Fluid, Electrolytes, & Nutrition

IV Fluid Infused Volume Intervascular Volume Expansion Fluid Type Normal Saline* 1000 ml 250 ml crystalloid Lactated Ringers 1000 ml 250 ml crystalloid Normosol and Plasmalyte 1000 ml 250 ml crystalloid D5W 1000 ml 100 ml crystalloid Albumin 5% 500 ml 500 ml colloid Albumin 25% 100 ml 500 ml colloid Hydroxyethyl Starch 500 ml […]

Normal Sodium=136-145 Rapid changes in sodium can be life-threatening (demyelination seizures). Correct no more than 10-20 mEq in 24 hours. Hypernatremia: Determine fluid status and correct. If acute (occuring over 1-3 days), lower 1-2 mEq/L/h over 24 hours. If not acute, correct 0.5 mEq/L/hr over 48 hours. Hypernatremia: 3 % sodium: 100 cc bolus then […]

Potassium normal: 3.5-5.5 Hypokalemia: Mild: 3.0-3.5, moderate: 2.5-3.0, severe=<2.5 Common causes: thiazide and loop diuretics, kidney injury, GI loss, sweating, burns, Beta blockers, insulin, sodium bicarbonate Every 0.3 mEq decrease is a 100 mEq deficit Symptoms start at < 3.0 Correct Mg too. It’s used in potassium transport. Seen in EKG as U waves. Hyperkalemia: […]

Increased calcium is often caused by malignancy. Calcium regulation is carried by PTH (increases serum calcium, decreases serum phosphate, increases bone resorption) , calcitonin (decreases calcium, decreases bone resorption) and active vitamin D (increases calcium and phosphate, increases bone resorption).  Increases bone resorption = pulls calcium out of the bone, into the blood. Hyperparathyroid conditions affect calcium levels […]

Hypomagnesemia: Normal magnesium is 1.7-2.3 mg/dl. Usually associated with ulcerative colitis, diarrhea, pancreatitis, laxative abuse, inadequate intake, alcohol use, diuretic use, often occurs concurrently with hypocalcemia and hypokalemia. Symptoms include tetany, twitching, seizures, arrhythmias, hypertension, and sudden cardiac death. Treatment: Oral supplements Symptomatic patients treated with 1-4 mg by IV infusion (1 g/hour to avoid hypotension and […]

Hypophosphatemia: Normal phosphate: 2.5-4.5 mg/dl Usually caused by diuretics, glucocorticoids, sodium bicardbonate, rapidly refeeding patients, respiratory alkalosis, treatment of diabetic ketoacidosis (phosphate shifts into intracellular space) Symptoms: hypoxia, confusion, delirium, seizures, coma, respiratory failure, difficulty breathing, heart failure, arrhythmias Treatment: Supplement IV fluid with 10-30 mmol/L of phosphate in patients at risk. Oral products (K-Phos) can […]

They aren’t going to ask you to make a TPN, but here’s some of the most basic info. TPN Makeup Glucose should be 30-70% Fat should be 15-30% Protein: 1g/kg/day + stress (up to 2) Electrolytes I remember 50% glucose, 20% fat and 1g/kg of protein. Caloric requirements: The dirty way to calculate caloric needs: 30 […]