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SURGERY > IV FLUIDS > Flashcards

IV FLUIDS Flashcards

1
Q

A 26 y.o. man is brought to the ED with 2nd-3rd degree burns over 27% of his body. Which type of IV fluid should be administered?

A

Lactate Ringers (LR) *Use the Parkland Formula

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2
Q

What is the parkland formula?

A

(% body burn) x (body weight in kg) x 4

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3
Q

Your burn patient weighs 70kg and the burns cover 27% of his body – how much fluid should you give him in the first 24hours? At what rate?

A

7560ml over 24 hours

Give ½ over 1st 8 hours (from time of burn)

¼ over second 8 hours

¼ over third 8 hours

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4
Q

When you write IV orders, what must you do?

A

Re-evaluate them EVERY DAY

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5
Q

What percentage of the body is water?

A

50-70% of weight

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6
Q

If a person has more lean body mass does it increase or decrease their TBW?

A

Increases

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7
Q

Where does the water live in the body?

A

TBW = 42L (in a 70kg man)

66% in ICF, 33% ECF (Intravascular and Interstitial)

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8
Q

How do we maintain our normal fluid balance?

A

Via renal and neuroendocrine control

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9
Q

What is normal water intake?

A

about 35mL/Kg/d (~2500)

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10
Q

What 3 ways do we intake water?

A

Oral liquid intake; oral solid intake; and metabolic (normal by-product of normal oxidative metabolism)

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11
Q

What is (generally) the normal total output of water?

A

1400-2400mL/d

*Usually equal input to output

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12
Q

How do we lose water?

A 
Urine/Stool
Insensible losses (evaporated from skin & lungs) = 600-900mL/d

Sweat (varies with exercise)

Fever = every degree about 98.6 add 2.5mL/kg/d

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13
Q

If the kidneys are functioning normally, what is the MINIMUM daily urine output? Maximum urine osmolality?

A

Minimum = around 600mL/d

Max urine osmols = 1400mOsm/l
*no further water intake (stranded on desert island) this is how concentrated/urine output

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14
Q

What does obligatory renal water loss mean?

A

Absolute minimum amount of water that must be excreted along with the solute load excreted daily.

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15
Q

What regulates osmolality?

A

Dependent on water intake and excretion

kidney and posterior pituitary (ADH)

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16
Q

What is the average daily NA losses? What regulates Na loss?

A

100-150mEq/d (balanced with intake and output)

Regulated TIGHTLY by the kidneys

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17
Q

What happens to serum Na if no oral intake of Na?

A

It will stay the same (early on while your kidneys hold on to it)

But URINE concentration will decrease

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18
Q

What’s the average daily K loses?

A

50-70mEq/d (balanced with intake and output)

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19
Q

What happens to serum K if no oral intake of K?

A

It will go DOWN (kidneys are not as good at holding onto potassium)

If volume depleted = it will continue to decrease

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20
Q

If we have a hospitalized patient who is unable to take fluids and nutrients orally – what must we replace?

A

Replace basal fluids/lytes

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21
Q

If we have a surgical patient – what must we replace?

A

Basal requirements PLUS losses (suction, vomiting, diarrhea, intraluminal sequestration, 3rd space losses).

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22
Q

What are some important contributory factors we must always take into account in order to avoid error in fluid/electrolyte administration?

A

**Unrecognized renal impairment

**Unrecognized electrolyte abnormalities (especially albumin!)

Giving dilute fluids when you needed a hypotonic fluid (NS)

Overzealous saline or Na/Water administration

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23
Q

What’s the best type of fluid to give a hypotensive, volume depleted patient requiring fluid replacement? Why?

A

1L of NS (isotonic)

**All of the isotonic will move into the intravascular space *THAT’S OUR GOAL TO EXPAND IN THE INTERSTITIAL AND INTRAVASCULAR SPACE

If we give D5W it will move from intracellular → extracellular → to intravascular spaces (with little left in the intravascular spaces)

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24
Q

What’s the calculation for giving basal fluid (water)?

A

35mL/kg/d

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25
Q

What’s the calculation for Na basal requirement?

A

1-2 mEq/kg/d

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26
Q

What’s the calculation for K basal requirement?

A

0.5-1.0 mEq/kg/d

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27
Q

How much Ca do we give on a daily basis?

A

1-3gm/d

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28
Q

How much Mg is required/day?

A

20meq/d)

29
Q

What’s the pediatrics requirements for Na or K?

A

They are higher than adult requirements

30
Q

When does the surface area “rule of 6’s” apply? What is it?

A

Pediatric water requirements

31
Q

Why do we almost always add glucose to IV therapy?

A

To protect our protein (we don’t want the body to attack protein for energy)

32
Q

What are the minimum glucose requirements? What form of glucose is used in IV’s?

A

100-200 grams/day

Use Dextrose

33
Q

We almost always add glucose to IV fluids, when would we NOT add glucose to IV fluids?

A

Burn patients and DKA with high BG levels

34
Q

What is one of the main goals of IV therapy with glucose?

A

Protein Sparing Effect -

**administering 100g of glucose → reduces protein loss by more than 50%

35
Q

Maintaining basal needs, correct volume/electrolyte deficits, replace ongoing losses, minimize protein breakdown – are all examples of what?

A

Goals of IV therapy for people not eating or drinking x 7 days

36
Q

What should you consider on day 4 or 5 with your patient not eating or drinking and on IV fluids?

A

know how we are going to give that patient nutrition if on IV for longer than 7 days
- Use the GI tract via tube

37
Q

What is essential to monitor periodically in a patient without PO intake but is on maintenance IV fluids?

