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Flashcards in IV Fluids Deck (76):
1

Things to Consider with IV Fluids

Why an IV?
Know your patient: age, heart/lung/kidney problems
Watch for signs of dehydration
Monitor: weight, BP, HR, BMP, & urine output

2

Disorders of Volume in a Surgical Patient

Depletion
Excess

3

Disorders of Electrolyte Concentrations

Sodium
Potassium
Chloride
Calcium
Magnesium
Phosphate

4

Sequelae of Inappropriate Fluid & Electrolyte Management

Increased length of stay
Increased cost
Wound infection
Delayed wound healing
Anastomotic failure
Tachyarrhythmias
Cerebral edema, seizures, death
Pulmonary edema, CHF, renal failure

5

3 Things to Accomplish with IV Therapy

Maintenance therapy
Replacement therapy
Volume resuscitation

6

Reason for Maintenance Therapy

Patient not expected to eat or drink for a while

7

Reason for Replacement Therapy

Correct abnormalities in volume and/or electrolytes

8

Reasons for Volume Resuscitation

Hypotension
Hemorrhage

9

What does total body water depend on?

Age
Gender
Muscle mass
Fat

10

Total Body Water as a % of Weight Decreases in

Morbidly obese individuals
Elderly
People with low muscle mass due to disease or injury

11

How much of total body weight does the intracellular fluid hold?

2/3

12

How much of total body weight does the extracellular fluid hold?

1/3

13

What does the plasma portion of the ECF contain?

Main: Na+
Cations: K+, Ca++, Mg++
Anions: Cl-, HCO3-, proteins, sulfates, organic acids

14

What does the ICF contain?

Main: K+, Mg++
Anions: phosphates, sulfates, & proteins

15

What can flow freely among all of the compartments in the body?

Water

16

Normal Body Fluid Osmolarity

285 osmol/L

17

Types of Fluid Replacement Products

Crystalloids
Colloids

18

Types of Crystalloids

Dextrose in water
Saline
Combination
Ringer's Lactate (physiologic)

19

Examples of Colloids

Albumin
Dextran
Hetastarch
Blood
FFP

20

Define Crystalloid

Solution that contains small molecules & are able to pass through semi-permeable membranes

21

Define Colloid

Solutions that contain high molecular weight proteins or starch
Can not cross semi-permeable membranes
Remain in the intravascular space

22

When are colloids indicated?

Rapid hemodynamic equilibration is required

23

What is important when addressing a specific situation?

Composition of the solution
Rate of administration

24

Why are isotonic solutions given?

To expand the ECF volume

25

Why are hypotonic solutions given?

To reverse dehydration

26

Why are hypertonic solutions given?

To increase the ECF volume & decrease cellular swelling

27

Examples of Isotonic Fluids

Normal Saline
Ringer's solution
Lactated Ringers

28

What does Ringer's solution contain?

Sodium
Potassium
Calcium

29

What is missing from Ringer's solution?

Dextrose
Magnesium
Bicarbonate
Calories
Free water

30

What does Lactated Ringer's contain?

Sodium
Potassium
Calcium
Chloride
Lactate

31

What is missing from Lactated Ringer's

Dextrose
Magnesium
Free water

32

What is hypotonic solutions used for?

Prevent & treat cellular dehydration by providing free water to the cells

33

Contraindications to Hypotonic Solutions

Acute brain injuries

34

Why are hypotonic solutions contraindicated in acute brain injuries?

Cerebral cells are very sensitive to free water, absorbing it rapidly & leading to cerebral cellular edema

35

Examples of Hypotonic Fluids

5% dextrose in water (D5W)
1/2 NS
1/4 NS

36

D5W & the Body

Dextrose metabolized
Free water shifts from vessels to cells

37

1/2 NS & 1/4 NS & the Body

Provide free water to cell as well as small amounts of sodium & chloride
Frequently used as maintenance therapy

38

Adverse Effects of Normal Saline (NS)

