Fluid and Electrolyte Management with Parenteral Nutrition Flashcards
Total body water makes up between ____-____% of body weight
50-60
What makes up total body water?
-Extracellular fluid (1/3 TBW)
-Intracellular fluid (2/3 TBW)
-Transcellular fluid (<3% TBW)
Extracellular fluid is made up of…
-Interstitial space (3/4 ECF)
-Intravascular space (1/4 ECF)
How to calculate total body water in women:
Weight in kg x 0.5
How to calculate total body water in men:
Weight in kg x 0.6
What factors affect total body water?
-Fat (total body water decreases with increasing body fat)
-Age (muscle mass declines and the proportion of fat increases, causing total body water to decrease)
-Sex (women have higher body fat than men, causing lower total body water)
____ ____ is the pressure required to maintain equilibrium with no net movement of solvent
Osmotic pressure
Osmotic pressure is a prime importance in determining the distribution of water between the ____ and ____
ECF and ICF
The ECF and ICF both contain a major active ____ that determines the osmotic pressure
Solute
____ is the dominant extracellular osmole holding water in the extracellular fluid
Sodium
_____ is the primary intracellular osmole holding water within the cells
Potassium
The activity of the sodium-potassium-ATPase pump allows for the maintenance of these ____ ____ of the EFC and ICF
Solute composition
_____ IV solutions are solutions that supply water, sodium, and/or dextrose
Crystalloids
Crystalloids contain small molecules that flow easily from the blood into ___ and ___
Cells and tissues
What are examples of crystalloid IV solutions?
–NS
-1/2 NS
-D5W
-D10W
-Lactated ringer
____ are another type of IV solution that contain proteins or carbohydrates
Colloids
Colloid IV solutions ____ intravascular oncotic pressure and move fluid from the interstitial space to the intravascular space
Increase
What are examples of colloid IV solutions?
-5% albumin
-25% albumin
With free water (such as DW5->no electrolytes), the free water distributes evenly across all ____ (2/3 ICF, 1/3 ECF)
Compartments
With isotonic IV solutions (such as NS or LR-> contains electrolytes), 100% of the solution will stay in the ____ space
Extracellular
Plasma ____ and ____ pressures govern the movement of fluid between the intravascular and interstitial spaces
Oncotic and hydrostatic
Disruption in oncotic and/or hydrostatic pressure results in a flow of fluid from one ____ to another
Compartment
When the disruption in oncotic and/or hydrostatic pressure favors a shift from intravascular to interstitial fluid, ____-____ occurs
Third-spacing
Fluid intake is made up by anything that is ____ at room temperature
Liquid
Fluid losses are made up of…
-Sensible losses: visible and measurable
-Insensible: usually not seen or measured
How can we assess hydration status?
-Daily weights
-I/O records
-Physical evaluation of skin, eyes, lips, and oral cavity
-Evaluation of respiratory rate and lung sounds
-Blood pressure
-Assessment for peripheral edema
What is an energy-based formula to estimate fluid needs?
1 mL per kcal
What are some weight-based formulas for determining fluid needs?
-Ages 18-55 years: 35 mL/kg
-Ages 56-75 years: 30 mL/kg
-Age >75 years: 25 mL/kg
-Fluid restriction in adults: <25 mL
Another weight-based formula for determining fluid needs is the ____-____ formula
Holiday-Segar
Holiday-Segar formula:
-Age 50 and younger: 1500 mL for first 20 kg body weight + (20 mL x remaining kg body weight)
-Over 50: 1500 mL for first 20 kg body weight + (15 mL x remaining kg body weight)
With weight-based formulas, the use of an ___-___ weight should be used to calculate the fluid needs in obese patients to account for their increased percentage of body fat
Obesity-adjusted
What are some conditions that increase fluid needs?
-Severe diarrhea or emesis
-Large draining wound
-Excessive diaphoresis
-Paracentesis losses
-High gastric fistula
-High ostomy output
-Persistent fever
-Lactating women
What are some conditions that decrease fluid needs?
