1. Flashcards
What IV fluid to give a patient with ↑ Na+ or ↓BM?
5% Dexterose
(instead of NaCl)
What IV fluid to give a patient with ascites?
Human Albumin Solution (HAS)
(instead of NaCl)
What IV fluid to give a patient who is shocked from bleeding?
Blood transfusion or crystalloid (if no blood available)
What’s the maximum fluid volume prescribed to a sick patient?
Never prescribe more than 2L of fluid for sick patient
What’s the maximum IV K+ volume per hour?
Max 10 mmol/hour
3 questions to ask a nurse if asked to prescribe IV fluid
- Why? (the reason)
- Can they drink on their own?
- Other comorbidities (e.g. HF)
If maintenance fluids indicated, what’s the difference in adult vs elderly requirements per 24 hours (in general/in practice)?
- ADULTS: require 3L/24 hours (3 x 8 hourly bags)
- ELDERLY: require 2L/24hours ( 2 x 12 hourly bags)
How to provide electrolytes in maintenance bags of fluid?
Electrolytes provided by:
1L of 0.9% saline and 2L of 5% dextrose
(1 salty & 2 sweet)
add 20 mmol KCl in two bags (either to dextrose 5% or saline 0.9%) in order to achieve 40 mmol KCl per day requirement
(but use U&Es as a guide - in practice do not add potassium unless NBM tr U&Es guided)
When prescribing fluids, what to check
- U&Es
- Is patient fluid overloaded? (↑JVP, pulmonary/peripheral oedema, basal crackles)
What additional thing do we need to check for when prescribing fluids for ↓ urinary output?
Ensure there is no urinary obstruction
(ensure the bladder is not palpable)
When to avoid prescribing metoclopramide as an antiemetic? (2)
Metoclopramide (a dopamine antagonist)
Avoid in:
- Parkinson’s disease - as can exacerbate symptoms
- Young women - high risk of dyskinesia (e.g. unwanted movements, acute dystonia)
Regular antiemetic choice and dosage in a nauseated person (3)
- Cyclizine 50 mg 8 hourly IM/IV/PO for most cases (but causes fluid retention so not in cardiac causes)
- Metoclopramide 10 mg 8 hourly IM/IV if HF
- Ondansetron 4mg or 8mg 8-hourly IV/PO
Can we prescribe Cyclizine in cardiac disease?
Not, because cyclizine can worsen fluid retention
A better choice would be metoclopramide
What to prescribe as PRN antiemetic for a no nauseated person? (2)
As required antiemetic:
- cyclizine 50 mg up to 8 hourly IM/IV/oral (but not in cardiac disease or fluid overload - as causes fluid retention)
- metoclopramide 10 mg up to 8 hourly IM/IV if heart failure (but not in Parkinson, intestinal obstruction or young patients)
Analgesic choices for no pain
- regular
- PRN
No pain
- Regular: NIL
- PRN: Paracetamol 1g PO up to 6 hourly
