Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Hospital Medicine > Intravenous Nutrition, Fluid, and Electrolyte Therapy > Flashcards

Intravenous Nutrition, Fluid, and Electrolyte Therapy Flashcards

1
Q

What is malnutrition associated with?

A
  • Increased infection rates
  • Longer hospital length of stay
  • Increased hospital costs
  • Mortality

Should be assessed throughout hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

How is nutrition status assessed?

A
  • BMI
  • Unintentional weight change
  • Changes in oral intake
  • Severity of illness
  • IBW

Assessing purely based on weight may miss some patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the diagnostic criteria for malnutrition according to the AND and ASPEN?

A

2 or more of the following 6 characteristics:
* Insufficient caloric intake
* Weight loss
* Loss of muscle mass (temporal/interosseous muscle wastingl clavicular prominence)
* Loss of subcutaneous fat (cheeks/orbital area, or space between thumb and forefinger)
* Localized or generalized fluid accumulation, that may mask weight loss (pitting edema)
* Diminished functional status (assessed by handgrip strength with a dynamometer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are risks of overfeeding?

A
  • Excess carbs: hyperglycemia, excess carbon dioxide production, concerning in lung disease
  • Long-term overfeeding: hepatic steatosis, ureagenesis, immunosuppression (especially overfeeding of lipids)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is used to determine nutrition requirements?

A

Harris Benedict Equation
Mifflin-St Jeor Equation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the general rule for protein requirements in hospitalized patients?

A
  • 1.2-1.5 g/kg/d
  • Burn patients: 2.0 g/kg/d
  • Critically ill obese patients: 2.5 g/kg/d (IBW)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Quick rule of thumb for most hospitalized patients caloric and protein needs (IBW)

A
  • 25-30 calories/kg/d
  • 1.2 protein g/kg/d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the preferred route of feeding?

A
  • Oral if meets needs
  • May add supplemental shakes for calories/protein
  • Boost shakes have 10 g protein and 240 calories per shake and come in variety of flavors, may order with meal or in between meals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can be considered when patients cannot safely or adequately meet their nutrient requirements through oral diet alone?

A

Specialized nutritional support
Enteral or parenteral nutrition reserved for those who cannot take in orally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should enteral or parenteral nutrition be initiated?

A
  • After 7-10 days with no oral intake
  • ONly if going to be using for at least 5-10 days due to costs and risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is enteral nutrition?

A

Tubes enter GI system directly at stomach or small intestine
If gut works, should be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are relative and absolute contraindications to enteral feeding?

A
  • Major GI hemorrhage
  • Peritonitis
  • Severe ileus
  • Bowel obstruction or fistulae distal to enteral access site
  • Intestinal ischemia
  • Malabsorptive disorders with high volume diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are types of enteral formulas?

A
  • Elemental or semi-elemental (MC)
  • Polymeric
  • Immune enhancing diets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are indications for polymeric enteral formulas?

A
  • To meet daily requirements; for most patients 1-1.5 L/d
  • Concentrated feeding best if patient is volume restricted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are side effects of polymeric and elemental or semi-elemental enteral formula?

A

Diarrhea and polymeric may require free water supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is indication for elemental or semi-elemental enteral formula?

A

maximizes absorption in patients with malabsorptive disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is indication for immune enhancing diets?

A

May reduce infection risk in surgical patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is enteral feeding initiated?

A
  • Start at low rate, and gradually advance to infusion goal over period of 24-48 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What should patient sbe evaluated for with enteral nutrition?

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal Pain
  • Bloating
  • If develop, feedings held until resolution
  • Persistent intolerance –> alternative plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When would you consider parenteral nutrition?

A

Patient who cannot tolerate enteral nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is parenteral nutrition associated with?

A
  • Higher rates of infectious and metabolic complications
  • Volume overload
  • Hyperglycemia
  • Electrolyte abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What do parenteral solutions contain?

A
  • Carbohydrate in form of dextrose
  • Protein as crystalline amino acids
  • Lipids from polyunsaturated long-chain triglycerides such as soybean oil or a safflower/soybean oil mixture
  • Vitamins, electrolytes, and trace elements added to formulation as needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should patients be monitored for with parenteral nutrition?

