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Flashcards in fluids and nutrition Deck (21):
1

max safe glucose concentration

0.5gm/kg/hr (5%) unless monitoring

2

max safe concentration of K

40mEq/L

3

what is first space, second space, and third space

1st is intravascular compartment; 2nd is intracellular; 3rd where fluid does not usually but may accumulate

4

maintenance fluid

obligatory use by body in respiratory loss, sweating, and urine production

5

things that inc maintenance requirements of fluids (3)

tachypnea, fever, or diuretics

6

calculation for fluid maintenace

pt wt in kg:
100ml/kg for first 10kg
50 for second 10kg
20 for each kg over 20;

then divide total ml by 24 to get ml/hr rate

ex. 70kg man needs 104ml/hr

if pt starts w deficit need to add more than just the maintenance

7

most physiologic replacement in normal circumstances

d5 1/2NS + 20mEqK/L

8

estimated deficit for dry, tachycardia, and shock

dry 3% loss (5% if

9

tx volume overload

fluid restriction and diuretics

10

for general abd surgery, first 24hr losses (3rd spacing, urine, ng tube, insensible)

2rd (1000ml) + urine (1000) + ng tube (1000) + insensible (500)= 3500/24=146
+
maintenance of 104ml/hr
=
run fluids at 250ml/hr

(adjust so urine output is 30-50ml/hr)

11

kvo=keep vein open

run minimal amount of fluid, only enough to keep IV from clotting off

12

how to go about replacing the calculated deficits

1st half in first 24 hrs then reassess

13

BMI

wt (kg)/ ht (m)^2

normal 18.5-24.9
overweight 25-29.9
obese >30

14

when should iv feeding be done

if gut unavailable for more than 7-10d

15

enteral feeding

safe, less expensive; preserved functionality of the gut, both nutritionally and immunologically

16

types of enteral feeding

mouth*; dobhoff (weighted, radio opaque tip to pass into small bowel); percutaneous endoscopic gastrostomy or jejunal (PEG, if long term feeding)

17

what should be done is using tube for feeding before actually feeding

confirm tube in stomach, gi tract and not lung by X-ray and or ph measurement

18

peripheral parenteral nutrition (PPN)

safer than tpn, indicated if support needed for

19

total parenteral nutrition (TPN)

used when gut not available for prolonged time or to push in severely malnourished pts; bypasses portal system so hepatic processing is delayed

20

how long are TPN needed for repletion

at least 7-10d

21

what is included in TPN and what is not

protein/fat/calories included; vit and minerals are not