Great lecture on this topic, thank you so much! How would you estimate ongoing GI losses including vomiting and diarrhea? Or in case of above-average insensible losses such as in case of tracheostomy, hyperventilation, increased evaporation. Best regards Ingrid
Hi I worked at cardiac surgical ICU at TABBA heart institute in Karachi Pakistan as RN. Good job man excellent knowledge👍 Now I'm working here in Lahore as RN😎 Please mention TABBA heart institute's name in your upcoming video because I love that hospital alot because I've learned alot from that hospital. Nice place to work and for learning new things aswell. Tears were in my eyes when I was leaving that hospital an year ago .
I love your videos. I’ve recently accepted a job in the SICU as a new grad! I finish school up in may and start the job in June! I’ve been watching your videos to help prep me for what’s to come. Thanks for all the great videos!
This is great to hear Jacob! Congrats on the new SICU job! It's an exciting area to work and will have you learning for years to come! Happy to hear my videos have been helpful for you.
I found an interesting statement regarding the hourly rate: we don't need to know the patient's sodium concentration. calculate [Body Weight x Correction Factor x Correction rate / 140 ]
this is a super good upload, in my unit at work have a set parameter for neuro patients and Sodium is one of the things that we check as a priority. Keep Grinding man
(Infusate na- 140)/(tbw +1)=this gives change in serum na.where infusate sodium varies as per the fluid used.apart from d5w,we can also use ns,rl,half ns which have 154,130,77 meq sodium per liter and accordingly can predict which fluid would correct the sod level by how much.
sodium con. varies in intracellular and extracellular ... we have the value of serum sodium , then how the total body sodium equals serum sodium times total body water
In your last example you divided by a correction factor of 0.5, but shouldn't it have been 0.6 since the patient was male in the example and that is the correction factor you used in the computation to get the free water deficit in the earlier computation?
I guess formula for fluid deficit doesn't sound right. FWD = TBW- Actual water in dehydrated body at [Na+] Using unitary method of calculation, At 140 Na concentration body water is TBW At 1 Na concentration body water is 140xTBW At [Na+] body water will be 140xTBW/[Na+] So, FWD= TBW-140×TBW/[Na+] ie, FWD=TBW ([Na+]-140)/[Na+] Please correct me if I am wrong, or I grabbed wrong concept in creating formula
How can I add daily maintenance fluid therapy [ 1500+( IBW -20) × 20 ] together with water deficit in hypernatremic patient That's would be huge volume / hr
Hey! Great videos, just starting working on TICU, has helped so much! Thank you and keep on going! A question though? So if Na will stay the same in the body, what is that pathway for 3% bolus? Is it just temporary in the body to help with cerebral edema? Thanks again! Looking forward to more videos.🤩
I had a question, what are some cases where total sodium could/would get elevated? I work in organ procurement and frequently see pts with complete brain herniation with diabetes insipidus, with elevated sodium levels. Would this be an accurate way to calculate free water deficit?
With DI, they are dumping water, hence the elevation in sodium. I know once DI is established, typically we do 1:1 replacement for urine output hourly, but you certainly could calculate FWD to see how far behind you are and what would need to be made up. Otherwise, just doing 1:1 replacement you'd remain in deficit, but just prevent it from worsening (hopefully).
If the same 50 year old woman had concentation serum Na= 160, total ammount of Na would be 160xTBW=6400 mmol. If Na=155, total=6200 mmol. But you said that the ammount of total Na doesnt change. I am confused😔
