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CDM2 - Final > Van Bockern - IV Fluids > Flashcards

Van Bockern - IV Fluids Flashcards

(75 cards)

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1
Q

what are the 2 fluid compartments

A

intracellular: 60% of body weight
extracellular: 20% of body weight

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2
Q

extracellular fluid consists of

A

intravascular: 80% of ECP
interstitial: 20% of ECP

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3
Q

both fluid compartments account for __% of our body weight

A

intracellular: 60% of body weight
40L

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4
Q

intracellular ions

A

K+
phosphoric acid (-)
non-penetrating anions: proteins, organic anions

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5
Q

extracellular ions

A

Na+
Cl-

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6
Q

BMP

A
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7
Q

what is third spacing

A

-shift of fluid from intravascular to interstitial space
-increased vascular permeability

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8
Q

4 conditions associated w. third spacing losses

A

pancreatitis
hypoalbuminemia (cirrhosis)
surgery
sepsis

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9
Q

3 goals of IV fluids

A

replacement/resuscitation
maintenance
electrolyte balance

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10
Q

4 considerations in IVF management

A

how much
assessment of volume status
sources of loss
maintenance

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11
Q

3 ways to assess fluid volume status

A

JVP - Janice’s fave
peripheral edema
crackles

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12
Q

6 sources of fluid/lyte loss

A

renal
respiratory
hemorrhage
GI
skin
third spacing

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13
Q

most significant cause of skin fluid/lyte losses

A

burns

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14
Q

normal water losses

A

urine: at least 0.5 L/day
stool: 200 mL/day
insensible (skin/resp): 400-500 mL/day
endogenous metabolism: 250-350 mL/day
total: 1400 mL/day

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15
Q

minimum fluid required for maintenance

A

60 mL/hr

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16
Q

what type of fluid loss increases w. rr, metabolic state, and body temp

A

insensible (skin/resp)

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17
Q

daily lyte requirements

A

Na+: 75-175 mEq
K+: 20-60 mEq

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18
Q

daily CHO requirements

A

100-150 g/day dex

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19
Q

maintenance dosing for NS

A

D5 1/2 NS w. 20 mEq/L KCl @ 75 mL/hr = 1.8 L

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20
Q

1.8 L of D5 1/2 NS w. 20mEq KCl maintenance fluids adds how much K+, Na+, and dex

A

K+: 36 mEq
Na+: 139 mEq
dex: 90 g

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21
Q

4 considerations of volume status management

A

clinical assessment
daily weights
intake vs output
SCr

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22
Q

3 clinical assessment tools that Janice likes to assess hypervolemia

A

jvp
body weight
orthopnea

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23
Q

5 sx of hypovolemia

A

hypotn
tachycardia
oliguria
decreased skin turgor
dry mm

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24
Q

2 types of crystalloid fluids

A

NS
LR (balanced crystalloid)

