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CDM2 - Final > Van Bockern - IV Fluids > Flashcards

Van Bockern - IV Fluids Flashcards

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
Q

colloid fluid

A

albumin

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26
Q

NS content compared to plasma

A

NS contains more Na and Cl -> can cause:
-hyperchloremic metabolic acidosis
-chloride mediated renal vasoconstriction

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27
Q

study that janice referenced showed better outcomes (3) when what type of fluid was used

A

better outcomes w. LR:
-death from any cause
-new renal replacement therapy
-persistent renal dysfxn

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28
Q

what is added to LR to provide buffer

A

sodium lactate

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29
Q

compared to plasma, LR contains __ Na
and __ K+

A

less
equal

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30
Q

3 problems w. LR

A

-falsely high serum lactate measurements
-ionized Ca can cause clots
-4 mEq of K -> hyperkalemia in renal insufficiency

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31
Q

moa for colloids (albumin)

A

high molecular wt -> increase plasma oncotic pressure

32
Q

which fluid lasts longest in intravascular space

A

colloids (albumin) - 16 hr vs 30-60 min

33
Q

3 types of dex containing fluids

A

-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
Q

benefit of dex containing solutions

A

non-protein calories -> prevent protein catabolism

35
Q

indication for dex containing solutions

A

ongoing hypoglycemia

36
Q

what do you need to calculate in order to treat hypernatremia

A

free water deficit

37
Q

goal of maintenance fluid

A

maintain homeostasis in euvolemic pt who cannot accomplish maintenance w. oral intake

38
Q

how do you adjust maintenance fluid for pt w. CHF, CKD etc

A

decrease to 50 mL/hr

39
Q

many healthy pt’s can tolerate __ mL/hr of maintenance fluids

A

100-125

40
Q

goals of replacement fluid (2)

A

maintain hemodynamic stability
replenish intravascular volume

41
Q

what dosing of replacement fluid does Janice like

A

bolus:
1L
500 mL
250 mL

42
Q

bolus dosing considerations for sicker pt

A

smaller bolus needed

43
Q

3 conditions that require aggressive IVF

A

sepsis
acute pancreatitis
DKA/HHS (hyperosmolar hyperglycemic state)

44
Q

initial replacement fluid for sepsis

A

crystalloid bolus of 30 mL/kg

45
Q

in sepsis, fluid adjustments are guided by (2)

A

serum lactate
hypotn

46
Q

initial replacement fluid for acute pancreatitis

A

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
Q

consequence of inadequate fluids in acute pancreatitis

A

necrotic pancreas

48
Q

initial replacement fluids for DKA/HHS

A

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
Q

how do you monitor effectiveness of IVF in DKA/HHS

A

BMP -> make sure gap is closing

50
Q

2 conditions that require serious caution w. fluid replacement

A

acute pulmonary edema
CHF

51
Q

for CHF, fluid bolus should be at most

A

250 mL

52
Q

consequence of over aggressive fluid replacement in CHF

A

acute pulmonary edema

53
Q

what do you need to do every single time before fluid bolusing CHF pt

A

echo

54
Q

K+ replacement rule of thumb based on serum K+

A

-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
Q

lab value to always check w. hypokalemia

A

Mg -> can not correct hypokalemia in setting of hypomagnesemia

56
Q

s.e of IV K+
how do you avoid this

A

phlebitis: painful burning sensation
avoid: limit to 10 mEq q 2 hr through peripheral IV

57
Q

use __ IV access for rapid K+ repletion

A

central

58
Q

route of admin for Mg repletion

A

always IV: 1-4 g at a time
oral absorption is poor

59
Q

goals for K+ and Mg in heart disease

A

K+: > 4.0
Mg: > 2.0

60
Q

route of admin for phos repletion

A

PO tabs
IV

61
Q

hypophosphatemia is mc seen w. what 3 conditions

A

malnutrition
refeeding
alcoholics

62
Q

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?

A

-give NS bolus 1000 mL
-replete K+ w. 60 mEq to get him to 3.6 (each 10 mEq = 0.1 mEq increase)

63
Q

pt from previous card develops severe epigastric pain that radiates to his back - what do you do?

A

order cbc, lft’s, lipase, and continue IVF

worried about pancreatitis

64
Q

what lab always needs to be ordered if you are concerned for pancreatitis

A

lipase

65
Q

pt from previous card has lipase 3x upper nl and bili is elevated - hgb is normal

what do you do

A

start LR 150 mL/hr
start IV pain control
obtain CT abd

66
Q

what lab elevation is concerning for gallstone related pancreatitis

A

elevated bilirubin

67
Q

2 mc causes of acute pancreatitis

A

gallstones
etoh

68
Q

diagnostic criteria for acute pancreatitis

A

2 of the following:
-acute epigastric pain radiating to back
-lipase 3x unl
-acute pancreatitis on CT/MRI/US

69
Q

tx for acute pancreatitis (3)

A

LR
NPO
pain control

70
Q

what is FENa
what does it tell you

A

-fractional excretion of sodium
-tells you if renal dz is pre vs post vs intrinsic -> guides you in terms of fluid type

71
Q

indication for calculating FENa

A

elevated SCr

72
Q

contraindication for FENa

A

pt on diuretics
use FEUrea instead

73
Q

first thing you do in pt w. AKI

A

order BMP and UA to calculate FENa

74
Q

components of FENa (4)

A

serum Na
urine Na
serum Cr
urine Cr

75
Q

FENUrea uses __ instead of urine Na

A

urine urea

CDM2 - Final (9 decks)

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