308 Prescribing IV fluids and blood products

Question 1

What things can help you asses fluid status?

Answer 1

-History
-Respiratory rate >20 breaths per minute
-Dry mucous membranes and loss of skin turgor
-Capillary refill time >2 seconds and/or peripheries are cold to touch
-Pulse >90 bpm – weak; thready
-SBP <100 mmHg – postural hypotension
-Passive leg raising suggesting fluid responsiveness
-↑JVP
-↓Urine output
-Acid-base disturbance
-Serum urea and electrolytes – AKI
-Serum osmolality

Question 2

What is the treatment for hyperkalaemia?

Answer 2

30ml of 10% calcium gluconate/10ml of 10% calcium chloride IV over 15 minutes (with ECG changes)

Insulin/glucose IV infusion (10units human actrapid in 50ml of 50% glucose over 15 -20 minutes)

Salbutamol nebulizer

Calcium resonium/Sodium zirconium cyclosilicate/Patiromer sorbitex calcium all increase potassium clearance

Haemodialysis

Question 3

What is the treatment for hypercalcaemia?

Answer 3

IVI 0.9% Sodium Chloride (+furosemide)

Bisphosphonates (Zoledronic acid and Pamidronate)

Question 4

What is the treatment for Hypocalcaemia?

Answer 4

10ml of 10% calcium chloride IV over 15 minutes (with ECG changes)

Alfacalcidol (if vitamin D low)

Replace Mg (if low)

Question 5

What are the different blood product infusion rates?

Answer 5

Red cells over 1-2 hours (no slower than over 4 hours)

Platelets over 30-60 minutes

Fresh frozen plasma (FFP) over 10–20 mL/kg/hour

Question 6

What are some blood product transfusion reactions?

Answer 6

-Fever, chills, rigors
-Hyper- / Hypo-tension
-Collapse
-Flushing
-Urticaria
-Pain (bone, muscle, chest, abdominal)
-Respiratory distress
-Nausea
-General malaise