4: IV fluid prescribing Flashcards
Why may patients be given fluids?
Resuscitation in emergencies
Replacement in deficiency (could also be an emergency)
Routine maintenance
It is important that people being given IV fluids are ___.
reassessed
passive leg raise for indication of fluid level
If a patient is hypotensive, how much fluid can you give them in 500ml boluses before you should call for help?
2L
If a patient is at risk of heart failure, you should give ___ml boluses of fluid.
250ml
look at values for routine maintenance
look at table for types of fluid therapy and what to use for each
In routine maintenance, your daily fluid requirement depends on your ___.
weight
All fluids apart from crystalloids (and colloids) rapidly ___ out of the vascular system.
redistribute
Why isn’t 0.9% NaCl used for routine maintenance?
Twice the daily Na
potassium chloride is almost a controlled drug
use hartmann’s in dka (contains K) - hypokalaemia, monitor
remember for routine maintenance:
need to make up to 2L
and need to be within daily requirements
you can half / double / mix things
When are colloid solutions used?
Severe sepsis
revise that lecture
large volume ascites paracentesis in liver failure:
evacuated space > loads of fluid drains in after paracentesis
so blood volume goes down, renals not perfused, nothing else perfused
give colloids (hyperoncotic, stays in the vascular system) to avoid this
hepatorenal syndrome in liver failure:
kidneys don’t work
give colloid fluids
blood products which can be given IV:
packed red cells
platelets
fresh frozen plasma (full of antibodies)
cryoprecipitate
What can cause hyponatraemia?
Too much water (fluid overload e.g SIADH)
Too little salt
How do you treat hyponatraemia due to
a) too much water
b) too little salt?
a) Fluid restrict
b) Give 0.9% NaCl
Which endocrine disorder causes hyponatraemia in a euvolaemic patient?
SIADH
What happens to plasma and urine osmolality in SIADH?
Plasma osmolality decreases - too much salt
Urine osmolality increases - MORE salty water excreted as RAAS turns off
In SIADH, urine sodium levels are (high / low).
high
How is SIADH treated?
Fluid restrict until cause (inflammation/infection/tumour) is resolved
If sodium imbalance is corrected far too quickly, what occurs?
Brain damage
Which patients are at risk of brain damage by rapid sodium correct?
Hyponatraemic
Malnutrition
Extremes of age
By how much can you change a patient’s [Na] in a 24h period?
4-6
Sodium excess / deficiency must be corrected very ___.
slowly
In emergency correction of hyponatraemia, how much are you aiming to correct [Na] by?
4-6
just in less time
