McGowan: Adult IVF

Question 1

What is a crystalloid?

Answer 1

• pass readily through a membrane (between intravascular and extravascular fluid compartments
• saline or LR

Question 2

colloid

Answer 2

• do not pass readily through a membrane

- albumin or hetastarch

Question 3

Isotonic

Answer 3

-solution is close to that of plasma

Question 4

Free water

Answer 4

-water that is not bound by macromolecules

Question 5

Hypotonic

Answer 5

-solution has less osmotic pressure than plasma

Question 6

Hypertonic

Answer 6

-solution has more osmotic pressure than plasma

Question 7

What is in 1/2 NS?

Answer 7

-77 of Na and CL

Question 8

NS

Answer 8

-154 of Na and Cl

Question 9

D5W

Answer 9

• 170Kcal/L

- 50g/L of Glucose

Question 10

D10W

Answer 10

just double D5W

Question 11

What fluid is used in hypoglycemia

Answer 11

-D10W

Question 12

What is LR?

Answer 12

-has a lot of things in it

Question 13

What is 3% NaCl?

Answer 13

-513 Na and Cl

Question 14

How does the sizes of the needles work?

Answer 14

-the smaller the number, the bigger the needle

Question 15

How do we calculate maintenance hourly fluids?

Answer 15

• 4 mL for each kg 1-10
• 2 mL for each kg 11-30
• 1 mL for each kg >30

Question 16

So how much fluid would a 70 kg person need?

Answer 16

-120 mL/hr

Question 17

How do you calculate Body water Deficit?

Answer 17

0.6x weight (kg)x (pt Na- normal Na)/normal Na

Question 18

What are the isotonic fluids we could give?

Answer 18

• 0.9% NaCl…. Normal saline

- Lacated ringers: contains the cations K and Ca

Question 19

What do we use NS and LR for?

Answer 19

-expand EC fluid volume

Question 20

What do we use just NS for?

Answer 20

• hypovolemia
• peri/post operative fluid management
• shock… any cause
• hemorrhage
• burns

Question 21

What do we use a lactated ringer for?

Answer 21

• vascular expansion

- electrolyte replacement

Question 22

What can NS cause if we aren’t careful?

Answer 22

-hyperchloremic metabolic acidosis

Question 23

What do we have to worry about with LR’s

Answer 23

• calcium can bind to certain drugs and reduce their bioavailability and efficacy
• contraindicatesd as a diluent for blood transfusions**

Question 24

If we want to expand EC fluid volume and add free water, what fluid do we use?

Answer 24

• hypotonic kind
• D5W
• 1/2 of 1/4 NS

Question 25

What cautions should we use with hyptonic IVF’s?

Answer 25

• if used for ECFV depletion…. dangerous hyponatremia
• so monitor sodium closely**
• It could also worsen hypotension, increase edema

Question 26

What is our hypertonic solutions?

Answer 26

• 3% NaCl
• D5NS
• N5(1/2)NS
• D5LR

Question 27

Uses for hypertonic

Answer 27

• 3% NS tx of severely symptomatic yponatremia

- D5NS for head injury patients

Question 28

Cautions with hypertonic IVF’s

Answer 28

• frequently monitor sodium and correct SLOWLY**
• fluid overload
• Iatrogenic hypernatremia
• irritating to veins

Question 29

Isotonic

Answer 29

-stay where I put it

Question 30

Hypotonic

Answer 30

-go Out of the vessel and into cells

Question 31

HyperTonic

Answer 31

• Enter the vessel

- shifts fluid back into circulation

Question 32

What happens with the glucose in all of the “D” solutions?

Answer 32

• gets taken up by cells and does not change the glucose concentration of the pt
• but! in a diabetic pt, glucose may not be assimilated into the cells and they can develop hyperglycemia