A3- Intravenous Fluid Flashcards
WHat are the three things to think for patients fluid status?
Physiology of water and electrolytes
Composition of IV fluids
Fluid and electrolyte disturbances in acute illness
What % of our body is made up of water
60%
What is the main extracellular cation in our body?
Sodium
How much Na and water is reabsorbed in the PCT
60-70%
RECAP of RAAS system
- drop in bp
- kidney release renin
- renin converts angiotensiongen in the liver into angiotensin I
- angiotensin I is converted to angiotensin II
- acts on the adrenal glands
- releases aldosterone
- increases bp
How does ADH control osmolarity?
Two ways
Osmotic control: more salt, less water so reduce ADH,
Non osmotic control: reduction in ECF volume, hypoT, Nausea so increase in ADH
What happens to sodium and water retention in unwell patients?
- Physiological stress increases RAAS
- Kidney: ability to dilute and concentrate urine is impaired
- Raised urea production: reduces ability to concentrate urine
- Acute Kidney Injury: reduced GFR
- Hypokalaemia
- Increased capillary permeability : albumin leak
Name different types of solutions
Crystalloid Solution
Colloid Solution
compare
Crystalloid Solution
Colloid Solution
Type of FLUIDs in Crystalloid solutions ?
Types of fluids in colloid solutions?
What are the dangers of excess sodium?
High sodium means high osmolaluty and so stimulates ADH more and reabsorb loads of water.
This will reduced excretion of soidum which can lead to AKI
What are the dangers of excess chloride?
Causes renal vasoconstriction which reduced eGFR and affects the kidney function
That then increases morbidity and leads to AKI/Acute illness
Principles of IV Fluid therapy?
➢Review/ Assessment
➢Routine maintenance
➢Resuscitation fluid
➢Replacement of abnormal losses
➢Redistribution
What are the Indicators for Resuscitation IV Fluid Therapy?
•Hypovolaemia
➢systolic blood pressure is less than 100 mmHg
➢heart rate is more than 90 beats per minute
➢capillary refill time is more than 2 seconds or peripheries are cold to touch
➢respiratory rate is more than 20 breaths per minute
➢National Early Warning Score (NEWS) is 5 or more
➢passive leg raising suggests fluid responsiveness
What is the ideal IV fluid that you would want for Resuscutation?
◆Produces a predictable and sustained increase in intravascular volume
◆Chemical composition as close as possible to that of extracellular fluid
◆Metabolized and completely excreted without accumulation in tissues
◆Does not produce adverse metabolic or systemic effects
◆Cost-effective in terms of improving patient outcomes
Compare and contrast colloids and crystalloids (eg expense etc)
What are the three main types of colloids?
ALbumin
Gelatin
HES
COmpare the different types of colloids?
Albumin versus Crystalloids
- Albumin versus crystalloid solutions in patients wit hypovolemia, burns, or hypoalbuminemia • Albumin was associated with a significant increase in the rate of death
- A comparison of albumin and saline for fluid resuscitation in the ITU • Albumin was associated with a significant increase in the rate of death at 2 years among patients with traumatic brain injury
No clear evidence on efficacy of Albumin as resuscitation fluid
HES versus Crystalloids
- Hydroxyethyl starch versus Ringer’s acetate in severe sepsis • HES had an increased risk of death at day 90 and were more likely to require renal-replacement therapy
- A comparison of 6% HES (130/0.4), as compared with saline, in the intensive care unit • HES was associated with a significant 21% relative increase in the rate of renal replacement therapy
What are the two types of isotonic IV fluids?
And what are there adverse effects?
What are the hypotonic IV fluids
DO you use HES for fluid resuscitation
NO
COnsider human albumin solution 4-5% for fluid reesus only in patients with severe sepsis
What is the Preferred IV replacement
- Hartmann’s solution should be used rather than normal saline when the plasma chloride is >108 mmol/l
- If plasma chloride is <98 mmol/L e.g. vomiting or gastric drainage, normal saline is more appropriate than Hartmann’s
Hartmans is preferable to normal saline except in?
How do you monitor IV fluid therapy?
Patients should have an IV fluid management plan, which should include details of fluid and electrolyte prescription over the next 24 hours
Daily reassessments of clinical fluid status, U&E and fluid balance charts, along with weight measurement twice weekly
IV fluid prescriptions should be reviewed on the consultant post take round and on each senior doctor ward round during the patient’s hospital stay
Clear incidents of fluid mismanagement should be reported through standard critical incident reporting
