Fluids, fluids, and more fluids Flashcards
A 25-year-old athlete presents with symptoms of hyponatremia following a marathon. What is the initial assessment and management for exercise-associated hyponatremia?
What specific electrolyte needs to be monitied and why
- LR would be the best fluid choice because of the multiple electrolytes present in the fluid and NS would likely be too acidic
- Need to closely monitor Na+ and make sure you dont correct the level too rapidly
- If Na+ is corrected too rapidly it will lead to osmotic demylenation syndrome
An 80-year-old patient with end-stage renal disease on hemodialysis presents with hypotension. What fluid would be the best choice to treat this patient and why
What things need to be monitored
.9% normal saline because a patient with ESRD often require sodium containing fluid without the other electrolytes (specificaly K+)
Need to be careful to monitor electrolyte levels and fluid levels
What management would be best to prevent third spacing
- Crystalloids like LR / plasmalyte to maintain the bodies normal electrolyte balance can help keep fluid intravascularly.
- limit excessive fluid resucitation
- manage urine output and blood pressure
- early mobility
w/ major surgery colloids like albumin or vasopressors can be useful
A 4-year-old child presents with sunken eyes, dry mucous membranes, and decreased skin turgor. What is the initial fluid of choice for rehydration
LR
A 60-year-old patient with congestive heart failure presents with peripheral edema and shortness of breath. Which diuretic is commonly used to manage fluid overload in this patient?
Furosemide (lasix)
A patient with acute kidney injury has oliguria. What is the primary goal of fluid management in this patient?
And what type of fluid?
Administer isotonic fluids to maintain blood pressure
A 45-year-old patient presents with signs of severe sepsis. Which type of intravenous fluid is recommended for initial resuscitation
What are examples of this fluid
Crystalloids
D5W, LR, NS
A patient with cirrhosis presents with ascites. Which medication is commonly used to manage fluid retention in these patients?
Loop diuretics
A patient presents with excessive thirst and urination. A water deprivation test reveals the inability to concentrate urine. What is the name of this condition and what is the treatment of choice?
Diabetes insipidus
DDAVP (desmopressin)
A patient with end-stage renal disease has a potassium level of 6.5 mEq/L. What is occuring in this patient and what do you give to immediately treat it.
Hyperkalemia
Insulin/glucose infusion
How does an insulin and glucose infusion help with hyperkalemia
Glucose pushes K+ back into the cells and insulin prevents hypoglycemia. This act stabilizes the cardiac membrane potential and lowers potassium level quickly.
An elderly patient presents with confusion and a serum sodium level of 120 mEq/L. What is the most likely diagnosis and what is the most appropriate treatment
Hyponatremia
3%NS or mannitol
A 5-year-old child presents with a history of vomiting and diarrhea. How would you assess the degree of dehydration in this pediatric patient
Dry Mucous Membranes: Dry mucous membranes, particularly dry mouth and dry lips, may indicate moderate dehydration.
Very Dry or Sticky Mucous Membranes: Severely dry or sticky mucous membranes, along with other signs like sunken eyes, decreased urine output, and lethargy, could indicate severe dehydration.
A trauma patient arrives at the emergency department with profuse bleeding. Describe the signs and symptoms of hypovolemic shock, and outline the immediate management steps
- Patient needs a type and screen, PRBCs and a cell saver
- Patient will be pale, tachycardic, and hypotensive
A 70-year-old patient is admitted with sepsis. What is the preferred fluid of choice for initial resuscitation, and what parameters would you monitor to assess the patient’s response to fluids
- Patient should be given LR
- Monitor HR, electrolyte balance, Kidney function, and blood pressure
