IV Fluid Therapy Flashcards
What is the goal of maintenance fluid therapy with normal kidney function?
maintain volume and electrolyte balance
If NPO= H2O, Na, K, +/- dextrose
What is the best estimator of volume status?
weight
How often should you reassess maintenance IVF?
daily
What is the goal of replacement fluid therapy?
correct volume status or serum electrolytes
What is volume status?
weight, JVD, urine output, ht, BP, HR, pulmonary edema, peripheral edema
Remember…
LOOK AT YOUR PATIENT
Describe the hypervolemic patient.
EXCESS TBNa= Na retention and decreased circulating volume
What are the si/sx of hypervolemic patients?
edema, ascites, pleural effusions, pulmonary edema, increased JVP, dyspnea
What are the treatments for hypervolemic patients?
treat underlying cause
DIURETICS
limit Na intake
Describe the hypovolemic patient.
DEFICIT TBNa= renal and extrarenal
renal- diuresis, MC def
extrarenal- GI, burn, respiratory issues, bleeding
What are the si/sx for hypovolemic patients?
thirst, weakness, mm cramps, postural dizziness
What are the treatments for hypovolemic patients?
REPLENISH IV VOLUME
MILD= oral rehydration
MOD- SEVERE= isotonic fluids (1-2 bolus)
What are the routes of fluid administration?
enteral and parenteral
How to calculate fluid deficit?
pre-illness weight - illness weight
Children:
TBW is ___% of weight (kg)
60
Infants:
TBW is ___% of weight (kg)
75
Oral rehydration therapy in children:
- > ___ mo old
- mild-mod ______
- tolerating ___ intake
- no _____ illness
6
dehydration
PO
severe
Oral rehydration therapy table:
When should IV rehydration be preferred over oral rehydration?
- ___ tolerating PO
- ___ dehydration
- Shock, _____
- ___glycemia
- ______ abnormalities
Not
severe
sepsis
hypo
electrolyte
___-___ mL/kg for mild dehydration
30-50
___-___ mL/kg for mod. dehydration
60-80
What are the 2 most common types of IV fluids?
crystalloids and colloids
Describe crystalloids.
pass through the capillary wall easily
Increase INTERSTITIAL volume (EC)
Describe colloids.
Do NOT pass through the capillary wall easily
Increase PLASMA volume (EC)
What are the 3 principal components of crystalloids?
water, electrolytes, glucose
isotonic saline, hypertonic saline, hypotonic saline, LR, D5W
Cellular Physiology Review
Isotonic fluid:
ECF and ICF have ___ osmolarity. No ____ movement.
Equal
water
When should you use isotonic saline?
hypovolemic shock, DKA, hyperosmolar hyperglycemic state, correct mild hypoNa, treatment of hyperCa, septic shock
Increase Na= ____ plasma osmolarity
Decrease Na= ______ plasma osmolarity
Increase
Decrease
NS components
Na= ___
Cl= ___
Mildly acidotic
154
154
LR components
Na= ___
Cl= ___
Lactate= ____
Neutral fluid
130
109
28
____ can cause a ____ AG metabolic acidosis (hyperchloremic) in large volumes.
NaCl
Normal
Is there a single resuscitation fluid that is optimal?
No
When should LR be used?
HyerpCl, Metabolic acidosis, renal dysfunction, burns, sepsis, large volume fluid infusion
What are the proportions of crystalloids and colloids in the intravascular space?
Crystalloids= 1/3
Colloids= 2/3
What must be considered for crystalloid infusion rates?
CHF, dialysis, volume status
How to correct hypoNa?
replace Na or restrict H2O
What is the max dose of Na you can replace in 24 hours?
6-8 mEq/L
What is the primary risk when correcting low sodium?
osmotic demyelination syndrome
What is the max correction rate with hypertonic saline?
0.5 mEq/L/hr or 10 mEq/L/24h
What is the correction of sodium deficiency dependent on?
sex, age, and weight
What is the complication associated with rapid Na correction of hypernatremia?
cerebral edema
What is the MCC of hypernatremia?
water deficit or Na gain
What is the MCC of hypokalemia?
vomiting/ diarrhea
What is seen on EKG during hypokalemia?
flattened T waves, U waves, QT prolongation, V fib
IV treatment of hypokalemia should be done carefully. __-___ mEq/hr. ____ should be corrected as well.
10-20
Mg
What are some examples of natural colloids?
Albumin, packed RBCs, plts, FFP
What are some examples of synthetic colloids?
dextran, starches
