what fluid would you use?

[militarymd]

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I had a guy recently who came to the OR for temp dialysis catheter placement.

HTN, DM, CRI....rhabdomyolysis..from crestor.

ck 45000 or so.

sodium 127
potassium 6.3
chloride 87
bicarbonate 16
bun 120
cr 7

Some urine output, but not much.....no evidence of hypervolemia.

Plan is MAC for the catheter , but what fluid would you hang?

 

[Tenesma]

doesn't really matter... he is going to have dialysis soon anyway...

 

[militarymd]

doesn't really matter... he is going to have dialysis soon anyway...

d5 1/2 NS + 20 meq of K+ ?

 

[toughlife]

d5 1/2 NS + 20 meq of K+ ?

D5 NS

 

[jetproppilot]

d5 1/2 NS + 20 meq of K+ ?

One could argue, if you're in an academic mood, that anything with D5 in it isnt good since you're essentially giving free H20.

Could argue against the 20mEq K since K is already up....could argue about the 1/NS

But its a MAC case; if the fluid is on a microdrip he's not gonna get more than 20mL or so....

....10 minute case

like Tenes said it doesnt really matter.

This guy doesnt need more fluid of any kind.

I'd still change it though, to a 500mL bag of .9% NS, if the D5 1/2 NS w 20mEq K is hanging, cuz I'd feel funny dropping them off with that up.

 

[SleepIsGood]

.9ns

 

[coprolalia]

No K+. I think you'd have a tough time defending that one in front of the guy with the long black robe. But, otherwise like others said, probably doesn't matter.

-copro

 

[Magnus67]

NS +/- bicarb depending on your belief in the necessity of alkalinizing the urine or if patient can make enough. Ca gluconate, d50w, 10units insulin, (im assuming the K will continue to rise) , tell the the medicine intern to give the guy some kayhexalate post op if they dont get patient to dialysis soon.😀

 

[toughlife]

NS +/- bicarb depending on your belief in the necessity of alkalinizing the urine or if patient can make enough. Ca gluconate, d50w, 10units insulin, (im assuming the K will continue to rise) , tell the the medicine intern to give the guy some kayhexalate post op if they dont get patient to dialysis soon.😀

Not sure how much alkalinizing the urine will help since his kidneys are already trashed.

 

[militarymd]

I used D5 W + 3 amps (150 meq) of bicarb and gave a FULL liter to induce more urine output...which occurred.

I didn't give his glucose....it was 60 something.

 

[IctalSmile]

I would hang mooon fluid.....It is 5,000 times more advanced than your primitive earth drugs

 

[mille125]

I used D5 W + 3 amps (150 meq) of bicarb and gave a FULL liter to induce more urine output...which occurred.

I didn't give his glucose....it was 60 something.

hate to tell you: ....it didnt really matter

 

[militarymd]

hate to tell you: ....it didnt really matter

not for his kidneys, but it made him more comfortable....no longer short of breath after the fluids

 

[Noyac]

.9 NS and push 1/2 amp of D50. I'm not really going to restrict his fluids.

 

[DrDre']

Not knowing his sugar, 3% saline could be a good option as his na and cl are low. If his cl was high, you could do 3% saline (50% cl 50% acetate). I would do this if i needed a lot of fluids. Your bicarb gtt is essentially the same.