IV Fluids Flashcards
describe the normal breakdown of body water compartments
ECW: 20% plasma volume: 4.3% interstitial fluid: 15.7% ICW: 40% Minerals, protein, glycogen, fat: 40%
compare colloids, 0.9% NaCl/Ringer’s Lactate, and 5% Dextrose in terms of their distribution in the body water compartments
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
list the 3 isotonic crystalloids mentioned
- NS (normal saline - sodium chloride)
- lactated ringer’s
- D5W (+/0)
list the 2 hypotonic crystalloids mentioned
- 1/2 NS (normal saline - sodium chloride)
- D5W (+/-) (can be isotonic and hypotonic?)
list the 5 hypertonic crystalloids mentioned
- 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)
composition of lactated ringer’s
130 NaCl 4 K+ 109 Cl- 3 Ca2+ 28 Lactate 0 Dextrose
what electrolytes does the average person require
25-30 mL/kg water/day
1 mmol/Kg of Na+ and K+
most common reasons to initiate IV therapy and antibiotics in kids
dehydration that occurs from gastroenteritis
describe the holliday-segar method for IV fluids in pediatrics
- 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
describe how to replace fluid loss in pediatric patients
1 kg = 1 L
- replace half of fluid loss in first 8 hours
- replace second half in next 16 hours
what is the total fluids given to a pediatric patient in 24 hours
deficit + maintenance
(holliday-segar method) + (fluid loss replacement)
first 8 hours will have higher replacement than subsequent 16 hours
how to fix volume deficit in adult patients
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
when giving fluid replacement therapy in an adult pt, how do you avoid worsening of the volume depletion
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)
example of a regimen to induce positive fluid balance in adult patients receiving fluid replacement therapy
administration of fluid at a rate of 50-100 mL/hour greater than estimated fluid loss
what are most patients treated w/ for fluid replacement
isotonic or one-half isotonic saline
what fluid to give in hypernatremic patients
hypotonic
what fluid to give in hyponatremia patients
isotonic or hypertonic saline
what fluid to give in patients w/ blood loss
isotonic saline and/or blood
- potassium and bicarbonate may need to be added in pts w/ hypokalemia or metabolic acidosis
adverse effects of isotonic saline (NS) infusion
can induce metabolic acidosis w/ aggressive resuscitation
adverse effects of giving D5W while isotonic
causes significant electrolyte shifts due to hypotonicity after initial response phase
in what patients should you avoid using lactated ringer’s
in rhabdomyolysis pts
- use NS instead
adverse effects of lactated ringer’s in pts and its cause
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
how do you decide when to give hypertonic saline to a hyponatremic patient
the hyponatremia demands astute investigation into the cause of low sodium
- sx are more significant when deciding for hypertonic saline
why is D51/2W considered to be inferior to NS and lactated ringer’s
it is an isotonic fluid, but it becomes a more hypertonic fluid after its initial response
