IV Fluids Flashcards by Melicia Sanchez

Total body water =

60% total body weight

ICF: 2/3
ECF: 1/3

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Who will have more body water; normal weight ind. or obese ind.?

normal weight pt

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Ways that we get water input? output?

fluid intake, H20 in food, metabolically produced H20

insensible loss, sweat, feces, urine

input = output

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What are some causes of hypovolemia?

GI losses, renal losses, sweat losses (sweats, burns), sequestration without loss

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What are some examples of sequestration without loss?

Intestinal obstruction, pancreatitis, rhabdomyolysis

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Clinical features of hypovolemia

Increased thirst, decreased sweating

Decreased skin turgor & drymm

Oliguria

CNS depression

Weakness and muscle cramps

Decreased BP; postural

hypotension/dizziness

tachycardia

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What is third spacing?

fluid getting into spaces where its not supposed to be

fluid accumulation in the interstitium of tissues

ascites
pleural effusions
edema assoc. with burns

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third spacing can causes…

relative hypovolemia

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What are the types of replacement IVF?

crystalloids

colloids

blood and blood products

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What are crystalloids?

fluids that contains crystal-forming elements (electrolytes) which easily pass through vascular endothelial membrane barriers followed by water, leading to their equilibrating between the intravascular & extracellular space

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What are colloids?

Fluids that contain both large organic marcomolecules and electrolytes

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What are blood and blood products?

RBC’s are similar to colloids because they stay in vascular space

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What are some examples of crystalloids?

normal saline

plasma-lyte

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What are the different types of crystalloids?

isotonic crystalloids

hypertonic crystalloid

hypotonic crystalloids

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Describe isotonic crystalloids

NaCl

They distribute uniformly throughout the ECF space.

Internists tent to prefer NS and surgeons LR…intensivists prefer Plasma-Lyte.

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What are isotonic crystalloids used for?

for tx of dehydration/hypovolemia

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What is hypertonic crystalloid?

3% NS

use very cautiously!

good in situations where there is life-threatening hyponatremia
also somestimes used in neurosurg pts to decrease cerebral edema

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When you use hypertonic crystalloid need to be careful not to cause….

central pontine myelinolysis

-Overly rapid correction of sodium can lead to osmotic demyelination

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How do hypotonic crystalloids work?

distribute throughout the total body water, used for maintenance fluids

not used for tx of dehydration/hypovolemia- not really used in general

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What is D5W?

another type of crystalloid

5% dextrose in water

used to tx hypoglycemia

used in hypernatremia with a free water deficit

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Describe colloids

More likely to expand vascular compartment

Used when crystalloids fail to sustain plasma volume due to low osmotic pressure
-when there is sig. protein loss

What are the dif. types of colloid fluids?

Albumin** used clinically

Dextran

Hydroxyethyl Starch

When do we use Albumin?

Used in edematous patients to mobilize interstitial fluid into the vascular space
-not really used if albumin is norm.

Which pts are albumin helpful in?

in patients with liver disease, peritonitis or burns or surgical patients experiencing “third spacing”

Crystalloid v. Albumin

Albumin temporarily increases MAP BUT no dif. in mortality

What are the dif. types of blood products?

Packed red blood cells (PRBCs) Platelets Fresh frozen plasma (FFP) Cryoprecipitate

Most commonly used blood product?

PRBCs

Describe PRBCs

prepared from whole blood, remain entirely within vascular space used for blood transfusions - improves oxygen delivery to tissues - need to type and screen/cross

I unit of PRBCs should increase Hgb by...

When do we transfuse blood?

if: actively bleeding, sxs or Hgb <7

When are platelets used?

in patients with thrombocytopenia or impaired platelet function to prevent or treat bleeding

What is fresh frozen plasma (FFP)? What is it used for?

Contains all factors of the soluble coagulation system Used to correct major bleeding complications in patients on warfarin and/or with a vitamin K deficiency

When do you give FFP?

when INR is elevated?

What is another agent that works similar to FFP?

PCCs prothrombin complex concentrates

What is cryoprecipitate?

Prepared by thawing fresh frozen plasma and collecting the precipitate. -It contains high concentrations of factor VIII & fibrinogen

When are cryoprecipitate used?

in pts with low fibrinogen, typically in the setting of massive hemorrhage or consumptive coagulopathy.

What are the dif ways that we can give IVF (time wise)?

bolus maintenance replacement

Describe Bolus IVF

NS, LR, and Plasma-Lyte can be given as a bolus depending on the clinical situation can give 250ml-IL caution in pts with HF

How do you determine how much fluids to give?

depending on how dry they are can give a L at a time, reassessing btwn each (Assuming no HF or other concern from volume overload)

Describe maintenance IVF

Maintains/accounts for ongoing losses of water and electrolytes under normal physiologic conditions via urine, sweat, respirations, and stool goal is to provide water and lyte balance

When are maintenance IVF used?

when pts are not eating/drinking norm.

What are some common fluids for maintenance?

NS, plasma-lyte, LR D5/0.5NS +/- 20 meg KCL

What can we used to determine rate for maintenance IVF?

"the Kg method" (body weight) to determine water needs

How are calculated maintenance IVF different for peds as opposed to adults

"Kg method" but children require less sodium than adults

What are the 3 most common rates for maintenance fluids in adults?

75ml/hr, 100ml/hr, 125ml/hr

maintenance IVF & potassium can be used to tx...

hypokalemia or for maintenance fluids if pt NPO

Role for replacement IVF?

Corrects any existing water and electrolyte deficits caused by GI, urinary, skin, or blood losses or “third-spacing”

amount of replacement fluids in surg pts should be determine based on?

UOP and vitals

Replacement fluids in burn pts?

use parkland formula -total fluid required during 1st 24 hrs (percentage of 2nd/3rd deg burns) x (body weight in kg) x 4ml

How do you determine percentage of body burned?

rule of nines