IV Fluids

Question 1

adverse effects of IV fluids: Normal Saline

Answer 1

Fluid overload
Metabolic acidosis (hyperchloremic)
Hypernatremia

Question 2

adverse effects of IV fluids: Lactated Ringers

Answer 2

Fluid overload
Hyponatremia
Hyperkalemia

Question 3

adverse effects of IV fluids: D5W

Answer 3

Hyponatremia

Question 4

Hypernatremia: Management

Answer 4

Only hypotonic fluids are appropriate unless frank circulatory collapse exists
Hypernatremia is usually due to water loss
Loss of free water …increase in ECF osmolarity (serum sodium)
Always be careful when correcting hyper or hyponatremia…cerebral edema or central pontine myelinosis

Question 5

What are the expected losses ?

Answer 5

Measurable:
urine (measure hourly if necessary)
GI (stool, stoma, drains, tubes, fistula, N/V/D)
Insensible (500ml a day in health)
Sweat
Exhaled
Fever (increase by 100ml/day/degree centigrade)

Question 6

Crystalloids

Answer 6

solutions that contain small molecules and are able to pass through semipermeable membranes
Solution transfers easily across the cell membrane of the blood vessels (small particles)
Crystalloids are generally adequate for most situations needing fluid management.

Question 7

Colloids

Answer 7

solutions that contain high molecular weight proteins (like albumin) or starch
Do not cross the capillary semipermeable membrane
Remain in the intravascular space (pulling fluid out of the intracellular and interstitial space) for several days
Colloids may be indicated when more rapid hemodynamic equilibration is required

Question 8

Isotonic/Hypotonic/Hypertonic

Answer 8

Isotonic solutions: given to expand the ECF volume
Hypotonic solutions: given to reverse dehydration
Hypertonic solutions: given to increase the ECF volume and decrease cellular swelling