L7: What fluid to choose? Flashcards
Surgical patients with 3rd spacing
Albumin
Alternatives to albumin
Dextran 40
Dextran 70
Hydroxyethyl Starch
Severe anemia
PRBCs
Hemorrhage
PRBCs
Burns/peritonitis
Colloids
Albumin
Complete bowel obstruction
TPN
Inflammatory bowel disease
→ bowel rest may induce remission
TPN
Maintenance fluids for peds
D5/.25NA with 20 meq KCL
IV boluses
Isotonic crystalloid
Correct warfarin bleeding
Fresh frozen plasma
Significant multisystem disease
TPN
Correct vitamin K deficiency bleeding
Fresh frozen plasma
Edema
Albumin
Treatment of dehydration/hypovolemia
Isotonic crystalloid
Thrombocytopenia
Platelets
Liver disease
Albumin
Serum albumin >2.5
albumin is not useful
Small bowel resection
TPN
Replacement therapy
depends on fluid lost
Preferred choice rapid correction of severe hypovolemia
Isotonic crystalloid
Impaired platelet function
Platelets
Life threatening hyponatremia with significant water excess
Hypertonic crystalloid: 3% NS
Maintenance fluids
.5 NS
.25 NS
Severe hypovolemia
Don’t use colloids
Hypoglycemia
D5W
Bolus
NS
LR
Plasma-lyte
PRBCs
When crystalloids fail to sustain plasma volume due to low osmotic pressure: considerable protein loss from vascular space (burns, peritonitis)
Colloids
Maintenance fluids for an adult
D5/.5NS with 20 meq KCL
Pre-existing nutritional deprivation
→ unable to tolerate enteral
TPN
What’s better to use that fresh frozen plasma anyhow
Prothrombin complex concentrates
Intra-operative alternative to albumin
Hydroxyethyl Starch
Anticipated/actual inadequate energy intake by mouth
→ adults >7-10 days
→ peds >3-7 days
TPN