A
  • Metabolic changes such as hyperglycemia or refeeding syndrome
  • Hyperglycemia may increase infectious complications, hospital length of stay, and cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is refeeding syndrome characterized by?

A
  • Electrolyte abnormalities that occur during the reinstitution of carbohydrate calories to a starved patient
  • Serum phosphate, magnesium, and potassium depletion may develop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How should parenteral nutrition be initiated?

A
  • Start low - 1 L for 1st day, monitoring glucose every few hours and BMP every 8-12 hours
  • Carbs make up 50-60%
  • Protein 15-25%
  • Lipids 20-25%
  • Central venous access requires for administration of TPN becasue TPN hyperosmolar
25
Q

Why would you order IV fluids?

A
  • NPO
  • SIgnificant volume deficit
  • Ongoing losses
  • Specific goal to fluid therapy
  • Make sure to assess appropriateness of IVF daily

If the gut works use it!

26
Q

What are potential complications of using IV fluids?

A
  • Fluid overload
  • Dangerous electrolyte derangements
  • Line infections
27
Q

What is total body water?

A
  • Wt (kg) x .6 (m) .5 (f) = TBW in liters
28
Q

2/3,1/3 rule

A

2/3 ICF 1/3 ECF

29
Q

How much ECF is intravascular vs interstitial?

A
  • 1/4 intravascular
  • 3/4 interstitial
30
Q

How much water are normal adults considered to need as a minimum per day?

A

1600 mL/day 500mL ingested water, 800 mL in food, 300 mL from oxidation

31
Q

What increases water intake requirement?

A
  • Fever
  • Sweating
  • Burns
  • Tachypnea
  • Surgical drains
  • Polyuria
  • Ongoing significant GI losses
  • Water requirements increase by 100 to 150 mL/day for each degree of body temperature elevation over 37 C
32
Q

What are sources of obligatory water output in normal adults?

A
  • 500 mL urine
  • 500 mL skin
  • 400 mL respiratory tract
  • 200 mL stool
33
Q

How much fluid is required daily?

A

35 mL/kg/d

34
Q

Weight based water requirements

A
  • 0-10 kg = 100 mL/kg
  • 10-20 kg = 1000 mL +50 mL per each kg above 10 kg
  • 20-70 kg = 1500 mL + 20 mL per each kg above 20 kg
  • Over 70 = 2500 (adult requirement)
35
Q

How much sodium is required per day?

A

1-3 meq/kg/day

Ex: 70 kg male requires 70-210 meq NaCl, 2500 cc fluid per day
.45% saline contains 77 meq NaCl per liter, 2.5 x 77 =192 meq
Thus .45% saline can be used as MIVF assuming no other volume or electrolyte issues

36
Q

How much potassium is required per day?

A
  • 1 meq/kg/day
  • Can be added to IV fluids but increases osm load
  • 20 meq/L is common IVF additione, will supply basal needs for pts who are NPO

Osmotically as active as sodium, addign 40 mEq to liter of .45% saline will create solution similar to 3/4 isotonic saline containing less free water

37
Q

If a patient is significantly hypokalemia what should be done?

A

Order separate K+ supplementation, oral potassium preferred

38
Q

What can Potassium do to a solution?

A

Limit infusion rate

39
Q

A plasma K+ 1 mmol/L below normal corresponds to a total body potassium deficit of approximately what?

A

200-400 mmol, and a drop in plasma K+ to 2 mmol below normal requires 400 -800 mmol for repletion

40
Q

Typically K+ daily repletion is significantly ….. than the total body deficit as the time required for redistribution is prolonged

A

less

41
Q

How is potassium deficit calculated?

A

Kdeficit (in mmol) = (Knormal lower limit-K measured) x kg body weight x .4
1 mmol = 1 mEq
Every 10 mEq of KCl raises serum K+ by .13 mEq/L

42
Q

If no immediate threat to life what should be used for hypokalemia?

