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Calculate the osmolarity of intravenous fluids and compare with normal plasma osmolarity
Ditto
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Recommend an appropriate intravenous fluid regimen and monitoring parameters given a patient’s clinical characteristics
Whats the maximal safe amount of change in serum sodium???
Maximal safe amount of change in a patient's Sodium is generally regarded as 10–12 mEq/L in 24 hours
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-Discuss the appropriate use and risks of hypertonic saline
-Recommend a treatment regimen and monitoring parameters to ensure safe and effective use of these intravenous fluids
List 2 major uses of Hypertonic Saline
- -HS is used in traumatic brain injury to reduce an elevated ICP(ICP>20mmHg) and to increase mean arterial pressure
- -HS is used for symptomatic hyponatremia (Severe symptoms of hyponatremia include coma and seizures)
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Assess electrolyte abnormalities and recommend an appropriate pharmacologic treatment plan based on individual patient signs and symptoms
Ditto
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Discuss appropriate indications for the use of enteral and parenteral nutrition (EN and PN)
Ditto
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Recommend a patient-specific EN formula, infusion rate, and monitoring parameters
Ditto
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Recommend a patient-specific PN formula and monitoring plan based on the type of intravenous access, nutritional needs, comorbidities, and clinical condition
Ditto
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Discuss strategies for preventing complications associated with EN and PN
Ditto
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DONT USE HS-Inappropriate use of HS includes:
-Chronic asymptomatic hyponatremia
-Hyponatremia w/ severe hypoglycemia
-Hyponatremia associated w/ hypervolemia
Instead of using HS, How do you treat Asymptomatic syndrome of inappropriate secretion of antidiuretic hormone (SIADH)??
Asymptomatic syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is usually treated with fluid restriction of less than 800 mL of fluid per day
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How do you Dose Hypertonic Saline for patients with symptomatic hyponatremia??
- Estimate an infusion rate of 3% HS by multiplying ideal body weight (IBW) by desired rate of serum sodium increase per hour. (Note: IBW is used to avoid overdosing obese patients.
- -For example, 70 kg × 1 mEq/L/hour = 70 mL/hour to increase serum sodium by 1 mEq/L in 1 hour
- -Infusion rate of 3% HS is generally 1–2 mL/kg/hour
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What is the HS Dose for traumatic brain injury?
Dose options for traumatic brain injury
- a. 3% HS 250 mL or 2–4 mL/kg intravenously over 1–15 minutes administered for elevated ICP
- b. 23.4% HS 30 mL over 20–30 minutes administered for elevated ICP
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OBJ:Recommend an appropriate intravenous fluid regimen and monitoring parameters given a patient’s clinical characteristics
Question: Crystalloids vs. Colloids: Which is recommended for fluid resuscitation?
- Crystalloids (0.9% NaCl or LR) are recommended for fluid resuscitation
- LR is historically preferred in surgery/trauma patients, but no evidence suggests superiority over NS for fluid resuscitation
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OBJ:Recommend an appropriate intravenous fluid regimen and monitoring parameters given a patient’s clinical characteristics
Question: What advantage does LR have over NS in patients undergoing fluid resuscitation?
- The lactate in LR is metabolized to bicarbonate and can theoretically be useful for metabolic acidosis; however, lactate metabolism is impaired during shock. Thus, it may be an ineffective source of bicarbonate.
- Recently (JAMA 2012;308:1566), a Cl-restrictive regimen (e.g., LR, Plasma-Lyte 148) was associated with a reduction in the incidence of acute kidney injury compared with a standard regimen
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Differentiate from when you use Resuscitation fluids (LR or Albumin) vs. Maintenance fluids (D5W with 0.45% NaCl plus 20–40 mEq of KCl per liter)
List 4 indications for Resuscitation fluids:
- Tachycardia (> 100 beats/minute)
- Hypotension (SBP < 80 mm Hg)
- Increased BUN/Cr ratio > 10:1
- Reduced urine output
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