Parenteral Fluid Therapy

Question 1

ICF ion composition?

Answer 1

K+, Mg2+, Na+

Prot-, PO4-

Question 2

ECF ion composition?

Answer 2

Interstitial:
Na+
HCO3-, Cl-

Plasma (25% of ECF vol):
Na+
Prot-, HCO3-, Cl-

Question 3

Total Body Water eqn?

Answer 3

TBW = weight kg x 0.60
ICF = TBW x 2/3
ECF = TBW x 1/3

Question 4

IVFluid: Crystalloids?

Answer 4

Na+ = main osmotically active particle

Question 5

IVFluid: Colloids?

Use when?

Answer 5

higher MW substances
(U) stay in vascular compartment

low osmotic pressure = crystalloids Ø maintain plasma vol

Question 6

IVFluid: Blood/Blood Products?

Answer 6

RBC’s

stay in vascular compartment

Question 7

Isotonic Crystalloids?

Distribution?

Tx?

Answer 7

same [Na+] as normal cells:
NS 0.9%
Lactated Ringer’s NaCl, K+, Ca2+, lactate

Distribute evenly throughout ECF

Dehydration

Question 8

Hypertonic Crystalloids?

Tx?

Misuse causes?

Answer 8

higher [Na+] than normal cells:
NS 3%

life-threatening hypoNa+ w/ high water excess

osmotic demyelination,
central pontine myelinolysis

Question 9

Hypotonic Crystalloids?

Distribution?

Tx?

Answer 9

lower [Na+] than normal cells:
NS 0.5, 0.25

Throughout total body water

Maintenance fluids
*can not replace intravascular volume deficits

Question 10

Other Crystalloids?

Distribution?

Tx?

Answer 10

D5W 5% dextrose in water

throughout total body water

hypoglycemia

Question 11

Albumin Colloid?

Action?

Tx?

Answer 11

5% or 25% albumin

move interstit fluid into vascular space

Edema or 3rd Spacing

Question 12

Dextran Colloid?

Action?

Tx?

Answer 12

40, 70 MW glucose polymer

expands intravascular vol equal to amount infused

alternate to albumin

Question 13

Hydroxyethyl Starch Colloid?

Action?

Tx?

Answer 13

hetastarch glycogen-like molecule

expands vascular vol >= amount infused

alternate to albumin (cheaper)

Question 14

Packed RBCs used w/?

Distribution?

Tx?

Answer 14

crystalloids to expand intravascular volume

stays in vascular space

blood transf

Question 15

Platelets used for?

Answer 15

thrombocytopenia
impaired platelet fxn
prevent/treat bleeding

Question 16

Bolus IVF:

Preparations used?

Amount?

Tx?

Answer 16

NS, LR, PRBCs

250 mL/1 L

hypovolemia

Question 17

Maintenance IVF:

Preparations used?

Tx?

Answer 17

D5/0.5 NS w/ 20 meq KCL

Abnormal food/fulid intake -> maintains ongoing H2O/elec loss FROM NORMAL urine/sweat/resp/stool

Question 18

Maintenance IVF: amount calculation for Normal Adult?

Answer 18

Kg Method (body weight):
1st 10 kg -> 100 ml/kg/day
2nd 10 kg -> 50 ml/kg/day
>20 kg -> 20 ml/kg/day

Total / 24 to get hrly rate

Question 19

Maintenance IVF: amount calculation for Normal Child?

Answer 19

USE 0.25 NS

Kg Method (body weight):
< 10 kg -> 100 ml/kg

> 10 to 20 kg -> 1000 ml 1st 10kg + 50 ml/kg over 10

> 20 to 80 kg -> 1500 ml 1st 20kg + 20 ml/kg over 20 (max 2400 ml/day)

Total / 24 to get hrly rate

Question 20

Maint IVF + K+: Used for?

Caution?

Answer 20

hypoK+ or NPO pt

NEVER use K+ in bolus
Careful in kidney dz

Question 21

Replacement IVF used for?

Answer 21

existing H2O/elec deficit from

GI/urine/skin/blood/3rd spacing loss

Question 22

Replacement IVF amount/rate for moderate hypovol?

Answer 22

50 - 100 ml/hr in excess of continued loss

Question 23

Replacement IVF amount/rate for hypovol WITH significant hypoNa+ or hyperNa+?

Answer 23

slower correction

Question 24

Replacement IVF for burn pts?

Answer 24

USE LR

Parkland Formula:
Total fluid requirement 1st 24 hrs =
% 3rd and 4thº x body weight kg x 4 mL

Infuse 1/2 total amount in 1st 8hrs,
1/4 in 2nd 8 hrs
1/4 in 3rd 8 hrs

Question 25

Rule of 9s

Answer 25

``` Each arm = 9% Head = 9% Ant/Post trunk = 18% each Each leg = 18% Perineum = 1% ```

Question 26

Inadequate nutritional intake tolerable for how long?

Answer 26

1 - 2 wks

Question 27

TPN venous access?

Answer 27

CENTRAL via SVC

Question 28

PPN venous access?

Answer 28

PERIPHERAL