Management of Fluids and Electrolyte Disorders Flashcards
what are the fluids of choice for treatment true hypovolemia
- normal saline
- lactated ringers (crystalloids)
what is the choice for treating hypernatremia in the absence of hyperglycemia or hypovolemia
- D5W
what do you use as maintenance fluids
- .5 normal saline
what do you have to do when giving .5 normal saline
- monitor volume every day
- monitor electrolytes every day
what will correct the acidosis associated with DKA
- insulin and normal saline
what is the therapeutic window for IV fluids
- low
does BUN contribute to tonicity
- no
which patients require stringent monitoring of IV fluids
- elderly
- diabetic patients
- CHF
what markers classify orthostatic hypotension
- upon standing up
- 20 point drop in systolic
- 10 point drop in diastolic
- 15 point increase in HR
how to measure urine potassium/creatinine ratio
- potassium/creatinine x 100
what is D5W
osmolality
tonicitity
- 5% dextrose in water
- isosomotic
- hypotonic
how many mEq in normal saline
- 154
what is in a lactated ringer
- 130 mEq Na
- 4 mEq K
- 28 mEq lactate
what does lactate get broken down to in the liver
- bicarbonate
when do you not give lactate
- if someone is having decreased kidney function
when do you give 3% hypertonic saline
- someone with symptomatic SIADH with acute hyponatremia
when you infuse normal saline, where will it go
- into the ECF
when you infuse .5 normal saline, where will it go?
- ECF and some will go into ICF
when you infuse D5W where will it go?
- ECF and ICF
- normal water so it’ll diffuse throughout
why do you not give bicarb in a person with hypokalemia?
- it would worsen the hypokalemia
if someone is hypertonic and hypovolemic, what do you do first
- correct the hypovolemia with normal saline and postural hypotension
modifiable targets for sepsis
- lactate
- urine output > 0.5 ml/kg/hr
what do we use for a lower acute kidney injury risk
- lactated ringers
do we ever use Hetastarch
- no
we only use albumin if
- unresponsive to crystalloids
avoid albumin if
- there is head trauma
central venous pressure is a poor measure of
- cumulative fluid balance
first choice for fluid management in critically ill patients
- crystalloids
why can D5W cause problems with hypokalemia
- the dextrose will cause insulin release
- insulin uptakes K+ into cells and out of blood which worsens hypokalemia
avoid _____ containing fluids with advanced kidney disease
- K+
treat _______ before correcting acidosis or adding D5 when possible
- hypokalemia
