IV Fluids

Question 1

Is the majority of fluid in our body inside or outside of our cells?

Answer 1

intracellular fluid (ICF)

Question 2

Is there more fluid in our interstitium or plasma?

Answer 2

Interstitial fluid

Question 3

Do M or F have a higher fluid total body mass %

Answer 3

males

Question 4

are these examples of intracellular or extraceullar fluid?

• Cerebrospinal fluid
• lymph
• synovial fluid in joints
• pleural fluid
• pericardial fluid
• peritoneal fluid
• aqueous humor of the eye

Answer 4

Extracellular (ECF)

Question 5

Osmotic vs Hydrostatic pressures

Answer 5

Question 6

We get our majority of water via

Answer 6

Food - 800mL
Drink water - 500mL
Oxidation - 300mL

Question 7

we lose the majority of our water via

Answer 7

Urine - 500mL
Skin - 500mL
Resp tract - 400mL
Stool - 200mL

Question 8

Maintenance vs Replacement fluids

Answer 8

• Maintenance -> Replaces ongoing losses of water and electrolytes under normal physiologic conditions
• Replacement -> Corrects existing water and electrolyte losses. (i.e. gastrointestinal, urinary, skin, bleeding, 3rd space sequestration)

Question 9

pt is eating/drinking normally. Do they need maintenance IV fluids?

Answer 9

No

Question 10

standard IV fluids order

Answer 10

Reasonable approach is to begin with 2 L per day of half normal saline in dextrose with 20mEq KCl per liter

Monitor Na+ and change as necessary

Question 11

Do these ppl need A LOT or LITTLE water?

• afebrile
• not eating
• physically inactive
• oliguric kideny injury
• use of humidified air
• edematous states
• hypothyroidism

Answer 11

a little (these ppl dont have high water demand or are already overfluided)

Question 12

Do these ppl need A LOT or a LITTLE water

• febrile
• sweating
• tachypnic
• burned
• polyric
• ongoing GI losses

Answer 12

A LOT

Question 13

What can you refer to to determine how much fluid is required for fluid replacement?

Answer 13

Use known wt loss, blood pressure, jugular venous pressure, urine sodium concentration/output, and hematocrit

Question 14

Replacement fluids

In severe volume depletion or hypovolemic shock, at least ___L of isotonic fluids are given a rapidly as possible.

Answer 14

1-2L

Question 15

Crystalloids

Answer 15

• Contain organic and inorganic salts (e.g., glucose and sodium chloride) dissolved in sterile water
• Ex. Normal saline, Lactated ringers, dextrose sol, bicarb sol

Question 16

what makes lactated ringers special?

Answer 16

Contain sodium lactate in addition to NaCl

Question 17

pt has metabolic acidosis, can you still give lactated ringers?

Answer 17

yes, sodium lactate is NOT an acid. it metab into bicarb

Question 18

Normal saline (____%) is isotonic and used for resuscitation

Answer 18

0.9

Question 19

___% saline is hypotonic and used for maintenance

Answer 19

0.45%

Question 20

____% saline is hypertonic and given for severe hyponatremia to prevent cerebral edema

Answer 20

3%

Question 21

D5W

Answer 21

Dextrose sugar water
starts off isotonic and then has hypotonic final effect
used for hypernatremia and hypoglycemia

Question 22

What tonicity are lactated ringers and are they used for Resuscitation or maintenance?

Answer 22

Isotonic
Resuscitation

Question 23

do isotonic fluids enter the intracellular fluid?

Answer 23

no, but hypotonic fluids do

Question 24

What tonicity are Resuscitation fluids?

Answer 24

Isotonic

Question 25

What tonicity are Maintenance fluids?

Answer 25

Hypotonic ## Footnote shove the fluid into the cells

Question 26

most crystalloids start to leave the venous system within ___ hrs, sometimes up to ___hrs if critically ill

Answer 26

2 hrs up to 8 hrs if critically ill

Question 27

Caution: in some cases too much NS can cause a ________ ________(non-anion gap acidosis) Be wary of fluid overloading your patients

Answer 27

hyperchloremic acidosis

Question 28

should you use lactated ringers for true end-stage liver disease?

