IV Fluids Lecture

Question 1

Maintain basal needs
Correct volume + electrolyts deficits/excess
Replace ongoing losses
Minimize protein breakdown
Caloric intake for pts NPO

Answer 1

Goals of IV therapy

Question 2

Electrolytes
BUN
Creatinine
Blood sugar (if NPO on maintence fluids)

Answer 2

ESSENTIAL to monitor in IV fluid patients

Question 3

Ca
Mg
Total protein
Albumin

..should be measured/replaced as needed in who?

Answer 3

Pts on IVF for several days

Question 4

Nutritional support (enteral or IV hyperalimentation/TPN) is initiated if pt is unable to eat for…

Answer 4

>3-4 days

Question 5

True or False…

You MUST measure I&O’s on IVF pts?

Answer 5

TRUE

Question 6

Must replace saline lost in which types of patients?

Answer 6

Dehydrated/volume depleted
Surgical patients

Question 7

NG suction
Diarrhea
Enteric fistulae
Losses from wounds/drains
Interstitial and 3rd space losses

…all contribute to?

Answer 7

Volume depletion (which requires saline replacement)

Question 8

• Provide maintence fluids if NPO
• Replace saline lost if volume depleted
• Match an additional fluid/electrolyte losses in urine (ie diuretics, DI, adrenal insufficiency)

Answer 8

Fluid replacement purposes

Question 9

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?

Answer 9

HypoNa
Cerebral edema

Question 10

Water excess can occur when what type of IVF is given? (in addition to an increase in ADH due to post op pain)

Answer 10

Hypotonic IVF

Question 11

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?

Answer 11

HF
Renal failure
Hypoalbuminemia

Question 12

>8000 daltons
high oncotic pressure
remains intravascular

Answer 12

Colloids

Question 13

Used for rapid volume expansion during shock or hemorrhage

Answer 13

Colloids

Question 14

PRBCs
5% albumin solution
Fresh frozen plasma

all examples of?

Answer 14

Colloids

Question 15

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)

Answer 15

PRBCs

Question 16

Plasma volume expander

Can draw extracellular fluid into circulation

Answer 16

5% albumin solution

Question 17

For massive blood loss: transufse as adjunct to PRBCs

also used for urgent reversal of clotting factor deficiency/bleeding on Coumadin

Answer 17

Fresh frozen plasma

Question 18

Prep time
Infection
Costly
Transfusion reaction

Answer 18

disadvantages of blood products

Question 19

LMW dextran, hetastarch

*costly
*no infection risk

Answer 19

Synthetic colloids

Question 20

D5 1/2NS with KCl 20 meq/L

used for?

Answer 20

gastric losses

(emesis, NG tube)

Question 21

D5LR with KCl 15-20 meq/L

used for…?

(replace 1 L for each Kg of body weight loss)

Answer 21

Diarrhea

Question 22

D5LR with 25 meq/L

…used for?

(1/2 amp NaHCO3)

Answer 22

Bile

Question 23

• *LR** using Parkland formula
• *avoid glucose initially**

Answer 23

Burn patients

Question 24

A previously healthy man who is NPO and awaiting for his colonoscopy, which is 24 hrs away

Answer 24

D5 1/2 NS with KCl

Question 25

Fluids for a marathon runner?

Answer 25

D5NS “wide open” for initial 500 ml or until postural changes resolve