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X Clin Lab Med > Parenteral Fluids > Flashcards

Parenteral Fluids Flashcards

1
Q

Crystalloid IVF

A

Solutions that contain sodium as main osmotically active particle (most common)

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2
Q

Colloid IVF

A

Solutions that contain high-molecular weight substances that do not migrate easily across cap walls (more likely to stay in vascular compartment)

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3
Q

Blood/blood product IVF

A

RBCs similar to colloids because they stay in vascular space

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4
Q

Isotonic crystalloids

A

Solutions with same salt concentration as normal cells of body
*most commonly used crystalloid cause similar to body
Ex: normal saline (.9% NaCl/NS), lactated ringer’s solutions, plasma-lyte

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5
Q

Hypertonic crystalloid

A

A solution with higher salt concentration than normal cells of body
Ex: 3% normal saline

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6
Q

Hypotonic crystalloid

A

Solutions with lower salt conc than normal cells of body

Ex: .5 or .25 NS (more in kids)

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7
Q

Other types of crystalloids

A

D5W (5% dextrose in water)

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8
Q

What does lactated ringer’s solution contain?

A

Lactate, K+ and Ca2+ in addition to NaCl

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9
Q

What does plasma-lyte contain?

A

Contains less chloride then the other isotonic crystalloids

Thought to be most physiologic solution

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10
Q

What do isotonic crystalloids do?

A

Distribute uniformly throughout ECF space

Interns prefer NS but surgeons like LR

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11
Q

When are isotonic crystalloids used?

A

For tx of dehydration or hypovolemia (when severe should be corrected ASAP to correct intravascular vol depletion)
*crystalloids are preferred choice

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12
Q

What are used for IV-boluses?

A

NS, LR and plasma-lyte (or PRBCs)

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13
Q

When is a hypertonic crystalloid used mostly?

A

Mostly used in situations where there is life-threatening hyponatremia with significant water excess
*must calculate replacement rate

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14
Q

What could overly rapid correction with a hypertonic crystalloid lead to?

A

Osmotic demyelination or central pontine myelinolysis

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15
Q

How do hypotonic crystalloids work?

A

Distribute throughout total body water

Used for maintenance fluids

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16
Q

When are hypotonic crystalloids inadequate?

A

For replacing intravascular vol deficits (not used for tx of dehydration/hypovolemia)

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17
Q

How does D5W work?

A

Similar total body water distribution to hypotonic crystalloids
Used to treat hypoglycemia (caution in DM)

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18
Q

When are colloids used?

A

When crystalloids fail to sustain plasma vol due to low osmotic pressure (b/c more likely to expand vascular compartment)

ex: pt with burns or peritonitis when there is considerable protein loss from vascular space
* more expensive

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19
Q

Colloid preparations

A

5 or 25% albumin
Dextran 40 or 70 (dif molecular weight)
Hydroxyethyl starch (hetastarch)

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20
Q

When are albumin preparations used?

A

Edematous pts to mobilize interstitial fluid into vascular space (not when pts albumin >2.5)

21
Q

What pts are albumin preps most helpful for?

A

With liver disease, peritonitis or burns, surgical pts or experiencing third-spacing

22
Q

What is third spacing?

A

Concept that body fluids collect in a third body compartment that isn’t normally perfused with fluids

23
Q

What is Dextran?

A

Synthetic glucose polymer which expands intravascular vol equal to amount infused
Less frequent than albumin

24
Q

What is hydroxyethyl starch?

A

Glycogen-like synthetic molecule that increases vascular vol to an amount > vol infused
Less expensive than albumin (so alternative)

25
Q

Types of blood products?

A

Packed RBCs
Platelets
Fresh frozen plasma

26
Q

When are packed RBCs used?

A

With crystalloids to expand intravascular vol (remain entirely within vascular space)
For blood transfusions

27
Q

When are platelets used?

A

Pts with thrombocytopenia or impaired platelet function to prevent or treat bleeding

28
Q

When is fresh frozen plasma used?

A

To correct major bleeding complications in pts on warfarin and/or with vitamin k deficiency

29
Q

Different amounts of IVF given at a time

A

Bolus (large amt at once)
Maintenance
Replacement

30
Q

When do you use a bolus IVF?

A

Hypovolemia (dehydration or acute blood loss)
Can give 250 ml-1 L bolus
Caution with HF

31
Q

What does maintenance IVF account for?

A

Ongoing losses of water and electrolytes under normal physiologic conditions via urine, sweat, respirations and stool

32
Q

When is maintenance IVF used?

A

When pts not eating or drinking normally (provide water and electrolyte balance)

33
Q

Normal maintenance IVF used

A

D5/.5 NS with 20 meq KCl (always dependent on clinical scenario)

34
Q

kg method for determining maintenance IVF in normal adult pts

A

For 1st 10kg of body wt–100 ml/kg/day
For 2nd 10kg of body wt–50 ml/kg/day
For weight >20 kg–20 ml/kg/day
Divide total of above by 24 hrs to determine hourly rate of infusion

35
Q

When would potassium be added to maintenance IVF?

A

Treat hypokalemia or for maintenance if pt is NPO
*never use bolus potassium-containing IVF
Caution when replacing K in pt with kidney disease

36
Q

What does replacement IVF do?

A

Correct any existing water and electrolyte deficits caused by GI, urinary, skin or blood losses or third spacing
*type used depends on electrolyte disturbances and type of fluid lost

37
Q

What to remember when pt is hypo or hypernatremic with replacement IVG

A

Caution exercised to avoid overly rapid correction (lead to demyelination or CPM)

38
Q

Replacement with a surgery pt

A

Need maintenance fluids and replacement of fluids lost (urine output, blood loss, third spacing due to intervention at operating site-abdomen)
Monitor urine output and vital signs

39
Q

Parkland formula for burn pts

A

Total fluid required during first 24 hrs= (% of 2nd and 3rd degree burns) x (body weight in kg) x 4 ml
Replace with LR:
1/2 total amount infused during 1st 8 hrs
1/4 total during 2nd 8 hrs
1/4 total during 3rd 8 hrs

40
Q

Rule of nines for burn pts

A 
Each arm is 9%
Head is 9%
Anterior and posterior trunk 18% each
Each leg is 18%
Perineum is 1%
41
Q

How does body compensate for inadequate nutrient intake?

A

Breakdown glycogen stores, gluconeogenesis, lipolysis and amino acid oxidation from muscle

42
Q

Types of parenteral nutrition

A

Total parenteral nutrition (TPN)

Peripheral parenteral nutrition (PPN)

43
Q

Indications for total parenteral nutrition

A

Small bowel resection
Complete bowel resection
IBD
Bowel rest may induce remission
Pre-existing nutritional deprivation (not tolerate nutrition)
Anticipates or actual inadequace energy intake by mouth
Significant multisystem disease

44
Q

Route of entry for TPN

A

Central venous access via SVC (most common type of access)

Support here expected to be longer term (>7 days)

45
Q

Route of entry for PPN

A 
Peripheral venous access
Infrequently used (support expected to be short tern <7 days)
46
Q

Why is central vein administration preferred for TPN?

A

Avoid intimal damage and thrombophlebitis due to osmolality of solution

47
Q

What to monitor while on TPN

A

Ins and outs
Daily weights
Labs (lytes, BUN, creatinine, BMP, LFTs-daily to weekly while inpatient)

48
Q

Complications associated

A 
Metabolic/lyte abnormalities
Cath related:
Air embolism
Pneumothorax
cath-associated DVT
Catheter infection
Thrombophlebitis

X Clin Lab Med (4 decks)

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