Fluids, Electrolytes,
Acid-Base Disorders, and
Fluids, Electrolytes,
Acid-Base Disorders, and
Nutrition Support
Nutrition Support
Fluids, Electrolytes,
Acid-Base Disorders, and
Nutrition Support
, Fluids, Electrolytes,
Acid-Base Disorders, and
Fluids, Electrolytes,
Acid-Base Disorders, and
Nutrition Support
Nutrition Support
,[Type here]
hypernatremia in a critically ill patient, and develop
an appropriate treatment plan.
2. Discuss the causes and treatment of common
intracellular electrolyte disorders.
3. Differentiate among the causative factors for
metabolic acidosis and alkalosis, and construct a
therapeutic treatment algorithm.
4. Specify the appropriate route (parenteral or enteral)
of nutrition administration, amount of nutrients, and
particular component formulation to be provided to a
given critically ill patient.
5. Identify appropriate markers for assessing the
tolerance, safety, and efficacy of enteral or parenteral
nutrition therapy.
6. Describe methods for ensuring appropriate glycemic
Fl
control in critically ill patients.
7. Identify pertinent drug-nutrient interactions, and
provide recommendations for the safe and effective
uids, delivery of medications to patients receiving enteral
or parenteral nutrition therapy.
Elect 8. Discuss current controversies in the initiation,
management, and monitoring of nutrition therapy for
the critically ill patient.
rolyt
es, Abbreviations in This Chapter
Acid-
ABG Arterial blood gas
AG Anion gap
AKI Acute kidney injury
Base ALI
ARDS
Acute lung injury
Acute respiratory distress syndrome
Disor BEE
BG
CKD
Basal energy expenditure
Blood glucose
Chronic kidney disease
ders, ECF
EN
Extracellular fluid
Enteral nutrition
and GRV
IBW
ICF
Gastric residual volume
Ideal body weight
Intracellular fluid
Nutritio ICU
LOS
Intensive care unit
Length of stay NB
n NG
Nitrogen balance
Nasogastric
Support
Learning Objectives
1. Appropriately assess hyponatremia and
ACCP Updates in Therapeutics® 2015: Critical Care Pharmacy Preparatory Review Course
1-3
, [Type here]
PN Parenteral nutrition
RCT Randomized controlled trial
SIADH Syndrome of inappropriate antidiuretic
hormone TBI Traumatic brain injury
UUN Urine urea nitrogen
Self-Assessment Questions
Answers and explanations to these questions may
be found at the end of this chapter.
1. Which is the most appropriate indication for
parenteral nutrition (PN)?
A. Severe anorexia.
B. Lack of bowel sounds.
C. Ileus.
D. High gastric residual volume (GRV).
2. Which is the most appropriate replacement
fluid for a patient with significant nasogastric
(NG) fluid drainage?
A. 0.9% sodium chloride and potassium
chloride 20 mEq/L.
B. 0.45% sodium chloride and potassium
chloride 20 mEq/L.
C. 5% dextrose in 0.225% sodium chloride
and potassium chloride 20 mEq/L.
D. Lactated Ringer solution.
3. Which trace mineral would best be increased for
a PN-dependent patient with intractable diarrhea?
A. Zinc.
B. Copper.
C. Iodine.
D. Manganese.
4. A 70-year-old man admitted to the intensive care
unit (ICU) for sepsis was recently given a
diagnosis of syndrome of inappropriate
antidiuresis. His serum sodium acutely fell from
130 mEq to 115 mEq/L during the past 3 days,
and he recently seized secondarily to this
problem. Which would be the most appropriate
treatment option?
A. Intravenous 0.9% sodium chloride.
B. Intravenous DDAVP (desmopressin acetate).
C. Intravenous 3% sodium chloride.
D. Intravenous conivaptan.
ACCP Updates in Therapeutics® 2015: Critical Care Pharmacy Preparatory Review Course
1-4
Acid-Base Disorders, and
Fluids, Electrolytes,
Acid-Base Disorders, and
Nutrition Support
Nutrition Support
Fluids, Electrolytes,
Acid-Base Disorders, and
Nutrition Support
, Fluids, Electrolytes,
Acid-Base Disorders, and
Fluids, Electrolytes,
Acid-Base Disorders, and
Nutrition Support
Nutrition Support
,[Type here]
hypernatremia in a critically ill patient, and develop
an appropriate treatment plan.
2. Discuss the causes and treatment of common
intracellular electrolyte disorders.
3. Differentiate among the causative factors for
metabolic acidosis and alkalosis, and construct a
therapeutic treatment algorithm.
4. Specify the appropriate route (parenteral or enteral)
of nutrition administration, amount of nutrients, and
particular component formulation to be provided to a
given critically ill patient.
5. Identify appropriate markers for assessing the
tolerance, safety, and efficacy of enteral or parenteral
nutrition therapy.
6. Describe methods for ensuring appropriate glycemic
Fl
control in critically ill patients.
7. Identify pertinent drug-nutrient interactions, and
provide recommendations for the safe and effective
uids, delivery of medications to patients receiving enteral
or parenteral nutrition therapy.
Elect 8. Discuss current controversies in the initiation,
management, and monitoring of nutrition therapy for
the critically ill patient.
rolyt
es, Abbreviations in This Chapter
Acid-
ABG Arterial blood gas
AG Anion gap
AKI Acute kidney injury
Base ALI
ARDS
Acute lung injury
Acute respiratory distress syndrome
Disor BEE
BG
CKD
Basal energy expenditure
Blood glucose
Chronic kidney disease
ders, ECF
EN
Extracellular fluid
Enteral nutrition
and GRV
IBW
ICF
Gastric residual volume
Ideal body weight
Intracellular fluid
Nutritio ICU
LOS
Intensive care unit
Length of stay NB
n NG
Nitrogen balance
Nasogastric
Support
Learning Objectives
1. Appropriately assess hyponatremia and
ACCP Updates in Therapeutics® 2015: Critical Care Pharmacy Preparatory Review Course
1-3
, [Type here]
PN Parenteral nutrition
RCT Randomized controlled trial
SIADH Syndrome of inappropriate antidiuretic
hormone TBI Traumatic brain injury
UUN Urine urea nitrogen
Self-Assessment Questions
Answers and explanations to these questions may
be found at the end of this chapter.
1. Which is the most appropriate indication for
parenteral nutrition (PN)?
A. Severe anorexia.
B. Lack of bowel sounds.
C. Ileus.
D. High gastric residual volume (GRV).
2. Which is the most appropriate replacement
fluid for a patient with significant nasogastric
(NG) fluid drainage?
A. 0.9% sodium chloride and potassium
chloride 20 mEq/L.
B. 0.45% sodium chloride and potassium
chloride 20 mEq/L.
C. 5% dextrose in 0.225% sodium chloride
and potassium chloride 20 mEq/L.
D. Lactated Ringer solution.
3. Which trace mineral would best be increased for
a PN-dependent patient with intractable diarrhea?
A. Zinc.
B. Copper.
C. Iodine.
D. Manganese.
4. A 70-year-old man admitted to the intensive care
unit (ICU) for sepsis was recently given a
diagnosis of syndrome of inappropriate
antidiuresis. His serum sodium acutely fell from
130 mEq to 115 mEq/L during the past 3 days,
and he recently seized secondarily to this
problem. Which would be the most appropriate
treatment option?
A. Intravenous 0.9% sodium chloride.
B. Intravenous DDAVP (desmopressin acetate).
C. Intravenous 3% sodium chloride.
D. Intravenous conivaptan.
ACCP Updates in Therapeutics® 2015: Critical Care Pharmacy Preparatory Review Course
1-4