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25
colloid fluid
albumin
26
NS content compared to plasma
NS contains more Na and Cl -> can cause: -hyperchloremic metabolic acidosis -chloride mediated renal vasoconstriction
27
study that janice referenced showed better outcomes (3) when what type of fluid was used
better outcomes w. LR: -death from any cause -new renal replacement therapy -persistent renal dysfxn
28
what is added to LR to provide buffer
sodium lactate
29
compared to plasma, LR contains __ Na and __ K+
less equal
30
3 problems w. LR
-falsely high serum lactate measurements -ionized Ca can cause clots -4 mEq of K -> hyperkalemia in renal insufficiency
31
moa for colloids (albumin)
high molecular wt -> increase plasma oncotic pressure
32
which fluid lasts longest in intravascular space
colloids (albumin) - 16 hr vs 30-60 min
33
3 types of dex containing fluids
-D5W: 50 g dex in 1L free water (5%dex) -D5NS: 50 g dex in 1L NS -D10LR: 100 g dex in 1 L LR
34
benefit of dex containing solutions
non-protein calories -> prevent protein catabolism
35
indication for dex containing solutions
ongoing hypoglycemia
36
what do you need to calculate in order to treat hypernatremia
free water deficit
37
goal of maintenance fluid
maintain homeostasis in euvolemic pt who cannot accomplish maintenance w. oral intake
38
how do you adjust maintenance fluid for pt w. CHF, CKD etc
decrease to 50 mL/hr
39
many healthy pt's can tolerate __ mL/hr of maintenance fluids
100-125
40
goals of replacement fluid (2)
maintain hemodynamic stability replenish intravascular volume
41
what dosing of replacement fluid does Janice like
bolus: 1L 500 mL 250 mL
42
bolus dosing considerations for sicker pt
smaller bolus needed
43
3 conditions that require aggressive IVF
sepsis acute pancreatitis DKA/HHS (hyperosmolar hyperglycemic state)
44
initial replacement fluid for sepsis
crystalloid bolus of 30 mL/kg
45
in sepsis, fluid adjustments are guided by (2)
serum lactate hypotn
46
initial replacement fluid for acute pancreatitis
always LR bolus: initial fluid bolus of 20 mL/kg given over 30 min, followed by 3 mL/kg/hr for 8-12 hr
47
consequence of inadequate fluids in acute pancreatitis
necrotic pancreas
48
initial replacement fluids for DKA/HHS
15-20 mL/kg/hr for first 2 hr, or approx 1L/hr 250-500 mL next few hr, reduce to 150 mL/hr
49
how do you monitor effectiveness of IVF in DKA/HHS
BMP -> make sure gap is closing
50
2 conditions that require serious caution w. fluid replacement
acute pulmonary edema CHF
51
for CHF, fluid bolus should be at most
250 mL
52
consequence of over aggressive fluid replacement in CHF
acute pulmonary edema
53
what do you need to do every single time before fluid bolusing CHF pt
echo
54
K+ replacement rule of thumb based on serum K+
-serum K+ 3.0-3.4: 10 mEq = serum increase by 0.1 mEq -serum K+ < 3.0: do PO + IV replacement - frequent recheck -whole body K+ deficit: often more severe than serum K+ reflects -> replete past nl on BMP
55
lab value to always check w. hypokalemia
Mg -> can not correct hypokalemia in setting of hypomagnesemia
56
s.e of IV K+ how do you avoid this
phlebitis: painful burning sensation avoid: limit to 10 mEq q 2 hr through peripheral IV
57
use __ IV access for rapid K+ repletion
central
58
route of admin for Mg repletion
always IV: 1-4 g at a time oral absorption is poor
59
goals for K+ and Mg in heart disease
K+: > 4.0 Mg: > 2.0
60
route of admin for phos repletion
PO tabs IV
61
hypophosphatemia is mc seen w. what 3 conditions
malnutrition refeeding alcoholics
62
A 38 year old male with PMH of ETOH use disorder presents to the hospital in EtOH withdrawal and severe electrolyte depletion. On exam his vitals are: HR: 109, RR 18, BP 90/70, Pulse Ox 95% Gen: ill appearing male, HEENT: Dry CV: Tachy RR Labs: Na: 131, K: 3.0 What do you want to do?
-give NS bolus 1000 mL -replete K+ w. 60 mEq to get him to 3.6 (each 10 mEq = 0.1 mEq increase)
63
pt from previous card develops severe epigastric pain that radiates to his back - what do you do?
order cbc, lft's, lipase, and continue IVF worried about pancreatitis
64
what lab always needs to be ordered if you are concerned for pancreatitis
lipase
65
pt from previous card has lipase 3x upper nl and bili is elevated - hgb is normal what do you do
start LR 150 mL/hr start IV pain control obtain CT abd
66
what lab elevation is concerning for gallstone related pancreatitis
elevated bilirubin
67
2 mc causes of acute pancreatitis
gallstones etoh
68
diagnostic criteria for acute pancreatitis
2 of the following: -acute epigastric pain radiating to back -lipase 3x unl -acute pancreatitis on CT/MRI/US
69
tx for acute pancreatitis (3)
LR NPO pain control
70
what is FENa what does it tell you
-fractional excretion of sodium -tells you if renal dz is pre vs post vs intrinsic -> guides you in terms of fluid type
71
indication for calculating FENa
elevated SCr
72
contraindication for FENa
pt on diuretics use FEUrea instead
73
first thing you do in pt w. AKI
order BMP and UA to calculate FENa
74
components of FENa (4)
serum Na urine Na serum Cr urine Cr
75
FENUrea uses __ instead of urine Na
urine urea

CDM2 - Final (9 decks)

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