Because 500 or 1000 ml of 0.9 NS have the same concentration of NaCL relative to the water amount, I can make a 500 ml bag of NS in two ways: 1. Mix 4.5 gm of NaCl in 500 ml of free water, that will still give me 154 meq of Na + 154 meq of Cl = 308 meq. 2. Mix 9 gm of NaCl in 1000 ml of free water then split the 1000 ml bag into two halves 500 ml each. It will result in the same 154 meq of Na + 154 meq of Cl = 308 meq.
Dr. Thank you very much for the excellent explanation. Doctor, I made a mistake once, and this mistake, when I felt burning urine, I applied clitromazole cream inside my penis, then the pain stopped for a while, but after seven months, the area turned black and caused severe pain. Now it is very painful. I'm in. I visited the different hospitals many times, but the medicines prescribed by the doctors could not give me any relief. So, what do you recommend me, doctor?
The point that it does not increase the sodium or used to treat hypernatremia is somehow not clear to me because it still has the half amount of Na as normal saline.
The fact that each bag of 0.45 NS has half the sodium amount in 0.9 NS means the same bag has 50% of its volume as a free war! For instance a 1000 ml bag if 0.45 NS has 500 ml of free water. The free water helps in hypernatremia treatment.
So total how much grams OF DEXTROSE we can give in ER .. SOMETIMES 50% NOT AVAILABLE ONLY 25% IS AVAILABLE THEN PLEASE EXPLAIN IN GRAM HOW MUCH WE CAN GIVE ACCORDING TO DIFFERENT AMPULE LS
I am sorry that I can’t give a specific clinical advice here as every patient is different! In general the type of the MRI we order depends on the type of headache or symptoms you have! Your doctor would be the best one to decide on that.
In context to rise in bun/cr with gradually improving volume status but still needs diuresis, can’t alternative be to decrease frequency or hold next dose to allow for plasma refill, rather then giving albumin? As main issues of over diuresis is too fast or or too much?
The albumin/diuretic combination is helpful if there are signs of volume overload and rising BUN/Cr. If the patient has no signs of volume overload then yes, loop diuretics should be cutdown in amount and/or frequency.
Your videos are so amazing and full of learning.....one issue that im having is the selection and duration of fluids peri and post-operatively....cna you kindly make a video on that or guide me about them?
Here we Have a patient with hypoxia, the current issue is Unconsciousenss All tests the ECG, MRI are Normal but patient feels pain no help from painkillers how Hundle such Dr
what if the patient presenting with a shock BP 70/40, should i give up the initial fluid resuscitation till i exclude the possibility of cardiogenic shock? or should i go on and give the 2-3 liters along with vasopressors and watch out for pulmonary edema till i complete my shock survey and if cardiogenic should i give up the fluids? that's an important question to answer for me sir.
Unless the patient is showing signs of active pulmonary edema, give IV fluid resuscitation. Stop IV fluid if any signs of pulmonary edema (patient becomes short of breath + hypoxia + crackles). Cardiogenic shock ( usually afteR acute MI, takatsubu's, or myocarditis) needs treatments with pressors/IABP or Impella/PCI.
two questions sir, why is volume depletion a concern to start enteral feeding? and why shouldn't i start enteral feeding till the 3rd day of icu admission?
two questions sir, why is volume depletion a concern to start enteral feeding? and why shouldn't i start enteral feeding till the 3rd day of icu admission?
1Q. How much a hospitalist can make after residency where he is in J1 visa ? 2Q. With J1 visa , Can he do extra shifts in the same hospital ? Then how much cane he make ?
Hi Israa, this series was intended for doctors but lot of nurses watched and found it useful! I suggest you watch the first few videos and see. Let me know if you have any further questions?
The patient was intubated, he is unable to drink water, mechanical ventilation means excessive insensible water losses, Na of 145 is a sign this patient is in need for free water, the goal is to prevent hypernatremia, to be proactive not reactive!
Hello doctor, Thank you so much for your lecture❤. I have a question: can we use the 12 ml sodium bicarbonate (8.4%) to mix with 100 ml NS (0.9%) to create a IVF solution? From my calculations, this formula will create a solution with 320 mEq, right? Can you still count it as an isotonic solution? And is it suitable for the patient who needs to rehydrate and correct an electrolyte imbalance (in this case, the blood results show that HCO3 is lower than normal)? Again, thank you so much for the wonderful lecture; it helped me so much in the learning process.
My apologies for the late reply! You exactly doing the purpose of this video series! To understand IV fluid to the point you can make own mix! 320 meq is a bit hypertonic. Keep two things in mind: osmolarity range 260-310, Your solution’s electrolytes concentration helps maintain or reinstate normal body electrolytes concentration
