How to determine which IV fluid patient needs? isotonic, colloid, NS, dextrose (5%, 10%, 50%)?

Question

I know little, except DKA (DM I) or hyperosmolar (DM II) may indicate fluids. For e.g., severe hypoglycemia, give dextrose 10% or 50% until BS>100. Seen surgical clients on Ringers lactose/ NS. Any info on indication for ALL IV fluids?

Answer 1

You're not going to give a diabetic in DKA or hyperosmolar coma dextrose. in any form. These patients need NS or in certains cases 1/2 NS. Ringer's lactate is mostly used in surgery as replacement for blood loss. Colloids are used as fluid replacement during/after surgery in cases of low oncotic pressure, people who refuse blood/blood products, or as an adjunct during massive fluid replacements (or cardiac surgery). As you stated, in cases of hypoglycemia, dextrose is appropriate.

Answer 2

First a rail against a wrongheaded modern trend: I never want to be your client, which implies you're selling drugs. Eventually I may be your patient, and you could care for me.

Isotonic solutions are the choice for rapid fluid expansion. That's why it's standard for surgery, so if the patient springs a leak the red stuff can be replaced with clear stuff quickly, though there are limits to how far/how well this will work, for obvious reasons. Normal saline is fine, but the difference is small enough that it really matters very little. Ringer's lactate (or for the truly picky, Ringer's pyruvate) essentially duplicates the fluids & electrolytes lost in the diarrhea of cholera. This is more for historical than aesthetic interest.
For daily maintenance, isotonic solutions have considerably more salt load than is needed. If the patient is a particularly delicate one, or if you're a bit in the direction of OCD, you can calculate the component requirements individually, but for generic use, 5% dextrose will give enough sugar to keep the brain happy (the CNS gets annoyed without glucose, where other organs will more easily burn alternative calorie sources), and half or quarter normal saline, plus a bit of potassium, will supply reasonably adequate requirements, with the kidneys taking up the slack for any minor adjustments from the ideal.
That pretty well covers what you'll see day-to-day. Now, TPN is a lot more complicated, but you should probably put that off for another day.

Answer 3

I've used the one about studying before falling asleep... Also, for facet stitches, carry your fingers & put your fingers on your head.... You're stretching your diaphragm.....