IV Fluid Replacement

Question 1

Which IV fluid should we use for burn victims?

Answer 1

LR without glucose (isotonic fluid)

Question 2

What is the formula we use to evaluate the amount of fluid to give burn victims?

Answer 2

percent burn x BSA x 4

Question 3

How much of the fluid do we give in the first eight hours?

Answer 3

Half of the total fluid

Question 4

After we have given half the amount of fluid in 8 hours, over how much time we do give the rest of the fluid?

Answer 4

16 hours

Question 5

What percent of total body weight is water?

Answer 5

50-70%

Question 6

Does the amount of water in your body increase or decrease with lean body mass?

Answer 6

Increase

Question 7

What percentage of our total body water is intra-cellular?

Answer 7

66%

meaning 33% for ECF

Question 8

What is a normal daily total water intake?

Answer 8

2500 or 35mL/kg/d

Question 9

In terms of water intake, how much is through

oral liquid intake?
oral solid intake?
metabolic?

Answer 9

oral liquid – 1500
oral solid – 500-700
metabolic – 150-400

Question 10

What is “normal” total output?

Answer 10

1400-2400 mL/d

Question 11

What is the maximum urine osmolality?

Answer 11

1400 mOsm/L

Question 12

The absolute minimum that must be excreted along with the solute load excreted daily is referred to as?

Answer 12

Obligatory renal water loss

Question 13

If the kidneys are functioning normally, the minimum daily urine output is around ______ mL/d

Answer 13

600

Question 14

Cells and capillary membranes pass solutes selectively, but _____ is freely permeable throughout all compartmens

Answer 14

water

Question 15

What is our daily sodium loss?

Answer 15

50-150 mEq/d

Question 16

what will happen to serum sodium if there is no oral intake of sodium?

Answer 16

should stay about the same

Question 17

What are our daily potassium losses?

Answer 17

50-70 mEq/d

Question 18

Improper IV fluid replacement in volume depleted patient, overzelaous saline administration in patient with hypoalbuminemia, excess sodium/water administration are all examples of?

Answer 18

Errors in fluid/electrolyte administration

Question 19

If we have a hypotensive patient that is requiring fluid resuscitation, how will the administration of 1 liter of D5W act differently than 1 liter of normal saline?

Answer 19

D5W – 666mL will diffuse intracellulary and 333 will remain extracellular. 83 of that 333 will remain intravascularly.

Normal saline – 750 mL will diffuse into the interstitium and 250 will remain intravascular

Question 20

In terms of basal fluid requirements - what are they for,

Sodium?
Potassium?
Calcium?
Magnesium?

Answer 20

Sodium – 1-2 mEq/kg/d

Potassium – 0.5-1.0 mEq/kg/d

Calcium – 1-3 gm/day

Magnesium - 20 mEq/day

Question 21

What is the minimum glucose requirement?

Answer 21

100-200 grams/day

Question 22

the administration of at least 100 grams of glucose/d reduces protein loss by more than ____ percent

Answer 22

50

Question 23

What two types of patients do we not want glucose in their IV administration?

Answer 23

Burns and DKA

their blood glucose is already so high – if we give glucose it will cause an osmotic diuresis

Question 24

IV solutions provide glucose as?

Answer 24

Dextrose

Question 25

Maintain basal needs, correct volume and electrolyte deficits or excesses, replace ongoing losses, minimize protein breakdown are all examples of?

Answer 25

Goals of IV therapy

Question 26

What are some signs on physical exam that are indicative of a volume depleted patient?

Answer 26

Weight down, increased pulse, decreased BP, postural changes, dry mucus membranes, increased skin turgor, flat neck veins, and decreased urine output

Question 27

what are some signs on physical exam that are indicative of a volume overloaded patient?

Answer 27

Weight gain, edema, neck veins, pulmonary congestion, pleural effusions, gallops, ascites

Question 28

What are some dangers of using hypotonic fluids?

Answer 28

Hyponatremia and cerebral edema

Question 29

what kind of fluids are greater than 8,000 daltons, have high oncotic pressure, and remain intravascular?

Answer 29

Colloids

Question 30

When would we use colloids?

Answer 30

Rapid volume expansion during shock or hemorrhage

Question 31

For every 5 units of packed red blood cells you must give _____ unit of fresh frozen plasma

Answer 31

1

Question 32

What is it so important to give patients plasma if we are giving packed red blood cells?

Answer 32

to give back clotting factors

Question 33

What are four disadvantages to blood products?

Answer 33

1. Preparation time 2. Infection 3. Costly 4. Transfusion reaction

Question 34

what is the advantage to synthetic colloids?

Answer 34

no infection risk! --but very expensive

Question 35

Fluids that are less than 8,000 Daltons and have a low oncotic pressure are what type of fluids?

Answer 35

Crystalloids

Question 36

Why is glucose often added to IV fluids?

Answer 36

protein sparing effects

Question 37

What if a patient doesn't need volume expansion, and they just need maintenance fluids -- what do we give them?

Answer 37

Usually give more hypotonic solutions -- 1/2 normal saline with glucose

Question 38

What type of fluid do you give someone who is vomiting and/or has a NG tube?

Answer 38

D5 1/2NS with KCl

Question 39

What type of fluid do you give someone with diarrhea?

Answer 39

D5LR with KCl

Question 40

What fluid do you give if someone is losing a lot of sweat?

Answer 40

Sweat is hypotonic -- so you may give a hyptonic solution If you've lost a lot of sweat, you're probably volume depleted, so may give an isotonic solution (NS)