-Renal dysfunction
-CHF
-Hypothyroidism
-Edema
A disturbance of ____ is caused by a gain or loss of fluid (water and solute such as sodium)
Volume
Outcome of a disturbance in volume…
-Hypovolemia
-Hypervolemia
A disturbance in ____ is caused by a gain or loss of water alone
Concentration
Outcome of a disturbance in concentration…
-Dehydration
-Overhydration
A disturbance in _____ is caused by a gain or loss of electrolytes
Composition
Outcome of a disturbance of electrolytes…
-Electrolyte disorders
Volume depletion is caused by a loss of water and solute from…
-GI tract
-Skin
-Urine
-Prolonged inadequate intake
Symptoms of volume depletion:
-Dry oral mucosa
-Poor skin turgor
-Tachycardia
-Hypotension
Treatment for volume depletion is prescribed based on underlying cause for fluid deficit; in sever cases, someone would require replacement of ECF losses which requires ____ solution (NS or LR)
Isotonic
Dehydration, or loss of water alone, is recognized by a change in…
-Serum sodium concentration
-Plasma osmolality
Causes of dehydration:
-Diabetes insipidus
-Prolonged fever
-Watery diarrhea
-Hyperglycemia
Treatment for dehydration:
-Provision of free water (ex: 5% dextrose solution)-> expands both fluid compartments, predominantly in the ICF
_____, or volume overload, involves water retention with a decrease in body sodium concentrations
Hypervolemia
Causes of hypervolemia:
-Decreased urinary output
-Excessive IVF
Symptoms of hypervolemia:
-Weight gain
-Edema
-Ascites
-Elevated blood pressure
-Pulmonary edema
Treatment for hypervolemia:
-Correction of underlying cause
-Limitation of sodium and fluid intake
-In some cases, diuretic therapy may be required
The first step in treating electrolyte disorders is a review of clinical ___; if inconsistent, the accuracy of the specimen should be validated
Labs
Treatment for electrolyte levels above the normal range:
-Remove exogenous sources
-Discontinue offending agents of meds
-Facilitate elimination of electrolyte
-Treat condition that may be contributing
Treatment for electrolyte levels below the normal range:
-Electrolyte replacement
What are some treatment considerations for electrolyte replacement?
-Available administration routes
-GI tract function
-Renal functions
-Fluid status
-Product availability
-Concurrent electrolyte abnormalities
Normal range for serum sodium:
135-145 mEq/L
Sodium is the principle ____ in the extracellular fluid
Cation
Functions of sodium:
-Major osmotic determinant in regulating extracellular fluid volume and water distribution in the body
-Determining membrane potential of cells
-Active transport of molecules across cell membranes
The ____ play a pivotal role in sodium balance
Kidneys
_____ is when serum sodium is less than 135 mEq/L
Hyponatremia
Symptoms of hyponatremia:
-Headache
-Nausea
-Vomiting
-Muscle cramps
-Lethargy
-Restlessness
-Disorientation
-Depressed reflexes
-Seizures
-Coma
Clinical manifestations of hyponatremia related to CNS dysfunction are more likely to occur when serum Na+ drops rapidly and when it falls below ____ mEq/L
125
Clinicians should determine the patient’s serum Na+ concentration and volume status to determine the ____ of hyponatremia
Etiology
Serum osmolality can be measured or it can be calculated with what formula?
Serum osmolality = 2 x [(serum Na + serum glucose/18) + (BUN/2.8)]
Classifications of types of hyponatremia differ in whether serum ____ is low, normal, or high
Osmolarity
____ hyponatremia is characterized by low serum osmolarity (<275)
Hypotonic
Hypotonic hyponatremia can be caused by…
-Volume depletion
-Syndrome of inappropriate antidiuretic hormone
-Congestive heart failure
-Cirrhosis
____ hyponatremia is characterized by normal serum osmolarity (275-300)
Isotonic
Isotonic hyponatremia can be caused by…
-Hyperglycemia
-Hyperlipidemia
_____ hyponatremia is characterized by high serum osmolarity (>290)
Hypertonic
Hypertonic hyponatremia can be caused by…
Severe hypoglycemia with dehydration
What are three types of hypotonic hyponatremia?
