dp101

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I am preparing for my surgery shelf and step 2 and have a hard time understanding when/what kind of fluids need to be given in certain situations.
Can anyone please help explain when to give:
- normal 0.9 saline
- half normal saline
- 3% hypertonic solution
- 5% dextrose in normal saline
- 5% dextrose in half normal saline
 

Psai

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You are an internal medicine doctor and patient needs fluids -> 0.9 sa. Patient is hypernatremic -> 1/2NS. Patient is hyponatremic and symptomatic or has edema in their brain then hypertonic saline. d51/2NS is maintenance fluid
 
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Apr 20, 2012
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I am preparing for my surgery shelf and step 2 and have a hard time understanding when/what kind of fluids need to be given in certain situations.
Can anyone please help explain when to give:
- normal 0.9 saline
- half normal saline
- 3% hypertonic solution
- 5% dextrose in normal saline
- 5% dextrose in half normal saline
Step up 2 medicine has a good discussion on this in the fluids/electrolytes chapter.
 
Apr 20, 2012
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If its a trauma patient, go with LR, unless they have some sort of renal insufficiency. Otherwise, NS is never incorrect (unless the person cant secrete fixed acids, which wont show up on the exam ₩.
 

Psai

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My understanding is that you need a ton of NS to get hyperchloremic acidosis, like 12 liters or something like that.
 
Mar 13, 2014
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My understanding is that you need a ton of NS to get hyperchloremic acidosis, like 12 liters or something like that.
AFAIK there is zero evidence based difference between NS & LR for resuscitation, outside of some really specific situations. I like LR because it makes theoretical sense
 
Apr 20, 2012
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AFAIK there is zero evidence based difference between NS & LR for resuscitation, outside of some really specific situations. I like LR because it makes theoretical sense
Agreed. It was just an interesting tidbit I learned, and thought someone else may get a kick out of it too.... If you need to dump enough NS to induce an acidosis in a trauma patient, you've likely transitioned to PRBCs or whole blood long before your 10th L of NS. I think. Maybe.
 
Aug 9, 2014
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Don't think there's any situation on step 2 where LR is an answer over NS.
Hypotensive = NS no matter what .. even if they're hypernatremic.
Na <120 = 3% saline
1/2NS = severe hypernatremia
D5NS = DKA once they hit glucose of 250 (some say 200)
D51/2 NS or D5W = never seen a question where this was the answer.
 

cbrons

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Of course, in actual reality, LR is a better choice than 0.9% NaCl for pretty much everything except hyponatremic dehydration, DKA (before switching to 1/2 NS), and in patients at risk of cerebral edema from TBI.