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IV Fluids Flashcards

1
Q

Things to Consider with IV Fluids

A

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

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2
Q

Disorders of Volume in a Surgical Patient

A

Depletion

Excess

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3
Q

Disorders of Electrolyte Concentrations

A 
Sodium
Potassium
Chloride
Calcium
Magnesium
Phosphate
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4
Q

Sequelae of Inappropriate Fluid & Electrolyte Management

A 
Increased length of stay
Increased cost
Wound infection
Delayed wound healing
Anastomotic failure
Tachyarrhythmias
Cerebral edema, seizures, death
Pulmonary edema, CHF, renal failure
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5
Q

3 Things to Accomplish with IV Therapy

A

Maintenance therapy
Replacement therapy
Volume resuscitation

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6
Q

Reason for Maintenance Therapy

A

Patient not expected to eat or drink for a while

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7
Q

Reason for Replacement Therapy

A

Correct abnormalities in volume and/or electrolytes

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8
Q

Reasons for Volume Resuscitation

A

Hypotension

Hemorrhage

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9
Q

What does total body water depend on?

A

Age
Gender
Muscle mass
Fat

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10
Q

Total Body Water as a % of Weight Decreases in

A

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

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11
Q

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

A

2/3

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12
Q

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

A

1/3

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13
Q

What does the plasma portion of the ECF contain?

A

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

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14
Q

What does the ICF contain?

A

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

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15
Q

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

A

Water

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16
Q

Normal Body Fluid Osmolarity

A

285 osmol/L

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17
Q

Types of Fluid Replacement Products

A

Crystalloids

Colloids

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18
Q

Types of Crystalloids

A

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

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19
Q

Examples of Colloids

A 
Albumin
Dextran
Hetastarch
Blood
FFP
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20
Q

Define Crystalloid

A

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

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21
Q

Define Colloid

A

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

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22
Q

When are colloids indicated?

A

Rapid hemodynamic equilibration is required

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23
Q

What is important when addressing a specific situation?

A

Composition of the solution

Rate of administration

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24
Q

Why are isotonic solutions given?

A

To expand the ECF volume

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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

Surgery (20 decks)

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