IVF

Question 1

What are the isotonic IVFs?

Answer 1

NS, lactated ringers, D5W (+/-)

Question 2

What are the hypotonic IVFs?

Answer 2

1/2 NS, D5W (+/-)

Question 3

What are the hypertonic IVFs?

Answer 3

3% NaCl, D10 W, D5 1/2 NS, D5 NS, D5LR

Question 4

What are the average person’s fluid and electrolyte requirements?

Answer 4

25-30 ml/kg water per day and about 1 mmol/kg of Na+ and K+

Question 5

What are some of the common reasons to initiate IV therapy in children?

Answer 5

Correct dehydration, most commonly from gastroenteritis, and to administer IV antibiotics

Question 6

How do you calculate using the Holliday-Segar Method for maintenance fluid (peds)?

Answer 6

First 10kg= 100 ml per kg in 24 hrs
Second 10 kgs= 50 ml per kg in 24 hours
Remaining kgs= 20 ml per kg in 24 hours

Question 7

How do you calculate volume loss in pediatrics?

Answer 7

Best calculated by comparing normal weight with current weight.
1 kg = 1 L

Question 8

Over what time period do you replace lost fluid volume in pediatrics?

Answer 8

Replace half of fluid volume replacement dose in 8 hours, the rest over the subsequent 16 hours with ongoing monitoring

Question 9

How do you calculate the total fluids for first 24 hours?

Answer 9

Deficit + maintenance. Deficit equal to weight lost (2 kg= 2L).

Question 10

How do you calculate volume deficit in an adult?

Answer 10

There is no formula to accurately estimate total fluid deficit. If pre- and post-deficit body weight it known, then weight loss provides reasonable estimate.

Question 11

What do you give with severe volume depletion or hypovolemic shock in an adult?

Answer 11

At least 1-2 L of isotonic saline are generally given as rapidly as possible in an attempt to restore tissue perfusion.

Fluid replacement is continued at a rapid rate until the clinical signs of hypovolemia improve

Question 12

How do you treat an adult patient with mild to moderate hypovolemia?

Answer 12

Administration of fluid at a rate that is 50 to 100 ml/hour greater than estimated fluid losses.

Estimated continued fluid losses is equal to the urine output plus estimated insensible losses (usually 30-50 ml/hour) plus any other fluid losses that may be present.

Question 13

What are most patients treated with for replacement fluid?

Answer 13

Isotonic or one-half isotonic saline

Question 14

What are hypernatremic patients treated with?

Answer 14

Hypotonic solutions

Question 15

What are hyponatremic patients treated with?

Answer 15

Isotonic or hypertonic saline

Question 16

What are patients with blood loss treated with?

Answer 16

Isotonic saline and/or blood

Question 17

What is a consideration in lactated ringers?

Answer 17

Increases tendency of emboli formation in midst of PRBC transfusion. Avoid use in rhabdomyolosis.

Question 18

What is a consideration in NS?

Answer 18

Can induce a metabolic acidosis with aggressive resuscitation.

Question 19

What is a consideration in hypertonic saline (3% NS)?

Answer 19

Demands astute investigation as to the cause for low sodium.

Question 20

What is a consideration in D5W?

Answer 20

While isotonic, causes significant electrolyte shifts due to hypotonicity after the initial response phase

Question 21

What is special about D5 1/2 NS?

Answer 21

Considered an isotonic fluid, but becomes more hypertonic after its initial response. Inferior to NS and LR.