-Hypovolemic hypotonic hyponatremia
-Hypervolemic hypotonic hyponatremia
-Euvolemic hypotonic hyponatremia
With hypovolemic hypotonic hyponatremia, patients lose more ____ in relation to ____
Sodium; water
What causes hypovolemic hypotonic hyponatremia?
Renal and extrarenal losses
Treatment for hypovolemic hypotonic hyponatremia:
Isotonic fluids
With hypervolemic hypotonic hyponatremia, patients retain more ____ than ____
Water; sodium
Cause of hypervolemic hypotonic hyponatremia:
Some element of end-organ failure resulting in fluid retention or third spacing
Treatment for hypervolemic hypotonic hyponatremia:
Fluid and sodium restriction
With euvolemic hypotonic hyponatremia, total body water is ____, causes a low concentration of sodium
Increased
Euvolemic hypotonic hyponatremia is commonly associated with ____ ____ ____ ____
Syndrome of inappropriate antidiuretic hormone
Patients with syndrome of inappropriate antidiuretic hormone have stable sodium intake/output, but retain additional ____ because of excessive levels of antidiuretic hormone
Water
Other causes of euvolemic hypotonic hyponatremia:
-Psychogenic polydipsia
-Hypothyroidism
-Reset osmostat
With euvolemic hypotonic hyponatremia, urine osmolality is always ____ than serum osmolality and urine sodium is over 20 mEq/L
Greater
When urine osmolality is greater than serum osmolality, this indicates that the kidneys are inappropriately ____ urine and volume status is adequate
Concentrating
The treatment for euvolemic hypotonic hyponatremia is…
-Treatment of underlying causes
-Fluid restriction
Hypernatremia is diagnosed with a serum sodium over ____ mEq/L
145
Symptoms of hypernatremia:
-Mild: headache, dizziness, confusion
-Severe: seizures, coma, death
___ status is the first step in diagnosing hypernatremia
Volume
All hypernatremia is ____
Hypertonic
With hypovolemic hypernatremia, patients lose more ____ than ___
Water than sodium
With hypovolemic hypernatremia, patients have above-normal serum ____
Osmolality
Cause of hypovolemic hypernatremia:
Renal and extrarenal losses
Treatment for hypovolemic hypernatremia:
Hypotonic fluids (Ex: D5) via enteral or parenteral route
With euvolemic hypernatremia, total body water ____
Decreases
With euvolemic hypernatremia, patients have ____ losses that exceed ____ losses
Water; sodium
Cause of euvolemic hypernatremia:
Diabetes insipidus
Treatment for euvolemic hypernatremia:
-Replacement of water via enteral or parenteral route
-Normalization of serum calcium and potassium
With hypervolemic hypernatremia, patients retain more ____ than ____
Sodium than water
Hypervolemic hypernatremia can be caused by…
-Iatrogenic: excessive administration of isotonic or hypertonic sodium
-Mineralocorticoid excess: Cushing’s syndrome or adrenal malignancy
Treatment for hypervolemic hypernatremia:
-Correcting the underlying issue
-Administering diuretics
-Replacing water
A potentially useful equation for hypernatremia is the free water deficit equation, which is…
Free body water (L)= TBW x [1-(140/serum Na)]
The normal range for serum potassium is ___-___ mEq/L
3.5-5.0
Functions of potassium:
-Plays a critical role in cell metabolism, including protein and glycogen synthesis
-Maintains resting membrane potential (abnormal concentrations-> EKG changes)
Normal daily requirements for potassium are ___-___ mEq/kg
0.5-2
It is important to remember that magnesium is a co-factor for the sodium-potassium-ATPase pump; therefore, hypomagnesemia can lead to refractory _____
Hypokalemia
The H+/K+ ATPase pump allows potassium to shift in/out of the cell in exchange for ____
Hydrogen
With ____ ____, there are too many H+ ions in the plasma; the body corrects by moving H+ back into the cell and pumping K+ outside of the cell, leading to hyperkalemia
Metabolic acidosis
With ____ ____, there are not enough H+ ions in the plasma; the pump moves H+ ions outside of the cell into the plasma and K+ will move into the cell, leading to hypokalemia
Metabolic alkalosis
Causes of hypokalemia:
-Abnormal losses via urine and stool
-Inadequate intake
-Transcellular shifts from extracellular fluid into cells (metabolic alkalosis, increases in insulin and catecholamines)
-Medications
Clinical symptoms of hypokalemia:
-Generalized weakness
-Lethargy
-Constipation
-More severe consequences: muscle necrosis, paralysis, arrhythmias, death
Treatment goals of hypokalemia:
-Avoidance/resolution of symptoms
-Restoring serum K+ to normal
-Preventing hyperkalemia
What drugs cause renal losses of potassium and lead to hypokalemia?
