IV Fluids Lecture

Question 1

Sensible losses - measurable

Answer 1

Urine and stool (generally 0.5cc/kg/hr minimum in an adult)

Question 2

Insensible losses - able to be estimated

Answer 2

Skin and URT

Question 3

Average daily fluid loss (and therefore requirement) in a healthy, at rest individual

Answer 3

2L

Question 4

Situations with increased fluid requirements

Answer 4

Fever, open surgery, respiratory tract (ventilated pt or hypermetabolic states)

Question 5

Crystalloid fluid

Answer 5

Isotonic: NS, lactate ringers
Hypotonic: 1/2 or 1/3 NS, D5W
Hypertonic: 3% saline

Question 6

Colloid fluid

Answer 6

Whole blood, PRBCs, FFP, albumin, dextran

Question 7

When is crystalloid used?

Answer 7

Pretty much every scenario where bleeding isn’t causing volume loss (PRBCs)

Question 8

Why is more crystalloid solution needed compared to colloid?

Answer 8

About 2/3 of crystalloid solution leaves intravascular space

Question 9

When would a dextrose solution (D5, D10) be used?

Answer 9

NPO pt > adds calories

Question 10

Bolus

Answer 10

• Large volume of fluids meant to replace volume that has been lost
• Isotonic crystalloids typically used

Question 11

Septic pt initial fluid bolus

Answer 11

30cc/kg

Question 12

Purpose of maintenance IV fluids

Answer 12

Prevent volume loss, provide nutrition, electrolytes, etc

Question 13

4-2-1 rule (hourly rate)

Answer 13

4cc/kg/hr for first 10 kg
2cc/kg/hr for second 10 kg
1cc/kg/hr for every kg over 20

Question 14

100-50-20 rule (estimated daily requirement)

Answer 14

100cc/kg/day for first 10 kg
50cc/kg/day for second 10 kg
20cc/kg/day for every kg over 20

Question 15

How do you know if you’re giving enough fluids?

Answer 15

Dry mucous membranes, dry skin, decreased skin turgor = not enough
-Measuring BP, HR, UO, central venous pressure