fluids and nutrition

Question 1

max safe glucose concentration

Answer 1

0.5gm/kg/hr (5%) unless monitoring

Question 2

max safe concentration of K

Answer 2

40mEq/L

Question 3

what is first space, second space, and third space

Answer 3

1st is intravascular compartment; 2nd is intracellular; 3rd where fluid does not usually but may accumulate

Question 4

maintenance fluid

Answer 4

obligatory use by body in respiratory loss, sweating, and urine production

Question 5

things that inc maintenance requirements of fluids (3)

Answer 5

tachypnea, fever, or diuretics

Question 6

calculation for fluid maintenace

Answer 6

pt wt in kg:
100ml/kg for first 10kg
50 for second 10kg
20 for each kg over 20;

then divide total ml by 24 to get ml/hr rate

ex. 70kg man needs 104ml/hr

if pt starts w deficit need to add more than just the maintenance

Question 7

most physiologic replacement in normal circumstances

Answer 7

d5 1/2NS + 20mEqK/L

Question 8

estimated deficit for dry, tachycardia, and shock

Answer 8

dry 3% loss (5% if

Question 9

tx volume overload

Answer 9

fluid restriction and diuretics

Question 10

for general abd surgery, first 24hr losses (3rd spacing, urine, ng tube, insensible)

Answer 10

2rd (1000ml) + urine (1000) + ng tube (1000) + insensible (500)= 3500/24=146
\+
maintenance of 104ml/hr
=
run fluids at 250ml/hr

(adjust so urine output is 30-50ml/hr)

Question 11

kvo=keep vein open

Answer 11

run minimal amount of fluid, only enough to keep IV from clotting off

Question 12

how to go about replacing the calculated deficits

Answer 12

1st half in first 24 hrs then reassess

Question 13

BMI

Answer 13

wt (kg)/ ht (m)^2

normal 18.5-24.9
overweight 25-29.9
obese >30

Question 14

when should iv feeding be done

Answer 14

if gut unavailable for more than 7-10d

Question 15

enteral feeding

Answer 15

safe, less expensive; preserved functionality of the gut, both nutritionally and immunologically

Question 16

types of enteral feeding

Answer 16

mouth*; dobhoff (weighted, radio opaque tip to pass into small bowel); percutaneous endoscopic gastrostomy or jejunal (PEG, if long term feeding)

Question 17

what should be done is using tube for feeding before actually feeding

Answer 17

confirm tube in stomach, gi tract and not lung by X-ray and or ph measurement

Question 18

peripheral parenteral nutrition (PPN)

Answer 18

safer than tpn, indicated if support needed for

Question 19

total parenteral nutrition (TPN)

Answer 19

used when gut not available for prolonged time or to push in severely malnourished pts; bypasses portal system so hepatic processing is delayed

Question 20

how long are TPN needed for repletion

Answer 20

at least 7-10d

Question 21

what is included in TPN and what is not

Answer 21

protein/fat/calories included; vit and minerals are not