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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
What’s the calculation for Na basal requirement?
1-2 mEq/kg/d
26
What’s the calculation for K basal requirement?
0.5-1.0 mEq/kg/d
27
How much Ca do we give on a daily basis?
1-3gm/d
28
How much Mg is required/day?
20meq/d)
29
What’s the pediatrics requirements for Na or K?
They are higher than adult requirements
30
When does the surface area “rule of 6’s” apply? What is it?
Pediatric water requirements
31
Why do we almost always add glucose to IV therapy?
To protect our protein (we don’t want the body to attack protein for energy)
32
What are the minimum glucose requirements? What form of glucose is used in IV’s?
100-200 grams/day Use Dextrose
33
We almost always add glucose to IV fluids, when would we NOT add glucose to IV fluids?
Burn patients and DKA with high BG levels
34
What is one of the main goals of IV therapy with glucose?
Protein Sparing Effect - | **administering 100g of glucose → reduces protein loss by more than 50%
35
Maintaining basal needs, correct volume/electrolyte deficits, replace ongoing losses, minimize protein breakdown – are all examples of what?
Goals of IV therapy for people not eating or drinking x 7 days
36
What should you consider on day 4 or 5 with your patient not eating or drinking and on IV fluids?
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
What is essential to monitor periodically in a patient without PO intake but is on maintenance IV fluids?
Electrolytes, Bun, Cr, and glucose
38
If a patient is on IV fluids for several days should have what measured/replaced prn?
Ca, Mg, Total protein, and Albumin
39
At what point is nutritional support initiated?
If unable to eat for greater than 3-4 days
40
In a patient on IV fluids what should we measure EVERY day?
Daily intake and output (I/O’s)
41
If a person is NPO, do we continue to provide maintenance fluids?
Yep!
42
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?
Post-op pain INCREASES ADH levels!!! | Thus, with fluids you can cause hyponatremia or cerebral edema… don’t do that
43
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?
Serum protein and albumin
44
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?
Intake/out put Serum protein/albumin
45
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?
Turn off the IV!! Oral intake increased to supplement protein (Ensure) Furosemide **
46
Weight loss, increased pulse, low BP, dry mucous membranes, increased skin turgor, and low urine output are sxs of what?
Volume depletion
47
What would your Hct, BUN/Cr, and urine Na labs look like with volume depletion?
Increase Hct and BUN/Cr Low urine Na
48
If you see weight gain, edema, increased neck veins, pulmonary congestion, pleural effusion, gallops, or ascites – are all sxs of what?
Volume excess
49
What are the most common types of IV fluids we will use?
Crystalloids
50
What are the various crystalloids available for use?
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
When would we utilize colloids?
Rapid volume expansion during shock or hemorrhage (when someone is hypotensive) High Molecular Weight
52
What type of product are colloids?
PRBC’s (Packed red blood cells)
53
If you give PRBC’s what must you give the patient?
Fresh Frozen Plasma (1U FFP for every 5U’s PRBC’s)
54
When else can we use FFP besides along with PRBC’s?
For bleeding while on coumadin
55
Do we give much albumin solution?
Nope
56
What is a disadvantage to blood products?
Preparation time, infection, costly, and transfusion reaction
57
What is a benefit of synthetic colloids?
No infection! (But costly)
58
If someone has gastric losses – what do we replace with?
D5 ½NS + KCl 20meq/L
59
If someone has diarrhea – what do we replace their losses with?
D5LR (isotonic with Bicarb in it) + KCl 15-20meq/L (replace 1L for each Kg of body weight loss)
60
If someone has bile loss – what do we replace with?
D5LR + 25meq/L NAHCO3
61
If we have a burn patient – how do we treat them?
LR using parkland formula (avoid glucose initially)
62
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?
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
Your calculations are correct for the man with abdominal pain that’s NPO – but what concerns might you have?
Concern for Na overload So alternate D5 ½NS with D5W + 20meq KCl each liter Or you could just use D5 ¼NS
64
When we write orders for IV fluids – when should they be reassessed?
EVERY DAY!!! (along with I/O’s)
65
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?
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
How much weight does a person lose during a marathon?
5-10lbs
67
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?
Need his electrolyte levels! Renal function
68
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?
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
What do we need to remember about giving potassium?
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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