Fluid Replacement

Question 1

What do we replenish with IV fluids?

Answer 1

intravascular space (plasma)

Question 2

TBW % for females

Answer 2

50%

Question 3

TBW % for males

Answer 3

60%

Question 4

TBW % for newborns

Answer 4

80%

Question 5

Why are infants and young children more vulnerable to dehydration?

Answer 5

high metabolic H20 turnover daily/hour
larger SA relative to their weight
greater % of TBW located in ECF (fluid in EC is more available for transfer to environment and is more readily available for evaporation –> dehydration)

Question 6

Sensible losses of fluid

Answer 6

urine
sweat
feces
vomitus

Question 7

Insensible losses of fluid

Answer 7

metabolic water (high metabolic = lose more)
evaporation from skin
evaporation from respiratory tract

insensible is relatively larger component in infants and young children

Question 8

Fluid loss rises during increased:

Answer 8

metabolic rate
fever
ambient temperature

Question 9

What is the first choice for resuscitation

Answer 9

isotonic fluid - normal saline = 0.9% saline

bc fluid needs to stay in the intravascular space

Question 10

what is the fluid choice for burn patient or surgical?

Answer 10

lactated ringers

Question 11

hypotonic solution

Answer 11

full of water –> swelling of cells

Question 12

hypertonic solution

Answer 12

full of solutes –> shrinking of cell

Question 13

Quick calculation for calculating hourly rate in adult (for weight > or equal to 20 kg)

Answer 13

Weight in kg + 40

Question 14

Na+ needs over 24H

Answer 14

30 mEq/L

Question 15

K+ needs over 24H

Answer 15

20 mEq/L

Question 16

Cl- needs over 24H

Answer 16

20 mEq/L

Question 17

1 L H2O =

Answer 17

1 kg

Question 18

1 kg =

Answer 18

2.2 lbs

Question 19

how are deficits given?

Answer 19

first 1/2 given over 8 hours

second 1/2 given over 16 hours

Question 20

Where is most sodium lost from?

Answer 20

the ECF

Question 21

amount of sodium last during first 3 days of illness

Answer 21

80% of H20 volume and Na+ are lost from the ECF
20% of H20 volume and Na+ are lost from ICF

Question 22

amount of sodium and water lost after day 3 of illness

Answer 22

60% of H20 volume and Na+ are lost from ECF
40% of H20 volume are Na+ are lost from ICF

Question 23

Total hourly rate is determined by calculating…

Answer 23

maintenance fluids + deficits - any initial bolus

Question 24

what tells us the RATE of fluid replacement

Answer 24

H2O

Question 25

What tells us the TYPE of fluid replacement

Answer 25

Na+

Question 26

Fluids given for volume expansion

Answer 26

crystalloid colloid

Question 27

Crystalloid fluid

Answer 27

water soluble electrolytes in solution exert a significant hydrostatic effect (pushes against walls to increase volume)

Question 28

colloid fluid

Answer 28

larger molecules suspended in aqueous solution; exert oncotic effect (pulls fluid in and retains it in intravascular space and doesn't let it go out to interstitial space) Natural: albumin, fresh frozen plasma (FFP), blood Synthetic: hetastarch

Question 29

What fluid should you use for acidosis

Answer 29

lactated ringers --> convert HCO3- in the liver

Question 30

What fluid for burns

Answer 30

saline solution from maintenance plus LR for deficit replacement

Question 31

What fluid for pyloric stenosis (babies --> projectile vomit --> hypochloremic, hypokalemic, metabolic alkalosis)

Answer 31

D5 0.45% NS or D10 0.45% NS Dextrose adds some calories (bc vomiting) Avoid LR due to alkalosis

Question 32

Effects of adding dextrose to maintenance fluids

Answer 32

water will be drawn into the intracellular compartment more effectively some calories -- but minimal -- may decrease ketone generation (prevents ketone generation so can be used for someone with DKA)

Question 33

For fever

Answer 33

add 10-12% to maintenance fluid per degree C above 37.8 degree C (99F) bc higher metabolic demands

Question 34

For burns: do not give KCl

Answer 34

cell lysis --> intracellular K+ release Rhabdomyolysis secondary to burn --> increased K+ patient will be hyperkalemic

Question 35

Daily need of Na+ if we are well

Answer 35

30 mEq/L or 3 mEq/100 mL

Question 36

signs of fluid overload

Answer 36

edema hepatic congestions crackles on lungs

Question 37

What tells us HOW MUCH solution

Answer 37

water

Question 38

Why is 0.22% NS banned from some hospitals

Answer 38

too hypotonic and often causes hemolysis