TSRA Content:
Author: Hannah McMullen, MD
Fluids
Total Body Water = 2/3 total body weight
2/3 intracellular, 1/3 extracellular (2/3 interstitial, 1/3 plasma)
Indicators of fluid status:
BP - Blood Pressure
HR - Heart Rate
UOP - Urinary Output
Bun/Cr ratio
CVP - Central Venous Pressure
Daily weights
Plasma Osmolality: (280-295 mosm/kg) (2xNa) + (glucose/18) + (BUN/2.8)
Volume Replacement (for trauma resuscitation):
| 4cc/kg/hr | 1st 10kg |
| 2cc/kg/hr | 2nd 10kg |
| 1cc/kg/hr | after |
(e.g., 70kg = 110kg/h)
Electrolyte Repletion
Calcium
Adjust Ca for albumin (For each 1.0 albumin below 4.0, add 0.8 to the Ca value)
CaCl only via central line
Ca Gluconate via PIV
Magnesium
Goal 2.0 mEq/L
IV Mag Sulfate 1g 🡪 increases serum level 0.1
PO Mag Oxide 800mg BID = ~1g elemental magnesium/day
Causes diarrhea, but IV takes many hours to administer
Phosphate
Goal level ~3.0 mEq/L
IV Phos 15mmol 🡪 increases serum level 0.5
PO NeutraPhos 1 packet = 8mmol Phos + 7mmol Na + 7mmol K
If K low also: KPhos. Each 15mmol contains 22mEq K
If K normal/high: NaPhos
Potassium
Goal: 3.5 mEq/L (4.0 mEq/L in cardiac patients)
KCl 10mEq IV 🡪 raises serum level by 0.1mEq/L
Max peripheral IV rate: 10mEq/hr
10mEq of KCl comes in 100cc of fluid
Amount of K in maintenance fluid can be adjusted
If normal: D5-1/2NS + 20mEq/L
If low: increase to 30mEq/L
If high: decrease to 10mEq/L
KCl 20 mEq PO 2-5x per day (causes nausea)
- Capsule/Tablet – large pills (K-Dur/ Klor-Con)
- Elixir – tastes bad
- Powder