IV Fluids Lecture Flashcards
Maintain basal needs
Correct volume + electrolyts deficits/excess
Replace ongoing losses
Minimize protein breakdown
Caloric intake for pts NPO
Goals of IV therapy
Electrolytes
BUN
Creatinine
Blood sugar (if NPO on maintence fluids)
ESSENTIAL to monitor in IV fluid patients
Ca
Mg
Total protein
Albumin
..should be measured/replaced as needed in who?
Pts on IVF for several days
Nutritional support (enteral or IV hyperalimentation/TPN) is initiated if pt is unable to eat for…
>3-4 days
True or False…
You MUST measure I&O’s on IVF pts?
TRUE
Must replace saline lost in which types of patients?
Dehydrated/volume depleted
Surgical patients
NG suction
Diarrhea
Enteric fistulae
Losses from wounds/drains
Interstitial and 3rd space losses
…all contribute to?
Volume depletion (which requires saline replacement)
- Provide maintence fluids if NPO
- Replace saline lost if volume depleted
- Match an additional fluid/electrolyte losses in urine (ie diuretics, DI, adrenal insufficiency)
Fluid replacement purposes
water excess with IVF can occur (uncommon):
iatrogenic via IV fluids (hypotonic) plus increase in ADH (post op pain)
..this is dangerous bc it can cause?
HypoNa
Cerebral edema
Water excess can occur when what type of IVF is given? (in addition to an increase in ADH due to post op pain)
Hypotonic IVF
Must avoid Na and H2O excess by giving too much IV fluid (esp in post op patients)
what categories of ppl must you be extra cautious of this?
HF
Renal failure
Hypoalbuminemia
>8000 daltons
high oncotic pressure
remains intravascular
Colloids
Used for rapid volume expansion during shock or hemorrhage
Colloids
PRBCs
5% albumin solution
Fresh frozen plasma
all examples of?
Colloids
Used for blood replacement for severe hemorrhage/blood loss/anemia, esp if pt is hemodynamically unstable or with underlying coronary heart disease or HF (administer slowly)
PRBCs
Plasma volume expander
Can draw extracellular fluid into circulation
5% albumin solution
For massive blood loss: transufse as adjunct to PRBCs
also used for urgent reversal of clotting factor deficiency/bleeding on Coumadin
Fresh frozen plasma
Prep time
Infection
Costly
Transfusion reaction
disadvantages of blood products
LMW dextran, hetastarch
*costly
*no infection risk
Synthetic colloids
D5 1/2NS with KCl 20 meq/L
used for?
gastric losses
(emesis, NG tube)
D5LR with KCl 15-20 meq/L
used for…?
(replace 1 L for each Kg of body weight loss)
Diarrhea
D5LR with 25 meq/L
…used for?
(1/2 amp NaHCO3)
Bile
- *LR** using Parkland formula
- *avoid glucose initially**
Burn patients
A previously healthy man who is NPO and awaiting for his colonoscopy, which is 24 hrs away
D5 1/2 NS with KCl
