q5 - guest1

[ArchivalUser]

After suitable calculations have been made using the modified Parkland formula, a 70-kg man with extensive third-degree burns is receiving Ringer's lactate at the calculated rate, which happens to be 750 mL/hr. The infusion was started within 30 minutes of the time when the burn occurred. Over the next 3 hours, his urinary output is recorded as 15 mL, 22 mL, and 18 mL. It is verified that the Foley catheter is open and draining freely. The urine is dark yellow, without blood, and has a specific gravity of 1040 and a sodium concentration of 10 mEq/L. The patient's blood pressure is 100/70 mm Hg, his pulse is 98/min, and his central venous pressure is 2 cm H2O. On the basis of these findings, which of the following is the most appropriate next step in management?

A. Diuretics should be given


B. Fluid administration should continue at the present rate


C. The rate of fluid administration should be decreased


D. The rate of fluid administration should be increased


E. Treatment is needed for renal failure

[ArchivalUser]

DDD????

[ArchivalUser]

D. agree

[ArchivalUser]

Explanation:
The correct answer is D. The calculations made by standard formulas are only an educated guess. Once fluid administration begins, we judge its adequacy by the information provided by urinary output and central venous pressure, aiming for an output of 1-2 mL/kg/hr, while not exceeding a venous pressure of 10 or 15. In this case, our calculations fell short of the mark, and the patient needs more fluids at a faster rate.
Diuretics (choice A) are not the answer when all indicators show fluid need: his venous pressure is low, his blood pressure and pulse rate are marginal, and he has very concentrated urine. He needs fluids!
The present rate (choice B) may follow the "formula," but it is clearly inadequate.
Decreasing the rate (choice C) is the very opposite of what is needed.
And as for renal failure (choice E), it is indeed part of the differential diagnosis whenever urinary output is not as high as it should be. However, the vignette told you that his urine is highly concentrated and has well less than 20 mEq/L of sodium: evidence of superb kidneys trying to conserve fluid to the best of their ability. Don't blame them.

[ArchivalUser]

thank u guest1

[ArchivalUser]

URW aimhigh.