Answer 28

No

Question 29

can lactated ringers be given to a patient with hyperkalemia?

Answer 29

yes, the 4mL equivalents of K in the lactated ringers will not drastically incr K+ levels (10mL for every 1K?)

Question 30

what is the preferred maintenance fluid?

Answer 30

D5-0.45%NS + 20mEq K+ ## Footnote Tonicity goes from Hypertonic -> Hypotonic

Question 31

Normal plasma Osmolarity is ~ ______mOsm/L

Answer 31

290

Question 32

What IV fluid do you use for symp hyponatremia and to reduce cerebral edema?

Answer 32

3% Saline (Hypertonic) ## Footnote Given as a bolus of 50 or 100mL initially or run at low rate for short periods

Question 33

What IV fluid is given to correct **kidney failure** or **refractory metabolic acidosis**

Answer 33

Sodium Bicarbonate Sol ## Footnote Usually made in a medium of D5W, 1/2NS, D5W1/2NS, Sterile water Select 50, 100, or 150mEq sodium bicarbonate to 1L of fluid

Question 34

Colloid solutions

Answer 34

* Contain large proteins that cannot cross capillary walls (proteins stay in vasculature) * Hypertonic solution pulls fluid from interstitial & extracellular spaces AND INTO THE VASCULATURE * Increases Intravascular vol & BP ## Footnote Note: Equal survival rate among patients treated with colloids or crystalloids when given for hypotensive issues

Question 35

What is the MC used colloid solution

Answer 35

Human Albumin (5% or 25%)

Question 36

Human Albumin comes in ___% or _____%

Answer 36

5% or 25%

Question 37

Signs of Dehyrdations: * No wet diapers for ____hrs * BUN/Creatinine Ratio >____ * Urine Specific Gravity > ______

Answer 37

* No wet diapers for 3 hrs * BUN/Creatinine Ration > 20 * Urine Specific Gravity > 1.030

Question 38

Max daily fluid vol for Adults and Children

Answer 38

Adults: 2L Children: 2400mL

Question 39

1kg = ____lbs

Answer 39

2.2

Question 40

Use the 4:2:1 rule to determine ____

Answer 40

How much fluids to give a child per hour

Question 41

The hourly infusion rate for a 60kg Child is _____mL/hr | use the 4:2:1 rule

Answer 41

100mL/Hr

Question 42

Consider Intraosseous Infusions (IO) if vascular access can not be obtained within ___ attempts or for >_____sec (collapses in on itself)

Answer 42

2 attempts >90 seconds

Question 43

Absolute Contraindications for IO

Answer 43

* Fractures or prev penetrated bone (fluids will leak out) * Extremity with vascular interruption * Cellulitis, burns, osteomyelitis -> SEPSIS * Caution in Osteoporosis/Osteogenesis imperfecta

Question 44

The EZ-IO drill needle length is based on _____

Answer 44

body weight

Question 45

Drill into the _____ or _____ for IO

Answer 45

Humerus or Tibia

Question 46

Drill into the _____ or _____ for IO

Answer 46

Humerus or Tibia

Question 47

# Intraosseous (IO) devices Impact-driven devices are inserted into the ______

Answer 47

sternum ## Footnote Pts must be 12yo+[Sternal EZ-IO PPT](https://slidetodoc.com/intraosseous-access-with-the-sternal-ezio-needle-set-2/)

Question 48

IO Complications

Answer 48

* Infusion pain -> Lidocaine 2% slow push * Tibial frx * Extraversion of fluid or meds into surrounding tissues (Compartment syndrome) * Infx -> Osteomyelitis -> sepsis

Question 49

Which is more painful: inserting the IO device or infusing through the device?

Answer 49

**Infusing** can be so painful that it makes ppl nauseous. Slowly push 2% lidocaine thru the IO device