Intravenous Fluids Administration: Flashcards
Identify appropriate infusion rates of intravenous fluids based on patient weight (pediatric)
Holliday-Segar Method (maintenance fluid)
First 10kg = 100ml per kg in 24 hrsSecond 10kg = 50ml per kg in 24hrsOther kg (or remaining kg) = 20ml per kg in 24 hrs.
24 kg child: 1000 ml + 500 ml + 80 ml = 1580 ml / 24 hr = 66 ml/hr
Volume loss best calculated by comparing normal wt with current wt.
1 kg = 1 L.
Replace half of fluid volume replacement dose in 8 hours, the rest over the subsequent 16 hours with ongoing monitoring.
What are the mentioned isotonic solutions within the powerpoint?
Isotonic:
NS, Lactated Ringer’s, D5W (+/-)
What are the mentioned hypotonic solutions within the powerpoint?
Hypotonic:
½ NS, D5W (+/-)
Discuss common indications for initiating and maintaining intravenous (I.V.)
therapy.
I.V. therapy is indicated to achieve or maintain fluid and electrolyte balance, replace or supplement needed blood components, provide nutrients, and administer medications.
Illness and injury alter fluid and electrolyte balance and distribution needs in many ways including:
Non-specific metabolic responses to stress (especially in the seriously ill or injured);
Changes in fluid or electrolyte handling directly attributable to specific organ or system dysfunction or the effects of drugs or other IV therapies used to treat such problems;
Changes in fluid or electrolyte handling due to very restricted recent food intake or malnutrition.
Identify appropriate infusion rates of intravenous fluids based on patient weight (adult)
The rate of correction of volume depletion depends upon its severity.
With severe volume depletion or hypovolemic shock, at least 1 to 2 liters of isotonic saline are generally given as rapidly as possible in an attempt to restore tissue perfusion
Fluid replacement is continued at a rapid rate until the clinical signs of hypovolemia improve (eg, low blood pressure, low urine output,and/or impaired mental status)
Rapid fluid resuscitation is not necessary in patients with mild to moderate hypovolemia.
To avoid worsening of the volume deficit, the rate of fluid administration must be greater than the rate of continued fluid losses, which is equal to the urine output plus estimated insensible losses (usually 30 to 50mL/hour)plus any other fluid losses (e.g. gastrointestinal losses) that may be present.
One regimen used to induce positive fluid balance in such patients is the administration of fluid at a rate that is 50 to 100mL/hourgreater than estimated fluid losses
Discuss guidelines for administration of I.V. fluids to infants and children.
I.V. therapy is indicated to achieve or maintain fluid and electrolyte balance, replace or supplement needed blood components, provide nutrients, and administer medications.
Among children, some of the most common reasons to initiate I.V. therapy are to correct dehydration that occurs most commonly from gastroenteritis and to administer I.V. antibiotics.
Most patients are treated with…
Most patients are treated with isotonic or one-half isotonic saline but the choice of therapy can be influenced by concurrent abnormalities in serum sodium or potassium or the presence of metabolic acidosis.
As examples, hypotonic solutions should be used in ____natremia, isotonic or hypertonic saline should be used in _____natremia, and isotonic salineand/orblood should be used in patients with _______ ______.
Potassium or bicarbonate may need to be added in patients with hypokalemia or metabolic acidosis.
As examples, hypotonic solutions should be used in hypernatremia, isotonic or hypertonic saline should be used in hyponatremia, and isotonic salineand/orblood should be used in patients with blood loss.
Potassium or bicarbonate may need to be added in patients with hypokalemia or metabolic acidosis.
What type of solution is favored by some surgical specialties?
Lactated Ringer’s is favored by surgical specialties
LR has tendency to increase tendency of emboli formation in the midst of PRBC transfusion.
In theory, the calcium in Ringer’s lactate solution could overwhelm the chelating capacities of the citrate in stored blood, resulting in clot formation.
Avoid use in rhabdomyolysis, NS is better choice.
Isotonic saline can induce what with aggressive resuscitation?
Isotonic saline (NS) can induce a metabolic acidosis with aggressive resuscitation.
D5W can induce what after the initial response phase?
Hypertonic saline (3% NS) given in hyponatremia demands astute investigation as to the cause for low sodium. Symptoms are usually more significant when deciding for hypertonic saline. D5W, while isotonic, causes significant electrolyte shifts due to hypotonicity after the initial response phase
D5 1/2 NS is considered an _____ fluid, but studies have shown this IV fluid composition to be _____ to that of NS and LR in that it becomes a more _______ fluid after its initial response.
D5 1/2 NS is considered an isotonic fluid, but studies have shown this IV fluid composition to be inferior to that of NS and LR in that it becomes a more hypertonic fluid after its initial response.
