IV Fluids

Question 1

goals of fluid & electrolyte tx

Answer 1

maintain ECF in normal range, maintain isotonic state (BUN does NOT contribute to tonicity), maintain electrolytes and pH in safe range

Question 2

principles of IVF usage

Answer 2

START and STOP dates, monitor and evaluate

Question 3

who should receive especially stringent monitoring of IVF

Answer 3

elderly, diabetics, CHF

Question 4

a U wave on ECG indicates..

Answer 4

hypokalemia

Question 5

how do you evaluate hyponatremia?

Answer 5

1. serum tonicity, 2. volume status, 3. urinary studies

Question 6

what are the three places that potassium can go in hypokalemia?

Answer 6

cells, urine, stool (extrarenal, diarrhea!)

Question 7

what test do you order to determine the cause of hypokalemia?

Answer 7

urine K+/Cr ratio (13=normal)

Question 8

low K+/Cr ratio is consistent with?

Answer 8

redistribution, decreased intake, diarrhea, remote use of diuretics

Question 9

what do you look at to determine the cause of low bicarb?

Answer 9

arterial blood gases and pH; anion gap

Question 10

what are common causes of normal anion gap metabolic acidosis

Answer 10

diarrhea, RTA, kidney disease

Question 11

D5W is?

Answer 11

isosmotic, but hypotonic (acts like water)

Question 12

normal saline (NS) is?

Answer 12

isotonic; [Na+] = 154 or 0.9g% (9g/L)

Question 13

be cautious with KCl because?

Answer 13

it is caustic to veins when given IV, must give at rate <40

Question 14

lactated ringers may be better for?

Answer 14

circulatory shock

Question 15

NaHCO3 may be used in cases of severe?

Answer 15

metabolic acidosis

Question 16

3% hypertonic saline is?

Answer 16

hypertonic

Question 17

who receives hypertonic saline?

Answer 17

SIADH, symptomatic hyponatremia

Question 18

the purpose of normal saline is to?

Answer 18

expand the ECF volume; all NS distributes into ECF

Question 19

what is the distribution of 1/2 NS?

Answer 19

1/3 into cells, 2/3 into ECF

Question 20

what is the distribution of D5W (or water)?

Answer 20

2/3 into cells, 1/3 into ECF

Question 21

what is the one scenario in which D5W is given to a patient with hypovolemia?

Answer 21

diabetes, because cells are shrunken (water goes into ECF but is lost by diuresis)

Question 22

what is the 4 step assessment for writing IVF orders?

Answer 22

1. ECF volume, 2. tonicity, 3. electrolytic abnormalities, 4. acid-base disturbance

Question 23

IVF tx for diarrhea

Answer 23

normal saline + KCl for hypokalemia

Question 24

which should be treated first: hypokalemia or hypobicarbonemia?

Answer 24

give K+ first, bicarb will worsen hypokalemia (think about maintenance phase of vomiting)

Question 25

in a pt with hypovolemic hypertonic hypernatremia, what should be done?

Answer 25

1. restore volume with NS, 2. restore water deficit

Question 26

how to calculate water deficit

Answer 26

(0.5*weight in kg) x (measured Na/140 - 1)

Question 27

if replenishing a water deficit, give it over ____ amount of time

Answer 27

24 hours

Question 28

early goal directed tx in septic shock (SBP less than 90)

Answer 28

NS or lactated ringers (better than colloidal solutions) decreases mortality and risk of AKI

Question 29

what is the best measure of cumulative fluid balance?

Answer 29

trends in weight (not central venous pressure)

Question 30

fluid management in critically ill patients

Answer 30

1. EGDT, 2. monitor weight, 2. AVOID FLUID OVERLOAD (goal pH 7.2)

Question 31

name two mechanisms by which endurance exercise may result in hyponatremia

Answer 31

1. pain induces SIADH, 2. increased water intake

Question 32

tx of exercise-associated hyponatremia

Answer 32

3% (hypertonic) saline

Question 33

tx of SIADH

Answer 33

3% saline (monitor every 1-2 hours)

Question 34

what should not be given to a hypokalemic pt?

Answer 34

NaHCO3 or D5W (will worsen hypokalemia)

Question 35

what should be avoided in pts with advanced kidney disease?

Answer 35

IV potassium

Question 36

NS and LR are the fluids of choice for treating?

Answer 36

true hypovolemia (usually seen in setting of metabolic acidosis and hypokalemia - always tx hypokalemia first)

Question 37

D5W is fluid of choice for?

Answer 37

hypernatremia IF no hyperglycemia or hypovolemia (if hypovolemic then NS first, then water replenishment)

Question 38

1/2 NS is used for?

Answer 38

maintenance fluids, but monitor closely because 1/3 have SIADH and are prone to hyponatremia

Question 39

IVF tx for DKA

Answer 39

insulin + NS