Fluid overload
Metabolic acidosis
Hypernatremia

39

Adverse Effects of Lactated Ringer's

Fluid overload
Hyponatremia
Hyperkalemia

40

Adverse Effect of D5W

Hyponatremia

41

Clinical Types of Volume Deficit

Total body water
Extracellular
Intracellular

42

Total Body Water Volume Deficit

Water loss
Ex: diabetes insipidus, osmotic diarrhea

43

Extracellular Volume Deficit

Salt & water loss
GI tract losses
Third spacing

44

Examples of Salt & Water Loss in Extracellular Volume Deficit

Secretory diarrhea
Ascites
Edema

45

Examples of GI Tract Losses

Vomiting
Diarrhea
NG Sx
Enteric fistulas

46

Intravascular Volume Deficit

Acute hemorrhage

47

Define "Third Space"

Acute sequestration in a body compartment that is not in equilibrium with ECF

48

Causes of Third Spacing

Intestinal obstruction
Severe pancreatitis
Peritonitis
Major venous obstruction
Capillary leak syndrome
Sepsis

49

Clinical Parameters to Help Judge Degree of Volume Loss

Weight loss
BP
JVP
Urine sodium concentration
Urine output
HCT

50

States of Increased Fluid Loss

Fever
Burns
Sepsis
Gastric fistulas
Surgical drains
Other states of increased metabolic activity

51

Clinical Findings of Extracellular Fluid Depletion

Thirst
Decreased urine output
Weight loss
Drowsiness to coma
Decreased skin turgor
Dry mucous membranes
Sunken eyes
Tachycardia
Orthostatic hypotension progressing to hypotension

52

Lab Findings in Extracellular Fluid Depletion

Increased HCT
Elevated BUN/Creatinine
Elevated urine sodium
Urine specific gravity >1.020

53

Clinical Signs to Monitor in Extracellular Fluid Depletion

Hemodynamic parameters
Urine output
Daily weights
Daily labs: HCT, BMP

54

Signs of HypOvolemia

Orthostatic hypotension
Tachycardia
Flat neck veins
Decreased skin turgor
Dry mucosa
Supine hypotension
Oligouria
Organ failure

55

Signs of HypERvolemia

Hypertension
Tachycardia
Increased JVP
Gallop
Edema
Pleural effusion
Pulmonary edema
Ascites
Organ failure

56

Management of Hypovolemic Shock

1-2 L of isotonic solution on rapid infusion
Continue until clinical signs begins to improve

57

Type of Replacement Fluid in Hypovolemic Shock

Blood up to a HCT of 35%
Then crystalloid vs. colloid (need more crystalloid than colloid)

58

Advantages of Albumin over an Isotonic Saline

More rapid volume expansion
Lesser risk of pulmonary edema due to dilutional hypoalbuminemia

59

Disadvantages of Albumin over an Isotonic Solution

Cost
Not as readily available

60

Why not hyperoncotic starches in treatment of hypovolemia?

Increased risk of acute kidney injury
Increased mmortality

61

What should be given if a patient becomes acidotic on isotonic saline for the treatment of hypovolemia?

Add sodium bicarbonate to the infusate

62

Treatment of Mild to Moderate Hypovolemia

Administer isotonic solution at a rate greater than the rate of continued fluid losses

63

Continued Fluid Loss is the Sum of

Urine output
Insensible losses
Other fluid losses (GI)

64

How much more fluid than fluid losses should be administered?

50-100 mL/hour

65

What type of fluid should be used in hypernatremia?

Hypotonic solutions

66

What type of fluids should be used in hyponatremia?

Isotonic solutions
Hypertonic solutions

67

What type of fluid should be used in blood loss?

Isotonic solution
Blood products

68

When would potassium or bicarbonate need to be added to the fluids?

Hypokalemia
Metabolic acidosis

69

What are disorders of sodium regulated by?

Thirst
ADH
Renal water handling

70

What is hypernatremia usually due to?

Water loss

71

Management of Hypernatremia

Correct slowly: 10 mEq/L
IVF: hypotonic
Rate of infusion calculated using the Midas Formula

72

Things to Consider When Determining how Much Fluid to Give

What is your starting point?
Expected losses?
Expected gains?

73

What are expected losses?

Measureable: urine, GI
Insensible: sweat, exhaled, fever
Fever: increase by 100 mL/day/degree centigrade

74

Who needs maintenance therapy?

Unable to eat or drink for a prolonged period of time
Preoperative period
Ventilated patients

75

Goal of Maintenance Therapy

Maintain fluid & electrolyte balance
Provide good "nutrition"

76

Monitoring for Maintenance Therapy

Baseline serum sodium
Baseline weight
Daily electrolytes