Management of Fluids and Electrolyte Disorders

Question 1

what are the fluids of choice for treatment true hypovolemia

Answer 1

• normal saline

- lactated ringers (crystalloids)

Question 2

what is the choice for treating hypernatremia in the absence of hyperglycemia or hypovolemia

Answer 2

• D5W

Question 3

what do you use as maintenance fluids

Answer 3

• .5 normal saline

Question 4

what do you have to do when giving .5 normal saline

Answer 4

• monitor volume every day

- monitor electrolytes every day

Question 5

what will correct the acidosis associated with DKA

Answer 5

• insulin and normal saline

Question 6

what is the therapeutic window for IV fluids

Answer 6

• low

Question 7

does BUN contribute to tonicity

Answer 7

• no

Question 8

which patients require stringent monitoring of IV fluids

Answer 8

• elderly
• diabetic patients
• CHF

Question 9

what markers classify orthostatic hypotension

Answer 9

• upon standing up
• 20 point drop in systolic
• 10 point drop in diastolic
• 15 point increase in HR

Question 10

how to measure urine potassium/creatinine ratio

Answer 10

• potassium/creatinine x 100

Question 11

what is D5W

osmolality

tonicitity

Answer 11

• 5% dextrose in water
• isosomotic
• hypotonic

Question 12

how many mEq in normal saline

Answer 12

• 154

Question 13

what is in a lactated ringer

Answer 13

• 130 mEq Na
• 4 mEq K
• 28 mEq lactate

Question 14

what does lactate get broken down to in the liver

Answer 14

• bicarbonate

Question 15

when do you not give lactate

Answer 15

• if someone is having decreased kidney function

Question 16

when do you give 3% hypertonic saline

Answer 16

• someone with symptomatic SIADH with acute hyponatremia

Question 17

when you infuse normal saline, where will it go

Answer 17

• into the ECF

Question 18

when you infuse .5 normal saline, where will it go?

Answer 18

• ECF and some will go into ICF

Question 19

when you infuse D5W where will it go?

Answer 19

• ECF and ICF

- normal water so it’ll diffuse throughout

Question 20

why do you not give bicarb in a person with hypokalemia?

Answer 20

• it would worsen the hypokalemia

Question 21

if someone is hypertonic and hypovolemic, what do you do first

Answer 21

• correct the hypovolemia with normal saline and postural hypotension

Question 22

modifiable targets for sepsis

Answer 22

• lactate

- urine output > 0.5 ml/kg/hr

Question 23

what do we use for a lower acute kidney injury risk

Answer 23

• lactated ringers

Question 24

do we ever use Hetastarch

Answer 24

• no

Question 25

we only use albumin if

Answer 25

• unresponsive to crystalloids

Question 26

avoid albumin if

Answer 26

• there is head trauma

Question 27

central venous pressure is a poor measure of

Answer 27

• cumulative fluid balance

Question 28

first choice for fluid management in critically ill patients

Answer 28

• crystalloids

Question 29

why can D5W cause problems with hypokalemia

Answer 29

• the dextrose will cause insulin release

- insulin uptakes K+ into cells and out of blood which worsens hypokalemia

Question 30

avoid _____ containing fluids with advanced kidney disease

Answer 30

• K+

Question 31

treat _______ before correcting acidosis or adding D5 when possible

Answer 31

• hypokalemia