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.
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 .
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
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
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 ]
(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
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
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
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😔
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.N "HALLUCINATION" | [Stray Kids : SKZ-PLAYER]](http://i.ytimg.com/vi/n5B5q1Hwt_U/mqdefault.jpg)
Thank you for this lesson. I’m preparing to take my NP board exam and your explanation of free water deficit was extremely helpful! Glory to God ❤
Just got off my first day in the ICU and needed to understand this concept. Thank you for explaining it so well!
Your videos are really helpful !! Respect from India 🇮🇳 !! Thank u 🙏🏻
Thank you very much for this. Would be great if you'd guys make one about acid-base balance :)
Great suggestion!
Yeah right kindly please do ❤️
I love your videos they're so informative man please never stop
Really happy to hear this! And I will! 😊
Clear easy to understand, great colors and nice handwriting!.
Awesome! Glad you liked it Lisa!
Thank you so much😊
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.
dude.. thank you. why was this so hard for any other resource to explain... sodium doesnt change, great thank you..thats all i needed to know haha
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 .
Ty very much you uploads are very appreciated
Thank you very much! you’re gonna save me for my ICU exam😭🩵
Made this tricky calculation so much easier than my text - THANK YOU!
Awesome! Happy to hear this and glad you enjoyed it!
You are a gifted teacher .may Gad reward you. Continue the good work
Your entire channel is gold!
Sweet!!! Thank you Alisha! Glad you are enjoying it :)
My favorite youtuber and Friend!, you are the best! ❤❤❤
Thanks friend! Always good to see you pop in and hope you are doing well!
Completed the series
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
Verry important issue. Well explained
Thank you for this clear perfect explanation.
You are very welcome Gihan!
Makes so much sense! Thanks.
Glad to hear this. Thanks!
Great 1 !!!!!thanks a bundle
You're welcome!
thank you
Welcome!
Thanks
Welcome! Good to see you pop in!
awesome thanks for the refresher, you rock
Thank you so much! Glad to help!
Awesome!!! Thanks 🙏
YW! Glad you liked it
Great content as always . I can't wait for a lesson on Anion Gap🤭
Awesome! On the todo list!
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
yes! Very important in Neuro patients! Thank you and I will certainly keep going.
Great lecture,simplified
Awesome. Thank you!
Excellent lecture.
Man, you great! I've learned a lot from your lectures! Respect from Russian's doctors ;)
Wow thank you so much Apect! Really glad to hear these videos are helpful around the world, Russia included!
Thats helpfull thank you
Great. Thanks
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 ]
Your videos are verry verry important us... please continue....
Thank you Nishad and I will definitely do so!
Orrrrrr you can just use MDCalc for the calculation part 😂 Love your videos!
Hahah I could say that about a lot of things 😂
Glad you enjoy the vids!
Thanks for the video and clear explanation ✨
You’re welcome 😊
(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.
Thank you for this!
My pleasure!
Dam good memories from chemistry. Thank you for the review!
Hahaha right!?! 😊 Glad you liked it!
Do you have any videos or resources with advices regarding drug dilution in either NS or D5W?
6.5586 Liters
THANK YOU SO MUCH FOR THIS!
You're so welcome!
@@ICUAdvantage Your videos are very crisp and totally dope!
@@PureWealthness Thanks man! I really appreciate that. Happy to know they are well received!
thank you for sharing!
My pleasure!
Another good lesson
Thank you!
Thanks for the very informative video!
How does the total body sodium not change ever? Not even in AKI, CKD?
Thank you very helpful
You're welcome!
Thank you for your good work =)
❤️❤️👌great effort
Appreciate that!
does this also apply for all crystalloids?
Give us a video on 3rd space loss
We have to replace free water only when we see that serum Na is abnormal? Otherwise we just have to give maintenance fluids ?
Is it possible to have a negative fwd?
What is the correction factor for pediatric??
Is there a similar algorythm for fluid management in hypovolemic hyponatremia?
hello , everyone
in case of hypernatremia caused by TBI
can i give the patient D5W ? is that going to cause cerebral edema ?
HOW LONG DO YOU GIVE THE 6'6LITRES?
Kindly,, if we can replace it orally or enterally,, how we can do it,, by ryle or what,, and will be same rate of iv or what,, and what about oral
Can you do lesson on setting up an arterial line?
Yes! I do have on the todo list!
Hi great video, are you planning any video on enteral nutrition? thanks
Yes, I do have that on the todo list for the future!
ICU Advantage thanks a lot!!!
how to decide to which fluids to be given in different conditions
how often would you recalc the fwd?
Usually just daily.
How does the body sodium not change if it can be excreted in urine?
answer is equal to 6.5571
6.6l
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
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
Dear sir can we obtain any written notes !?
Hey there. The notes are available to the RUclips or Patreon members. You just have to sign up for either one.
Dose the other types of iv fluids rathar than D5W considered is a free water or part of it ,, I means do they affect the replacement
I'm not sure I understand what you are asking?
Example result: 6.56 L
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?
6.557
How does sodium respond after water is valued as less to the heart.
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
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).
51
Why did you decide that correction factor is 0.5 ?
Then why we are useing ns 3%
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😔
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.🤩
6.5 L?
🤨 6600 vs 660. Ok.