-Diuretics (thiazides, bumetanide, furosemide)
-Fludrocortisone
-Glucocorticoids
-Drugs associated with magnesium depletion (Aminoglycosides, Cisplatin, Amphotericin B)
What drugs cause potassium losses in stool and lead to hypokalemia?
-Sodium Polystyrene
-Sulfonate
-Sorbitol
What drugs cause a shift of potassium from the extracellular fluid to the intracellular fluid and lead to hypokalemia?
-B-antagonist (Albuterol, Epinephrine)
-Insulin
-Theophylline
-Caffeine
Treatment of hypokalemia:
Oral or IV potassium supplements
Oral correction of hypokalemia is generally safer and reduces the risk of ____ ____
Rebound hyperkalemia
IV supplementation of potassium is reserved for the treatment of severe hypokalemia or when the condition of the ____ ___ precludes use of oral agents
GI tract
Infusion rates of potassium typically will not exceed ___-___ mEq/hr
10-20
With rates of IV potassium infusion higher than 10 mEq/hr, continuous ____ monitoring is recommended to detect signs of hyperkalemia
Cardiac
If possible, ____ solutions should be avoided if someone has hypokalemia
Dextrose
If someone has hypokalemia, _____ deficiencies should also be corrected
Magnesium
What are some commonly used oral K+ replacements?
-Potassium Chloride (K-Lor: 20 mEq/packet)
-Potassium Phosphate (K-Phos tablet: 500 mg; Phos-NaK: 250 mg)
IV K+ supplements are available in ____, ____, and _____ salts
Chloride, acetate, and phosphate
It is recommended that if someone’s serum potassium is between 3-3.5, they should receive between ___-___ mEq of IV potassium
20-40
It is recommended that if someone’s serum potassium is between 2.5-2.9, they should receive between ___-___ mEq of IV potassium
40-80
It is recommended that if someone’s serum potassium is less than 2.5, they should receive between ___-___ mEq of IV potassium
80-120
If someone with hypokalemia also has renal insufficiency, we should decrease the dose of K+ replacement by ____%
50
A rule of thumb is that 10 mEq K+ replacement should increase serum K+ by ____
0.1
A diagnosis of hyperkalemia is made when serum potassium is over ____ mEq/L
5
Causes of hyperkalemia:
-Most often occurs in CKD
-Shifts in K+ from intracellular fluid to extracellular fluid (metabolic acidosis, tissue catabolism, pseudohyperkalemia)
-Increased K+ intake alone rarely caused hyperkalemia
-Medications
Clinical presentation of hyperkalemia:
-Muscle twitching
-Cramping
-Weakness
-Paralysis
-Arrhythmias
-Cardiac arrest
Treatment goals for hyperkalemia:
-Prevent cardiac effects
-Reversing symptoms
-Returning serum K+ to normal
What drugs can cause impaired renal potassium excretion and cause hyperkalemia?
-Potassium-sparing diuretics
-NSAIDs
-ACE-inhibitors
-ARBs
-Cyclosporine
-Tacrolimus
-Everolimus
-Heparin
What drugs cause increased Potassium input, leading to hyperkalemia?
-Potassium supplements
-Salt substitutes
-Stored packed red blood cells
What drugs cause a shift of potassium from the intracellular fluid to the extracellular fluid, leading to hyperkalemia?
