IV Fluids Flashcards
Is the majority of fluid in our body inside or outside of our cells?
intracellular fluid (ICF)
Is there more fluid in our interstitium or plasma?
Interstitial fluid
Do M or F have a higher fluid total body mass %
males
are these examples of intracellular or extraceullar fluid?
- Cerebrospinal fluid
- lymph
- synovial fluid in joints
- pleural fluid
- pericardial fluid
- peritoneal fluid
- aqueous humor of the eye
Extracellular (ECF)
Osmotic vs Hydrostatic pressures
We get our majority of water via
Food - 800mL
Drink water - 500mL
Oxidation - 300mL
we lose the majority of our water via
Urine - 500mL
Skin - 500mL
Resp tract - 400mL
Stool - 200mL
Maintenance vs Replacement fluids
- Maintenance -> Replaces ongoing losses of water and electrolytes under normal physiologic conditions
- Replacement -> Corrects existing water and electrolyte losses. (i.e. gastrointestinal, urinary, skin, bleeding, 3rd space sequestration)
pt is eating/drinking normally. Do they need maintenance IV fluids?
No
standard IV fluids order
Reasonable approach is to begin with 2 L per day of half normal saline in dextrose with 20mEq KCl per liter
Monitor Na+ and change as necessary
Do these ppl need A LOT or LITTLE water?
- afebrile
- not eating
- physically inactive
- oliguric kideny injury
- use of humidified air
- edematous states
- hypothyroidism
a little (these ppl dont have high water demand or are already overfluided)
Do these ppl need A LOT or a LITTLE water
- febrile
- sweating
- tachypnic
- burned
- polyric
- ongoing GI losses
A LOT
What can you refer to to determine how much fluid is required for fluid replacement?
Use known wt loss, blood pressure, jugular venous pressure, urine sodium concentration/output, and hematocrit
Replacement fluids
In severe volume depletion or hypovolemic shock, at least ___L of isotonic fluids are given a rapidly as possible.
1-2L
Crystalloids
- Contain organic and inorganic salts (e.g., glucose and sodium chloride) dissolved in sterile water
- Ex. Normal saline, Lactated ringers, dextrose sol, bicarb sol
what makes lactated ringers special?
Contain sodium lactate in addition to NaCl
pt has metabolic acidosis, can you still give lactated ringers?
yes, sodium lactate is NOT an acid. it metab into bicarb
Normal saline (____%) is isotonic and used for resuscitation
0.9
___% saline is hypotonic and used for maintenance
0.45%
____% saline is hypertonic and given for severe hyponatremia to prevent cerebral edema
3%
D5W
Dextrose sugar water
starts off isotonic and then has hypotonic final effect
used for hypernatremia and hypoglycemia
What tonicity are lactated ringers and are they used for Resuscitation or maintenance?
Isotonic
Resuscitation
do isotonic fluids enter the intracellular fluid?
no, but hypotonic fluids do
What tonicity are Resuscitation fluids?
Isotonic
What tonicity are Maintenance fluids?
Hypotonic
shove the fluid into the cells
most crystalloids start to leave the venous system within ___ hrs, sometimes up to ___hrs if critically ill
2 hrs
up to 8 hrs if critically ill
Caution: in some cases too much NS can cause a ________ ________(non-anion gap acidosis)
Be wary of fluid overloading your patients
hyperchloremic acidosis
should you use lactated ringers for true end-stage liver disease?
No
can lactated ringers be given to a patient with hyperkalemia?
yes, the 4mL equivalents of K in the lactated ringers will not drastically incr K+ levels (10mL for every 1K?)
what is the preferred maintenance fluid?
D5-0.45%NS + 20mEq K+
Tonicity goes from Hypertonic -> Hypotonic
Normal plasma Osmolarity is ~ ______mOsm/L
290
What IV fluid do you use for symp hyponatremia and to reduce cerebral edema?
3% Saline (Hypertonic)
Given as a bolus of 50 or 100mL initially or run at low rate for short periods
What IV fluid is given to correct kidney failure or refractory metabolic acidosis
Sodium Bicarbonate Sol
Usually made in a medium of D5W, 1/2NS, D5W1/2NS, Sterile water Select 50, 100, or 150mEq sodium bicarbonate to 1L of fluid
Colloid solutions
- Contain large proteins that cannot cross capillary walls (proteins stay in vasculature)
- Hypertonic solution pulls fluid from interstitial & extracellular spaces AND INTO THE VASCULATURE
- Increases Intravascular vol & BP
Note: Equal survival rate among patients treated with colloids or crystalloids when given for hypotensive issues
What is the MC used colloid solution
Human Albumin (5% or 25%)
Human Albumin comes in ___% or _____%
5% or 25%
Signs of Dehyrdations:
* No wet diapers for ____hrs
* BUN/Creatinine Ratio >____
* Urine Specific Gravity > ______
- No wet diapers for 3 hrs
- BUN/Creatinine Ration > 20
- Urine Specific Gravity > 1.030
Max daily fluid vol for Adults and Children
Adults: 2L
Children: 2400mL
1kg = ____lbs
2.2
Use the 4:2:1 rule to determine ____
How much fluids to give a child per hour
The hourly infusion rate for a 60kg Child is _____mL/hr
use the 4:2:1 rule
100mL/Hr
Consider Intraosseous Infusions (IO) if vascular access can not be obtained within ___ attempts or for >_____sec (collapses in on itself)
2 attempts
>90 seconds
Absolute Contraindications for IO
- Fractures or prev penetrated bone (fluids will leak out)
- Extremity with vascular interruption
- Cellulitis, burns, osteomyelitis -> SEPSIS
- Caution in Osteoporosis/Osteogenesis imperfecta
The EZ-IO drill needle length is based on _____
body weight
Drill into the _____ or _____ for IO
Humerus or Tibia
Drill into the _____ or _____ for IO
Humerus or Tibia
Intraosseous (IO) devices
Impact-driven devices are inserted into the ______
IO Complications
- Infusion pain -> Lidocaine 2% slow push
- Tibial frx
- Extraversion of fluid or meds into surrounding tissues (Compartment syndrome)
- Infx -> Osteomyelitis -> sepsis
Which is more painful: inserting the IO device or infusing through the device?
Infusing can be so painful that it makes ppl nauseous. Slowly push 2% lidocaine thru the IO device
