IV Fluids

Question 1

describe the normal breakdown of body water compartments

Answer 1

ECW: 20%
plasma volume: 4.3%
interstitial fluid: 15.7%
ICW: 40%
Minerals, protein, glycogen, fat: 40%

Question 2

compare colloids, 0.9% NaCl/Ringer’s Lactate, and 5% Dextrose in terms of their distribution in the body water compartments

Answer 2

colloids: distribute among plasma volume of ECW
0. 9% NaCl/Ringer’s Lactate: distribute among all of ECW

5% Dextrose: distributes among all of ECW and ICW

Question 3

list the 3 isotonic crystalloids mentioned

Answer 3

• NS (normal saline - sodium chloride)
• lactated ringer’s
• D5W (+/0)

Question 4

list the 2 hypotonic crystalloids mentioned

Answer 4

• 1/2 NS (normal saline - sodium chloride)

- D5W (+/-) (can be isotonic and hypotonic?)

Question 5

list the 5 hypertonic crystalloids mentioned

Answer 5

• 3% NaCl (NS)
• D10W (10% dextrose in water)
• D5w1/2 NS (5% dextrose in half normal saline)
• D5 NS (5% dextrose in normal saline)
• D5LR (5% dextrose in lactate ringer’s)

Question 6

composition of lactated ringer’s

Answer 6

130 NaCl
4 K+
109 Cl-
3 Ca2+
28 Lactate
0 Dextrose

Question 7

what electrolytes does the average person require

Answer 7

25-30 mL/kg water/day

1 mmol/Kg of Na+ and K+

Question 8

most common reasons to initiate IV therapy and antibiotics in kids

Answer 8

dehydration that occurs from gastroenteritis

Question 9

describe the holliday-segar method for IV fluids in pediatrics

Answer 9

• first 10kg of weight = 100 mL in 24 hours (X)
• second 10 kg of weight = 50 mL in 24 hours (Y)
• other kg = 20 mL per kg in 24 hours (Z)

(X + Y + Z)/24 = mL/hour

Question 10

describe how to replace fluid loss in pediatric patients

Answer 10

1 kg = 1 L

• replace half of fluid loss in first 8 hours
• replace second half in next 16 hours

Question 11

what is the total fluids given to a pediatric patient in 24 hours

Answer 11

deficit + maintenance

(holliday-segar method) + (fluid loss replacement)

first 8 hours will have higher replacement than subsequent 16 hours

Question 12

how to fix volume deficit in adult patients

Answer 12

rate of correction volume depletion depends on its severity

• w/ severe volume depletion of hypovolemic shock –> give at least 1-2 L of isotonic saline as rapidly as possible
• fluid replacement continued at rapid rate until clinical signs of hypovolemia improve

Question 13

when giving fluid replacement therapy in an adult pt, how do you avoid worsening of the volume depletion

Answer 13

the rate of fluid administration must be greater than the rate of continued fluid losses, which is equal to the urine output plus estimated insensible losses plus any other fluid losses that may be present

rate of fluid administration > continued fluid losses (urine output + estimated insensible losses + any other fluid loss)

Question 14

example of a regimen to induce positive fluid balance in adult patients receiving fluid replacement therapy

Answer 14

administration of fluid at a rate of 50-100 mL/hour greater than estimated fluid loss

Question 15

what are most patients treated w/ for fluid replacement

Answer 15

isotonic or one-half isotonic saline

Question 16

what fluid to give in hypernatremic patients

Answer 16

hypotonic

Question 17

what fluid to give in hyponatremia patients

Answer 17

isotonic or hypertonic saline

Question 18

what fluid to give in patients w/ blood loss

Answer 18

isotonic saline and/or blood

- potassium and bicarbonate may need to be added in pts w/ hypokalemia or metabolic acidosis

Question 19

adverse effects of isotonic saline (NS) infusion

Answer 19

can induce metabolic acidosis w/ aggressive resuscitation

Question 20

adverse effects of giving D5W while isotonic

Answer 20

causes significant electrolyte shifts due to hypotonicity after initial response phase

Question 21

in what patients should you avoid using lactated ringer’s

Answer 21

in rhabdomyolysis pts

- use NS instead

Question 22

adverse effects of lactated ringer’s in pts and its cause

Answer 22

has a tendency to increase frequency of emboli formation

Cause: the calcium in the solution could overwhelm the chelating capacities of the citrate in stored blood, resulting in clot formation

Question 23

how do you decide when to give hypertonic saline to a hyponatremic patient

Answer 23

the hyponatremia demands astute investigation into the cause of low sodium
- sx are more significant when deciding for hypertonic saline

Question 24

why is D51/2W considered to be inferior to NS and lactated ringer’s

Answer 24

it is an isotonic fluid, but it becomes a more hypertonic fluid after its initial response