Post-Op patient question

KelRN215, BSN, RN · Feb 6, 2013

You haven't provided enough information to make this assessment.

Roseyposey · Feb 6, 2013

Depends on the situation and the patient. Is there more info?

Blue Cat · Feb 6, 2013

Were there lab results along with this?

Blue

Esme12, ASN, BSN, RN · Feb 6, 2013

trying to figure out my homework. I'm supposed to state what is wrong or right about this for a post-op patient.
IV – D₅1/2 NS c 20 mEq KCl at 200 mL/hr

The first I see is....

What is the concentration of the IVF to potassium.......How much IVF will the potassium be mixed into.....I know what assumption we all make because of the rate.....but in orders you cannot make assumptions.

ChipNurse · Feb 7, 2013

trying to figure out my homework. I'm supposed to state what is wrong or right about this for a post-op patient.
IV – D₅1/2 NS c 20 mEq KCl at 200 mL/hr

I know that the recommended rate for KCl infusion is 10mEq/h, but in order to know if the rate is too fast, you would need to know the total volume to be infused. There is not enough information to figure this problem out. Unless they just want to see if you noticed that there is no volume in the order for the D5 1/2NS?

nurseprnRN, BSN, RN · Feb 7, 2013

I know that the recommended rate for KCl infusion is 10mEq/h, but in order to know if the rate is too fast, you would need to know the total volume to be infused. There is not enough information to figure this problem out. Unless they just want to see if you noticed that there is no volume in the order for the D5 1/2NS?

You don't need a volume for a maintenance IV. However, 200/hr is a lot for IV fluids; perhaps the OP could give us her/his idea rather than us speculating?

truckinusa, BSN, LPN, RN · Feb 7, 2013

I was going to write 100-125mL/hr is normal for post-op. It also doesnt specify the amount of IV fluid the KCL is diluted in.

nurseprnRN, BSN, RN · Feb 7, 2013

Bingo, got it in one. It doesn't say "/L" for the potassium dose. Gold star. :anpom:

truckinusa, BSN, LPN, RN · Feb 10, 2013

I found out the answer and it was just the fact that 200mL/hr was too high

KelRN215, BSN, RN · Feb 10, 2013

I found out the answer and it was just the fact that 200mL/hr was too high

I disagree... how does one determine it's "too high" without knowing what's going on with the patient? Was there more information about the patient in this question? There are certain situations where it's appropriate to run IVF at 1.5 or even double maintenance. In the adult world, they typically run fluids at 100-125 mL/hr so if the patient requires 1.5-2x maintenance, you're going to be in the range of 200 mL/hr.

When I worked in the hospital, with certain neurosurgical/neurovascular conditions, IVF was always infused at 1.5x maintenance. This was always calculated based on the patient's body weight with the standard pediatric formula of:

4 mL/kg/hr for the first 10 kg of body weight

2 mL/kg/hr for the next 10 kg of body weight

1 mL/kg/hr thereafter.

So say you've got a teenage football player or something who weighs 100 kg. His maintenance fluid requirements are going to be 140 mL/hr. If he needed 1.5x maintenance fluids, they'd be running at 210 mL/hr. Have seen/done this many times.

With certain chemotherapies (those that can cause hemorrhagic cystitis and that you don't want sitting in the bladder for too long), IVF was run at this rate all the time. And this was in pediatrics. I've seen many a teenager on fluids running at 200 mL/hr for days.

Your standard post-op patient probably doesn't need that volume of fluids but without further information in the question, I wouldn't say that that rate is "too high" just because it's 200 mL/hr. For a patient with impaired renal function, it's absolutely too high but, again, I don't see any information in the question which leads me to automatically make this assessment.