-Beta-blockers
-Succinylcholine
-Digoxin intoxication
Treatment of hyperkalemia can be accomplished by…
-Discontinuation of all exogenous K+ sources and medications that can cause hyperkalemia (if feasible)
-Consider the use of loop or thiazide diuretics
In asymptomatic hyperkalemia patients, we can use…
-Sodium bicarbinate (50-100 mEq)
-Dextrose infusion (25-100 gm with 5-10 units of insulin)
In symptomatic hyperkalemia patients or those with EKG changes, we can use…
-IV calcium gluconate: 1-2 gm
The normal range for serum magnesium is between ____-____ mg/dL
1.8-2.4
Magnesium is predominantly found in the _____ fluid
Intracellular
Magnesium is essential in the activation of >300 _____ reactions such as glucose metabolism, fatty acid synthesis and breakdown, and DNA and protein metabolism
Enzymatic
Magnesium is a ___-___ for the sodium-potassium ATPase pump
Co-factor
Magnesium is regulated by the…
-GI tract
-Kidney
-Bone
Absorption of magnesium occurs primarily in the ____ ____ and ____
Distal jejunum and ileum
Hypomagnesemia is diagnosed with a serum magnesium level under ____ mg/dL
1.8
Causes of hypomagnesemia:
-Decreased absorption or intake (protein-calorie malnutrition, malabsorption syndromes, alcoholism, short bowel syndrome)
-GI or renal losses (acute tubular necrosis. hyperaldosteronism, drug-induced)
-Intracellular shifts (refeeding syndrome, diabetic ketoacidosis, hyperparathyroidism, MI)
Clinical presentation of hypomagnesemia:
-Neuromuscular hyperexcitability
-Cardiac complications
-May reduce insulin sensitivity
Treatment for hypomagnesemia:
IV magnesium (IV preferred due to GI side effects of PO supplementation)
What are commonly used oral magnesium replacements?
-Magnesium chloride (5 mEq)
-Magnesium gluconate (500 mg/2.4 mEq)
-Magnesium oxide (7-11 mEq)
IV magnesium is given in the form of ____ ____
Magnesium sulfate
If someone has a serum magnesium level between 1-1.5, we should supplement with ___-___ mEq, or <1 mEq/kg
6-32
If someone has a serum magnesium level under 1, we should supplement with ___-___ mEq, or <1.5 mEq/kg
32-80
We should decrease the dose of magnesium replacement by ____% if someone has renal insufficiency
50
8 mEq of magnesium sulfate should increase serum magnesium by ____
0.1
The maximum infusion rate of IV magnesium replacement is ____ mEq/hour
8
Hypermagnesemia is diagnosed when serum magnesium is over _____ mg/dL
2.4
Hypermagnesemia is primarily seen in the setting of ____ in combination with magnesium intake
CKD
Hypermagnesemia is generally well tolerated, but levels above 4.8 mg/dL can affect…
-Neurologic function
-Neuromuscular function
-Cardiac function
Treatment for hypermagnesemia:
-Asymptomatic patients: removal of exogenous sources of Mg, Mg restriction, loop diuretics
-Symptomatic patients: IV calcium
The normal range for serum calcium is ____-___ mg/dL
8.6-10.2
Calcium is one of the most abundant ____ in the body
Cations
Calcium is essential for…
-Bone metabolism
-Nerve conduction
-Functionality of cell membranes
-Coagulation cascade
-Regulation of secretory functions
99% of total body calcium is found in ___ and ____
Teeth and bones
Serum calcium exists in what 3 forms?
-Complexed
-Protein-bound
-Ionized
Hypocalcemia is diagnosed if someone has a serum calcium under ____ mg/dL or an ionized calcium under ___ mmol/L
8.6; 1.12
Causes of hypocalcemia:
-Decreased vitamin D activity
-Decreased PTH activity
-Renal impairment
-Critical illness
-Medications: Bisphosphonates, calcitonin, furosemide, long-term use of phenobarbital and phenytoin
Clinical presentation of hypocalcemia:
-Cardiovascular: hypotension
-Neuromuscular: muscle cramps, tetany, seizures
Treatment for hypocalcemia:
Oral or IV replacement
Treatment with oral ___ and ____ supplements is appropriate for asymptomatic hypocalcemia
Calcium and Vitamin D
What are some commonly used oral calcium supplements?
-Calcium acetate: 25% elemental Ca
-Calcium carbonate: 40% elemental Ca
-Calcium citrate: 21% elemental Ca
For acute symptomatic hypocalcemia, ____ treatment is recommended
IV
What are some IV calcium treatment options?
-Ionized Ca 1-1.12 mmol/L: 1-2 g calcium carbonate over 1-2 hours
-Ionized Ca <1 mmol/L: 2-4 g calcium carbonate over 2-4 hours
Hypercalcemia is diagnosed with serum calcium over ____ mg/dL or ionized calcium over ____ mmol/L
10.2; 1.3
Causes of hypercalcemia:
-Hyperthyroidism
-Cancer with bone metastases
-Toxic levels of vitamin A or vitamin D
-Chronic ingestion of milk or calcium-containing antacids in the setting of renal insufficiency
Clinical presentation of hypercalcemia:
-Fatigue
-Nausea/vomiting
-Anorexia
-Confusion
-Cardiac arrhythmias
Treatment for mild hypercalcemia (10.3-11.9 mg/dL):
-Hydration
-Ambulation
Treatment for severe hypercalcemia (>14 mg/dL):
-IV hydration using 0.9% NS at 200-300 ml/hour to reverse volume depletion caused by hypocalcemia
-Controversial treatment: once adequate hydration is achieved, 40-80 mg IV Furosemide to enhance renal Ca excretion
-Hemodialysis may be necessary
The normal range for phosphorus is between ____-___ mg/dL
2.5-4.5 mg/dL
Functions of phosphorus include…
-Bone and cell membrane composition
-Maintenance of normal pH
-Required in all cellular functions that require energy
Most phosphorus is found in ___ and ____ ___
Bones and soft tissue
Hypophosphatemia is diagnosed when serum phosphate levels are under ____ mg/dL
2.5
Causes of hypophosphatemia:
-Chronic alcoholism
-Critical illness
-Respiratory and metabolic alkalosis
-Refeeding syndrome
-Phosphate binding medications
Clinical presentation of hypophosphatemia:
-Neurologic: ataxia, confusion
-Neuromuscular: weakness, myalgia
-Cardiopulmonary: cardiac and ventilatory failure
-Hematologic: hemolysis
Treatment of hypophosphatemia:
Oral or IV phosphate replacement
With asymptomatic, mild hypophosphatemia, treatment is ____ phosphate supplements
Oral
What are some commonly used oral phosphate supplements?
-K-Phos tablet: 500 mg
-Phos-NaK powder: 250 mg
-OsmoPrep tablet: 1.5 mg
For symptomatic moderate/severe hypophosphatemia, the preferred treatment is ____ ____, unless the K+ concentration is >4 mEq/L or renal insufficiency exists
IV KPhos
What are some examples of IV phosphate replacement?
