fluids

Question 1

daily fluid requirements

Answer 1

wt in kg + 40 = hourly IVF

35 mL/kg/24h

Question 2

electrolytes to consider for fluids

Answer 2

sodium
potassium
chloride

Question 3

ways to assess volume status

Answer 3

pCVP - not reliable!!!!
body weight
passive leg raise**
vitals
I&Os
pulse pressure variation
CXR - hypervolemia (late)
bedside US

Question 4

potentially helpful diagnostics

Answer 4

CBC - hemoconc?
BMP - elevated BUN/CRT?
FENA
FEUrea
urine osmo
UA

Question 5

dehydration vs volume depletion

Answer 5

dehydration - loss of total body water producing hypertonic state

volume depletion - deficit in extracellular fluid volume

Question 6

isotonic dehydration /hypertonic/hypotonic

Answer 6

iso - water loss proportionate to sodium loss

hyper - more water than na loss

hypo - more na than water loss

Question 7

TBW deficit

Answer 7

0.6 * wt in kg *( (serum NA/140)-1)

0.5 for females

Question 8

crystalloid fluid options

Answer 8

iso - NS, LR, D5W, plasmalyte

hypertonic - 3% NS (draws H2O out of cells into ECF)

hypotonic - 0.45% NS (pulls H2O into cells from ECF) can cause cerebral edema

Question 9

why is NS evil?

Answer 9

way more Na and chloride than body normal
can cause hyperchloremic metabolic acidosis

Question 10

LR contraindications

Answer 10

liver disease
severe TBI

can cause metabolic alkalosis
not for large volume resuscitation (cerebral edema)

Question 11

D5W/D5 .45% NS indication

Answer 11

serve hypernatremia

Question 12

indications for 3%

Answer 12

severe hyponatremia
TBI w cerebral edema

significant AEs

Question 13

CI to dextrose containing fluids

Answer 13

neurologic injuries