 25% NS
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5
Q

Other non-tonic crystalloids

A

D5W (5% dextrose in water) - useful for someone who is hypoglycemic

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6
Q

What is a lactated ringer solution?

A

Contains lactate, K+ and Ca2+ in addition to NS

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7
Q

What is plasma lyte?

A

Contains less chloride than NS

Thought to be the most physiologic solution

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8
Q

All isotonic crystalloids…

A

Distribute uniformly throughout the ECF space

Internists tend to prefer NS and surgeons LR

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9
Q

Isotonic crystalloids are used for…

A

Treatment of dehydration/hypovolemia

Severe hypovolemia should be corrected as rapidly as possible to correct intravascular volume depletion

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10
Q

Why do we use hypertonic crystalloids cautiously?

A

Most valuable in situations where there is life-threatening hyponatremia with significant water excess (to prevent hyponatremic seizures)

BUT must calculate replacement rate (and double check) because overly rapid correction could lead to osmotic demyelination or central pontine myelinolysis (CPM) — IRREVERSIBLE!

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11
Q

When are hypotonic crystalloids use?

A

For maintenance fluids to prevent hypernatremia when one continuous fluids (ie - a patient who is NPO for several days)

INADEQUATE for replacing intravascular volume deficits (ie dehydration)

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12
Q

What do colloids do to the vascular compartment?

A

Typically expand it

Used when crystalloids fail to sustain plasma volume due to low osmotic pressure

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13
Q

Perfect examples of when colloids should be used

A

Patients with burns, peritonitis, or liver disease, where there is considerable protein loss from the vascular space

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14
Q

What is the most common type of colloid?

A

Albumin preparations

5% albumin
25% albumin

Other types:
Dextran (40 or 70)
Hydroxyethyl starch (Hetastarch)
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15
Q

Albumin colloids are not useful if patient’s serum albumin is …

A

> 2.5mg/dL

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16
Q

What is third-spacing?

A

Physiological concept that body fluids collect in a third body compartment that isn’t normally perfused with fluids

Patient becomes edematous very quickly (ie ascites) so crystalloids will just make it worse

Colloids put the fluids in the right place

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17
Q

What is Dextran?

A

A synthetic glucose polymer which expands intravascular volume equal to the amount infused

Used less frequently as an alternative to albumin

18
Q

What is hydroxyethyl starch?

A

A glycogen-like synthetic molecule that increases the vascular volume to an amount ≥ the volume infused

Less expensive than albumin

19
Q

Colloid more frequently used intra-operatively

A

Hydroxyethyl starch (hetastarch)

20
Q

What are the three relative blood products?

A

Packed RBCs

Platelets

Fresh frozen plasma

21
Q

How are PRBCs used?

A

Used with crystalloids to expand intravascular volume

Remain entirely within the vascular space

Used for blood transfusions
• Hemorrhage, severe anemia
• Patients must be typed and screened/crossed in order to determine blood type and antibodies prior to transfusion

22
Q

When do we use platelets?

A

In patients with thrombocytopenia or impaired platelet function to prevent or treat bleeding

Watch out in condition with accelerated consumption of platelets
(ITP, DIC, TTP, hypersplenism, AIDS, sepsis, CABG)

23
Q

What do we use fresh frozen plasma for?

A

To correct major bleeding complications in patients on warfarin and/or with a vitamin K supratherapeutic INR

Also consider prothrombin complex concentrates

24
Q

What fluids can be used for boluses?

A

NS, LR, Plasma-lyte, PRBCs

Can give 250ml to 1L bolus

Use with caution in patients with HF

25
Q

When are maintenance IVFs used?

A

Maintain/account for ongoing losses of water and electrolytes under normal physiologic conditions via urine, sweat, respirations, and stool

Used when patients are not eating or drinking normally

Goal is to provide water and electrolyte balance

26
Q

What would a maintenance IVF look like?

A

D5/0.5NS with 20 meq KCl

27
Q

How do you determine the water needs in normal adult patients with no known deficits (for maintenance IVF)?

A

“The kg method”

For 1st 10kg body weight —> 100ml/kg/day
For 2nd 10kg body weight —> 50ml/kg/day
For weight>20kg —> 20ml/kg/day
Divide it all by 24 hours to determine the hourly rate of infusion

Ex. 70 kg man
10(100ml) + 10(50ml) + 50(20ml) = 1000+500+1000 = 2500ml/24hours
~100ml/hr

28
Q

Max daily infusion for kids

A

2400ml

Children require less sodium so use 0.25NS instead of 0.5NS

29
Q

When might you add additional potassium to IVF

A

To treat hypokalemia or for maintenance fluids if the patient is NPO

NEVER BOLUS POTASSIUM-CONTAINING IVF!!!

30
Q

Use caution when replacing potassium in patients with…

A

kidney disease

31
Q

What do you need to do when running replacement IVF?

A

Monitor vital signs, urine output, and clinical picture to determine effectiveness

If a patient is signicantly hypo- or hypernatremic, USE CAUTION TO AVOID RAPID CORRECTION (—> CPM)

32
Q

In addition to maintenance fluids, surgical patients need …

A

Replacement of fluids lost:
Urine output
Blood loss
Third spacing due to surgical intervention at the operative site with resultant leakage of fluids (most obvious in abdominal surgery)

Use urine output and vital signs as guides to the amount of additional fluid needed

33
Q

What is the Parkland Formula

A

Used to determine the fluid requirements for burn patients (who need more fluids)

Total fluid required during the first 24 hours
= (% of 2nd/3rd degree burns) x (body weight in kg) x 4mL

Replace with LR (may have to go to colloids later but start with LR)

1/2 of total amount infused in 1st 8 hours
1/4 total during 2nd 8 hours
1/4 during 3rd 8 hours

34
Q

How do we determine the percentage body burned?

A

“Rule of Nines”

Each arm = 9%
Head = 9%
Anterior/posterior trunk = 18% each
Legs = 18% each
Perineum = 1%
35
Q

How does the body compensate for inadequate nutrient intake?

A

By breakdown of glycogen stores, gluconeogenesis, lipolysis, amino acid oxidation from muscle

36
Q

If an adult is previously well-nourished, inadequate oral intake of nutrients can be tolerated for…

A

1-2 weeks

Beyond that, supplemental nutrients needed

37
Q

Most common type of Parenteral Nutrition?

A

Total parenteral nutrition (requires a PICC line)

Peripheral parenteral nutrition very uncommon (fucks up your veins)

38
Q

Indications for TPN

A 
Small bowel resection
Complete bowel obstruction
IBD
Bowel rest
Pre-existing nutritional deprivation
Anticipated or actual inadequate energy intake by mouth (esp if >7-10 days in adults or 3-7 days in kids)
Significant multisystem disease
39
Q

TPN requires what type of access?

A

Central venous access via SVC

Used when parenteral nutrition support is expected to be longer than 7 days

40
Q

What time of access is required for PPN?

A

Peripheral venous access

Used infrequently when parenteral nutrition support is expected to be short term

41
Q

Complications of TPN/PPN?

A 
Metabolic/electrolyte abnormalities
Air embolism
Pneumothorax
Catheter-associated DVT
Catheter-infection
Thrombophlebitis

Clin Lab Med Unit 2 (4 decks)

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