A

Oral potassium, most commonly potassium chloride
Typical dose with normal renal function is 40-100 mmol (40-100 mEq) per day in 2 to 3 divided doses

43
Q

What are glucose requirements?

A
  • 100-200 g/d
  • During starvation supplied by fat and protein
  • Protein-sparing effect goals of basic IV therapy
  • Administration of at least 100 g/d of glucose reduces protein loss by more than one half
44
Q

Types of fluids used in clinical practice?

A
  • Colloids
  • Crystalloids
  • blood products
45
Q

Qualities of colloid solutions?

A
  • Large molecules that don’t pass through cell membranes
  • When infused remain in intravascular compartment and expand intravascular volume and draw fluid from extravascular spaces via higher oncotic pressure
46
Q

Qualities of crystalloid solutions

A
  • Contain small molecules that flow easily acorss cell membranes, allowing for transfer from the bloodstream into the cells and body tissues
  • Increases fluid volume in both interstitial and intravascular spaces
  • Subdivided into isotonic/hypotonic/hypertonic
47
Q

What are isotonic fluid types?

A
  • .9% sodium chloride
  • LR
  • 5% dextrose in water (D5W)
  • Ringer’s acetate
48
Q

What is composition of .9% NaCL

A

154 meq of Na and 154 meq of Cl

49
Q

Composition of ringers lactate

A

Na 130 meq
K 4 meq
Ca 3 meq
Cl 109 meq
HCO3 28 meq

Most physiologically adaptable fluid because electrolyte content most closely related to composition of body’s blood serum and plasma
Choice for first-line fluid resuscitation in burn injuries

50
Q

When should ringers lactate or hartmann solution be used?

A
  • To replace GI tract fluid losses
  • Fistula drainage
  • Fluid losses due to burns and truama
  • Patients experiencing acute blood loss or hypovolemia due to third-space fluid shifts
51
Q

How is ringers lactate metabolized?

A

In liver, converting lactate to bicarb

52
Q

Which patients should not receive ringers lactate or hartmann solution

A
  • Liver disease
  • Lactic acidosis
  • Severe renal impairment because contains potassium
  • pH greater than 7.5
53
Q

Characteristics of D5W

A
  • Dextrose 50 g/L
  • Isotonic solution
  • Becomes hypotonic and causes fluid to shift into cells when metabolized
  • Provides free water that pass through membrane pores to both intracellular and extracellular spaces
  • Smaller size allows molecules to pass freely between compartments
  • Provides 170 calories per liter, but doesn’t replace electrolyte
54
Q

How do you decide on fluid?

A
  • Goal for therapy: maintenance, rehydration, or volume resuscitation?
  • Any baseline electrolyte abnormalities?
  • Always look at chemistry before ordering fluids
55
Q

What would you order in hypovolemia?

A

Primary goal volume expansion
NS or LR because will put most volume in intravascular space

56
Q

What would you order in dehydration?

A

Primary goal is free water replacement (not synonymous with hypovolemia)
Use hypotonic fluid usually .45% saline or D5W

57
Q

What fluids are best for post-operative patients?

A
  • Pain and narcotics can be stimulants of inappropriate ADH secretion
  • Giving hypotonic fluids can cause dangerous hyponatremia
  • .9% saline safer fluid but will also deliver free water in setting of SIADH
58
Q

Why NS for volume expansion?

A
  • Free water is distributed evenly throughout TBW compartment
  • Essentially 100% if sodium is confined to extracellular space
  • Normal saline contains essentially no free water
59
Q

Fluid requirements for pediatrics

A
  • First 10 kg = 4 cc/kg/hr
  • Second 10 kg = 2 cc/kg/hr
  • 1 cc/kg/hr thereafter

4,2,1 rule

60
Q

In adults fluid requirements

A

wt (kg) + 40
Ex: 70 kg+ 40 = 110 cc/hr

61
Q

What does the 4,2,1 rule need to be adjusted for?

A
  • This is maintenance rate so needs to be adjusted for dehydration or ongoing fluid loss
  • If taking some PO
  • Daily electrolytes, BUN, Cr, I/O and weight should be monitored

Hospital Medicine (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions