Fluids
Questions
Does pt need IVF
what type of IVF
if no longer need, what is maintenance
Symptoms
Symptoms of hypovolemia:
low bp
tachycardia: best indicator for hypovolemia but not response
low urine output: best for response for resuscitation. 35 cc/hr good for 70 kg adult
orthostatic hypotension
BUN/creatinine: greater than 20
altered mental status
hypernatremia: advanced
hyponatremia: early
osmolarity, FeNa
weight loss
CR delayed
acidosis, contraction alkalosis
Requirements
35 ml/kg/day requirements
weigh more than 20 kg, 60 + kg
Resusiscation Indicator
pulse: 100-120
good urinary output
clearance of lactate
resolution of base deficit: look at bicarb before and after surgery. Usually mildly lower after surgery.
Management
hemorrhaging: blood products
if no hemorrhage: IV fluids (crystalloids/isotonic: NS, LR)
Give 3 L for every 1 L loss. 2/3 goes to third space
bowel wall: ileus
lung: pulmonary edema
heart: CHF
Maintenance
Maintenance IVF: D5, 1/2NS + 20 meq KCL at 125cc/hr
dextrose: slow down depletion of glycogen before catabolic state
diabetics: still use sugar. Give dextrose
KCl: cardio protection
LR vs NS
NS: mildly acidotic. Pure gastric outlet obstruction, use NS instead of LR.
LR: acidotic, but has bicarb for buffer. Lactate cleared by liver into bicarb once fluid is restored. Better for patients that can easily be fixed. Also looks closer to plasma
Acid/Base
improve ventilation (CO2): respiratory rate, tidal volume
improve oxygenation (O2): FiO2 (immediate) + PEEP (takes time)
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