A

Electrolytes, Bun, Cr, and glucose

38
Q

If a patient is on IV fluids for several days should have what measured/replaced prn?

A

Ca, Mg, Total protein, and Albumin

39
Q

At what point is nutritional support initiated?

A

If unable to eat for greater than 3-4 days

40
Q

In a patient on IV fluids what should we measure EVERY day?

A

Daily intake and output (I/O’s)

41
Q

If a person is NPO, do we continue to provide maintenance fluids?

A

Yep!

42
Q

If a patient is post-op and hypotonic, so we give them fluids. What do we need to remember about post-op patients so we don’t make an error?

A

Post-op pain INCREASES ADH levels!!!

Thus, with fluids you can cause hyponatremia or cerebral edema… don’t do that

43
Q

If a patient is in HF or renal failure – we want to be careful with their fluids – but what else should we assess and replace if deficient?

A

Serum protein and albumin

44
Q

A woman has developed SOB with evidence of HF. She has been NPO at the hospital x 6 days, with fluids started 2 days ago. You start IV furosemide.
She has a puffy face and lung crackles – what else do you want to know?

A

Intake/out put

Serum protein/albumin

45
Q

Your female patient with HF has been receiving D5LR @ 175ml/hr continuous.
Her intake = 33,600ml
Output = 12,800m + insensible losses;
Serum protein = 2.5 (normal is 3.4-4.7) – dropping since NPO
What do you do for her?

A

Turn off the IV!!

Oral intake increased to supplement protein (Ensure)

Furosemide **

46
Q

Weight loss, increased pulse, low BP, dry mucous membranes, increased skin turgor, and low urine output are sxs of what?

A

Volume depletion

47
Q

What would your Hct, BUN/Cr, and urine Na labs look like with volume depletion?

A

Increase Hct and BUN/Cr

Low urine Na

48
Q

If you see weight gain, edema, increased neck veins, pulmonary congestion, pleural effusion, gallops, or ascites – are all sxs of what?

A

Volume excess

49
Q

What are the most common types of IV fluids we will use?

A

Crystalloids

50
Q

What are the various crystalloids available for use?

A

D5W

D10W (not popular)

D5NS (0.9% NaCl) – good for expanding intravascular volume (isotonic)

D5 ½NS

NS

LR

D5LR – another good isotonic solution

D5 ¼NS

51
Q

When would we utilize colloids?

A

Rapid volume expansion during shock or hemorrhage (when someone is hypotensive)

High Molecular Weight

52
Q

What type of product are colloids?

A

PRBC’s (Packed red blood cells)

53
Q

If you give PRBC’s what must you give the patient?

A

Fresh Frozen Plasma (1U FFP for every 5U’s PRBC’s)

54
Q

When else can we use FFP besides along with PRBC’s?

A

For bleeding while on coumadin

55
Q

Do we give much albumin solution?

A

Nope

56
Q

What is a disadvantage to blood products?

A

Preparation time, infection, costly, and transfusion reaction

57
Q

What is a benefit of synthetic colloids?

A

No infection! (But costly)

58
Q

If someone has gastric losses – what do we replace with?

A

D5 ½NS + KCl 20meq/L

59
Q

If someone has diarrhea – what do we replace their losses with?

A

D5LR (isotonic with Bicarb in it) + KCl 15-20meq/L (replace 1L for each Kg of body weight loss)

60
Q

If someone has bile loss – what do we replace with?

A

D5LR + 25meq/L NAHCO3

61
Q

If we have a burn patient – how do we treat them?

A

LR using parkland formula (avoid glucose initially)

62
Q

45y.o. man has been hospitalized for abdominal pain. He has normal renal function. He’s NPO while awaiting a colonoscopy (but normal metabolism otherwise). He’s 70kg – what are the maintenance fluids for him?

A

Water is: 35mL/kg = 2450mL/d

Na: 1-2 meq/kg = 105meq/d

K: 0.5-1meq/kg = 50meq/d

TOTAL: D5 ½NS + 20meq KCl/L at 100ml/hr (to cover everything)

63
Q

Your calculations are correct for the man with abdominal pain that’s NPO – but what concerns might you have?

A

Concern for Na overload

So alternate D5 ½NS with D5W + 20meq KCl each liter

Or you could just use D5 ¼NS

64
Q

When we write orders for IV fluids – when should they be reassessed?

A

EVERY DAY!!! (along with I/O’s)

65
Q

You’re working at a marathon when a 42y.o. female collapses at the finish line with a BP 90/60, and a postural drop of 70. – what do you do?

A

Give isotonic fluids!

D5NS WIDE OPEN for initial 500ml (or until postural changes resolve)

Followed by continuous infusion at 150-250ml/hr

Once stable = oral electrolyte solution (Gatorade)

66
Q

How much weight does a person lose during a marathon?

A

5-10lbs

67
Q

A 55y.o. male has had diarrhea x3 days and is now presenting to the ED with weakness and muscle cramps. His mucous membranes are dry, and has a postural BP drop from 100 to 80. What info do we need before starting IV fluids?

A

Need his electrolyte levels!

Renal function

68
Q

Your dehydrated male with weakness and muscle cramps has his electrolytes returned with:
Na 140; K 2.9 (low); Cl 107; HCO3 21, Cr 1.1; BUN 38
How do you treat him?

A

D5LR + 20 meq KCl/L → 250mL over 30” → then 250ml/hr (to a total of 100ml)

Then D5LR + 15meq/KCl at 150ml/hr for 24 hours

69
Q

What do we need to remember about giving potassium?

A

You can only give about 60 of potassium through a peripheral line!

Otherwise it will destroy the IV and you will need a central line

SURGERY (6 decks)

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