McGowan: Adult IVF Flashcards
What is a crystalloid?
- pass readily through a membrane (between intravascular and extravascular fluid compartments
- saline or LR
colloid
- do not pass readily through a membrane
- albumin or hetastarch
Isotonic
-solution is close to that of plasma
Free water
-water that is not bound by macromolecules
Hypotonic
-solution has less osmotic pressure than plasma
Hypertonic
-solution has more osmotic pressure than plasma
What is in 1/2 NS?
-77 of Na and CL
NS
-154 of Na and Cl
D5W
- 170Kcal/L
- 50g/L of Glucose
D10W
just double D5W
What fluid is used in hypoglycemia
-D10W
What is LR?
-has a lot of things in it
What is 3% NaCl?
-513 Na and Cl
How does the sizes of the needles work?
-the smaller the number, the bigger the needle
How do we calculate maintenance hourly fluids?
- 4 mL for each kg 1-10
- 2 mL for each kg 11-30
- 1 mL for each kg >30
So how much fluid would a 70 kg person need?
-120 mL/hr
How do you calculate Body water Deficit?
0.6x weight (kg)x (pt Na- normal Na)/normal Na
What are the isotonic fluids we could give?
- 0.9% NaCl…. Normal saline
- Lacated ringers: contains the cations K and Ca
What do we use NS and LR for?
-expand EC fluid volume
What do we use just NS for?
- hypovolemia
- peri/post operative fluid management
- shock… any cause
- hemorrhage
- burns
What do we use a lactated ringer for?
- vascular expansion
- electrolyte replacement
What can NS cause if we aren’t careful?
-hyperchloremic metabolic acidosis
What do we have to worry about with LR’s
- calcium can bind to certain drugs and reduce their bioavailability and efficacy
- contraindicatesd as a diluent for blood transfusions**
If we want to expand EC fluid volume and add free water, what fluid do we use?
- hypotonic kind
- D5W
- 1/2 of 1/4 NS
What cautions should we use with hyptonic IVF’s?
- if used for ECFV depletion…. dangerous hyponatremia
- so monitor sodium closely**
- It could also worsen hypotension, increase edema
What is our hypertonic solutions?
- 3% NaCl
- D5NS
- N5(1/2)NS
- D5LR
Uses for hypertonic
- 3% NS tx of severely symptomatic yponatremia
- D5NS for head injury patients
Cautions with hypertonic IVF’s
- frequently monitor sodium and correct SLOWLY**
- fluid overload
- Iatrogenic hypernatremia
- irritating to veins
Isotonic
-stay where I put it
Hypotonic
-go Out of the vessel and into cells
HyperTonic
- Enter the vessel
- shifts fluid back into circulation
What happens with the glucose in all of the “D” solutions?
- 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