-Serum phos 2.3-2.7 mg/dL: 0.08-0.16 mmol/kg
-Serum phos 1.5-2.2 mg/dL: 0.16-0.32 mmol/kg
-Serum phos <1.5 mg/dL: 0.32-1 mmol/kg
The maximum infusion rate of IV phosphorus is ____ mmol/hour
7
Hyperphosphatemia is diagnosed with a serum phosphate level over ____ mg/dL
4.5
Causes of hyperphosphatemia:
-CKD
-Endogenous release of phosphorus into the extracellular fluid from cellular destruction (massive trauma, cytotoxic agents, hypercatabolism, hemolysis, malignant hyperthermia)
-Transcellular shifts from the intracellular fluid to the extracellular fluid (respiratory and metabolic acidosis)
Clinical presentation of hyperphosphatemia:
-Anorexia
-Nausea
-Vomiting
-Dehydration
Complications of hyperphosphatemia:
-Soft tissue and vascular calcification (occurs when total serum calcium x serum phosphorus exceed 55 mg/dL)
-Secondary hyperparathyroidism
-Renal osteodystrophy
Treatment for hyperphosphatemia:
-Decrease or eliminate exogenous sources
-Phosphate binders
-Hemodialysis may be necessary
If someone has hyperglycemia with blood glucose over ____ mg/dL, should you use caution with using parenteral nutrition
300
If someone has azotemia with a BUN over ____ mg/dL, we should use caution with using parenteral nutrition
100
If someone has hyperosmolarity with osmolarity over ____ mOsm/kg, we should use caution with using parenteral nutrition
350
If someone has hypernatremia with serum sodium over ____ mEq/L, we should use caution with using parenteral nutrition
150
If someone has hypokalemia with serum potassium under ____ mEq/L, we should use caution with using parenteral nutrition
3
If someone has hypophosphatemia with serum phosphorus under ____ mg/dL, use caution with using parental nutrition
2
If someone has hyperchloremic metabolic acidosis with chloride levels over ____ mEq/L, we should use caution with using parenteral nutrition
115
If someone has hypochloremic metabolic alkalosis with chloride levels under ____ mEq/L, we should use caution with using parenteral nutrition
85
The average adult daily requirement of sodium is ___-___ mEq/kg
1-2
What factors increase sodium needs?
-Diarrhea
-Vomiting
-NG suction
-GI losses
The average adult daily requirement of potassium is ___-___ mEq/kg
1-2
What factors increase potassium needs?
-Diarrhea
-Vomiting
-NG suction
-Medications
-Refeeding
-GI losses
The average adult daily requirement of calcium is ___-___ mEq
10-15
Factors that increase calcium needs:
-High protein intake
The average adult daily requirement of magnesium is ___-___ mEq
8-20
What factors increase magnesium needs?
-GI losses
-Medications
-Refeeding syndrome
The average adult daily requirement of phosphorus is ___-___ mMol
20-40
What factors increase phosphorus needs?
-High dextrose intake
-Refeeding
NS solution contains ____ mEq/L of sodium (1/2 NS contains half)
154
1 gm magnesium =___ mEq/Mg
8
1 gm calcium = ____ mEq
4.65
1 mMol KPO4 contains ____ mEq potassium
1.47
1 mMol NaPO4 contains ____ mEq sodium
1.33
What should be included in the assessment for those on parenteral nutrition?
-Check for any fluid changes with IVFs and medications
-Check I/Os for increased/decreased output
-Check to see if PN goals are being met
-Check electrolytes
-Check for any nutrition changes
We should monitor blood glucose every 6 hours until stable; if high, we can start with low dose sliding scale _____
Insulin
If blood glucose is over ____, we can recommend increasing insulin in parenteral nutrition
180
Initial dose of insulin should be ____ previous day’s sliding scale
2/3
Grams of fat given per day should be monitored ____; if it has been over 3 weeks without lipids, recommend adding lipids
Daily
We should monitor magnesium, potassium, and phosphorus daily until stable; if magnesium, potassium, and phosphorus are all low, recommend adding 100 mg of ____ daily for possible re-feeding therapy and give replacement therapy
Thiamine
We should monitor serum CO2 daily; if over ____, evaluate for possible overfeeding
30
We should monitor triglycerides at baseline, and then weekly; if over ___ at baseline, hold lipids and re-check in 1 week; if over ___ at repeat, consider giving minimal lipid dose to prevent EFAD
300; 400
We should monitor body weight, electrolytes, ionized calcium, and prealbumin ___
Weekly
We should monitor LFTs ____ until stable, and then monthly
Weekly
If glucose is ____ or more mg/dL, stop TPN and run 1/2 NS at ordered TPN rate
400
If glucose < 70 mg/dL, we should…
-Initiate D12
-Administer 1 amp, 50% dextrose
-Stop insulin
If TNP is stopped taper rate by 1/2 x 1 hour, and then infuse ____ at the TPN rate until new bag is hung
D5 1/2 NS
If TPN must be stopped suddenly, infuse ____ at TPN rate x 1 hour, then ____ at the TPN rate until new bag is hung
D10; D5 1/2 NS
