Overdose senario questions

[Lfransis]

I am three months away from graduation, LVN. I feel like I should have a general rational behind my questions, but I do not.

The ED nurses were very vague in their answers.

While working the ED for clinical rotation:

30YO Over dose (poss. benadryl and tylenol)

Vitals were w/in norm. while we were performing procedures.(He was a fighter)

When pt. came back from x-ray to ED was resting: B/P was something like 84/58.

I informed the nurse, whom informed the Dr.

Dr. ordered IV fluids to be pushed w/ a pressure bag and a 2cd IV site started to hang another bag of fluids.

Question:

What is the rational behind pushing fluids so fast?

(to flush kidneys?, increase circulating volume?)

Also upon insertion of a foley cath, urine was very clear. As the day progressed urine became more colored.

Question:

Why was the urine initially so clear?

Thanks in advance.

L.fransis

[fire_911medic]

Most likely, the request for fluids was to raise blood pressure, remember, increasing volume increases resistance, so BP will increase if there is more blood circulating. Blood vessels had probably relaxed and expanded so needed more volume to maintain the BP. As far as why urine was so clear, you are pretty much sending straight water into him, so it's gonna come flowing right through. Due to the fact it may have been a tylenol overdose = potential kidney damage, there may have been the thought that increasing fluid and urine output may help prevent that. Not certain, but just a thought. I'm a medic, not a nurse, so usually we use fluid challenges for BP reasons, but it seems wasn't THAT low (as long as systolic above 90 we're happy). Just thoughts, you have made me curious as well.

[benthereseenit]

Volume,volume, volume. In any situation where there is a sudden decrease in b/p your first line of action is usually going to be increase the volume going in.

as to the 2nd question regarding the color of the urine you were diluting the volume he already had and also flushing out (hopefully) any etoh of board.

[MajorDomo]

Hope to answer your questions. The fluids were most likely for two things, one was his pressure, It was a little low, the second was that Benadryl can cause Rhabdomyolysis, big peices of protien blocking the kidneys leading to renal failure. That could also be the reason for the change in color of the urine overtime. A good article is on emedicine.com under antihistamine toxicity.

Hope this helps

Major Domo