Pharm IV Fluids

Normal treatment for Volume Depletion

1. .9% NS 2. .9% NS + 5% glucose (D5 NS) 3. .45% NS + 5% glucose (D5 1/2 NS) Free water deficit Formula for hypernatremia pt: .6* kg of weight * (serum sodium-1) Severe Loss: (Trauma, blood loss, sepsis, hyponatremia) a. 1-2 L NS rapid or b. 20-30ml/kg

Carb requirement

100-150 gm/day of dextrose if NPO to prevent or minimize protein catabolism

Average adult fluid intake

2.6 L

Simple method for 24 hr maintenance rate

35 ml * kg = 24 hrs total ml/24 hours for hr rate 70kg*35ml/24 hrs = 103ml/hr

Holliday-Segar Formula

4ml/kg/hr for first 10 kg 2ml/kg/hr for next 10 kg 1ml/kg/hr for rest of weight Everyone over 20 kg gets 60 ml then 1 ml/kg for rest of bodyweight

Other Electrolytes to Consider adding when giving IV fluids

Calcium Magnesium Potassium

3 examples of crystalloid fluids

Crystalloids are water + electrolytes 1. Normal Saline (NS): (NaCl + water) .45% hypotonic .90% isotonic 3% Hypertonic 2. Lactated Ringers (LR): (NaCl+Na Lactate+KCl+CaCl+water) (sx, blood loss, caution in liver failure, some med incompatabilities) 3. Dextrose: -carbs or carbs + water -D5: 50 mg -D10W: 100mg + water -D50: 500 mg

Discuss clinical scenarios in which additional IVF fluids are required to replace excessive, nonphysiologic loss

Fevers Drainage Tubes Diuretics 3rd Spacing Fluids (edema, ascites) Blood Loss

Daily sodium

Goal of 80-120 mEq 1-2mEq/kg/day 3-4 for peds

Daily potassium requirement

Goal: 50-100 mEq .5-1 mEq/kg/day 2-3 for peds

Appropriate gauge of needle to deliver IV fluids in a trauma situation

PPt Slides: 12g-16g for Trauma situations Real life MC doing 18 g

Maintenance Therapy Considerations

Water Sodium Potassium Carbs Calcium Mg Phosphate Chloride

Differentiate between maintenance and replacement IV fluids

maintenance rate= amount of fluid estimated to maintain normal patient fluid balance Maintenance fluid therapy is indicated for patients that are not eating or drinking, but do not have volume depletion, hypotension, or ongoing losses. Replacement fluids (LRS)= intended to replace lost body fluids and electrolytes. Using replacement solutions for short-term maintenance fluid therapy typically does not alter electrolyte balance (dehydration, volume loss)

Caution with these patients for fluid replacement

renal cardiac hepatic failure older adults hypernatremia patients (measure sodium if given many bags of IV fluid)

2 examples of colloid fluids.

water+electrolytes+colloid proteins (non permeable substances ex: albumin) -helps maintain osmotic pressure pulling water intravascularly (burns, Liver disease), expensive 1. Serum Plasma (Na, Cl, K, Ca, Lactate, Glucose) 2. Albumin 5% (Na, Cl, K, Albumin 50g/L) Albumin 25%=250 g/L