IV Fluid Therapy

Question 1

What is the goal of maintenance fluid therapy with normal kidney function?

Answer 1

maintain volume and electrolyte balance

If NPO= H2O, Na, K, +/- dextrose

Question 2

What is the best estimator of volume status?

Answer 2

weight

Question 3

How often should you reassess maintenance IVF?

Answer 3

daily

Question 4

What is the goal of replacement fluid therapy?

Answer 4

correct volume status or serum electrolytes

Question 5

What is volume status?

Answer 5

weight, JVD, urine output, ht, BP, HR, pulmonary edema, peripheral edema

Question 6

Remember…

Answer 6

LOOK AT YOUR PATIENT

Question 7

Describe the hypervolemic patient.

Answer 7

EXCESS TBNa= Na retention and decreased circulating volume

Question 8

What are the si/sx of hypervolemic patients?

Answer 8

edema, ascites, pleural effusions, pulmonary edema, increased JVP, dyspnea

Question 9

What are the treatments for hypervolemic patients?

Answer 9

treat underlying cause
DIURETICS
limit Na intake

Question 10

Describe the hypovolemic patient.

Answer 10

DEFICIT TBNa= renal and extrarenal

renal- diuresis, MC def
extrarenal- GI, burn, respiratory issues, bleeding

Question 11

What are the si/sx for hypovolemic patients?

Answer 11

thirst, weakness, mm cramps, postural dizziness

Question 12

What are the treatments for hypovolemic patients?

Answer 12

REPLENISH IV VOLUME

MILD= oral rehydration
MOD- SEVERE= isotonic fluids (1-2 bolus)

Question 13

What are the routes of fluid administration?

Answer 13

enteral and parenteral

Question 14

How to calculate fluid deficit?

Answer 14

pre-illness weight - illness weight

Question 15

Children:
TBW is ___% of weight (kg)

Answer 15

60

Question 16

Infants:
TBW is ___% of weight (kg)

Answer 16

75

Question 17

Oral rehydration therapy in children:
- > ___ mo old
- mild-mod ______
- tolerating ___ intake
- no _____ illness

Answer 17

6
dehydration
PO
severe

Question 18

Oral rehydration therapy table:

Answer 18

Question 19

When should IV rehydration be preferred over oral rehydration?
- ___ tolerating PO
- ___ dehydration
- Shock, _____
- ___glycemia
- ______ abnormalities

Answer 19

Not
severe
sepsis
hypo
electrolyte

Question 20

___-___ mL/kg for mild dehydration

Answer 20

30-50

Question 21

___-___ mL/kg for mod. dehydration

Answer 21

60-80

Question 22

What are the 2 most common types of IV fluids?

Answer 22

crystalloids and colloids

Question 23

Describe crystalloids.

Answer 23

pass through the capillary wall easily

Increase INTERSTITIAL volume (EC)

Question 24

Describe colloids.

Answer 24

Do NOT pass through the capillary wall easily

Increase PLASMA volume (EC)

Question 25

What are the 3 principal components of crystalloids?

Answer 25

water, electrolytes, glucose isotonic saline, hypertonic saline, hypotonic saline, LR, D5W

Question 26

Cellular Physiology Review

Answer 26

Question 27

Isotonic fluid: ECF and ICF have ___ osmolarity. No ____ movement.

Answer 27

Equal water

Question 28

When should you use isotonic saline?

Answer 28

hypovolemic shock, DKA, hyperosmolar hyperglycemic state, correct mild hypoNa, treatment of hyperCa, septic shock

Question 29

Increase Na= ____ plasma osmolarity Decrease Na= ______ plasma osmolarity

Answer 29

Increase Decrease

Question 30

NS components Na= ___ Cl= ___ Mildly acidotic

Answer 30

154 154

Question 31

LR components Na= ___ Cl= ___ Lactate= ____ Neutral fluid

Answer 31

130 109 28

Question 32

____ can cause a ____ AG metabolic acidosis (hyperchloremic) in large volumes.

Answer 32

NaCl Normal

Question 33

Is there a single resuscitation fluid that is optimal?

Answer 33

No

Question 34

When should LR be used?

Answer 34

HyerpCl, Metabolic acidosis, renal dysfunction, burns, sepsis, large volume fluid infusion

Question 35

What are the proportions of crystalloids and colloids in the intravascular space?

Answer 35

Crystalloids= 1/3 Colloids= 2/3

Question 36

What must be considered for crystalloid infusion rates?

Answer 36

CHF, dialysis, volume status

Question 37

How to correct hypoNa?

Answer 37

replace Na or restrict H2O

Question 38

What is the max dose of Na you can replace in 24 hours?

Answer 38

6-8 mEq/L

Question 39

What is the primary risk when correcting low sodium?

Answer 39

osmotic demyelination syndrome

Question 40

What is the max correction rate with hypertonic saline?

Answer 40

0.5 mEq/L/hr or 10 mEq/L/24h

Question 41

What is the correction of sodium deficiency dependent on?

Answer 41

sex, age, and weight

Question 42

What is the complication associated with rapid Na correction of hypernatremia?

Answer 42

cerebral edema

Question 43

What is the MCC of hypernatremia?

Answer 43

water deficit or Na gain

Question 44

What is the MCC of hypokalemia?

Answer 44

vomiting/ diarrhea

Question 45

What is seen on EKG during hypokalemia?

Answer 45

flattened T waves, U waves, QT prolongation, V fib

Question 46

IV treatment of hypokalemia should be done carefully. __-___ mEq/hr. ____ should be corrected as well.

Answer 46

10-20 Mg

Question 47

What are some examples of natural colloids?

Answer 47

Albumin, packed RBCs, plts, FFP

Question 48

What are some examples of synthetic colloids?

Answer 48

dextran, starches