Dehydration Flashcards
What is dehydration?
Dehydration is a common presentation in the elderly and can present with nonspecific symptoms.
What are some examination findings of dehydration?
Examination findings include dry mucous membranes, loss of skin turgor, and sunken eyes.
What are severe symptoms of dehydration?
In severe dehydration, symptoms may include tachycardia, hypotension, and delirium.
What is the sensitivity and specificity of examination findings for dehydration?
Examination findings have poor sensitivity and specificity.
What is the common task that junior doctors need to perform regarding fluid therapy?
The prescription of intravenous fluids.
What are the NICE recommendations for maintenance fluids in adults?
25-30 ml/kg/day of water, approximately 1 mmol/kg/day of potassium, sodium, and chloride, and approximately 50-100 g/day of glucose to limit starvation ketosis.
How much fluid is required for an 80kg patient over 24 hours according to NICE?
2 litres of water and 80 mmol of potassium.
What does NICE recommend for routine maintenance fluid on day 1?
25-30 ml/kg/day sodium chloride 0.18% in 4% glucose with 27 mmol/l potassium.
How does a patient’s medical history affect fluid requirements?
Patients with significant losses from drains require more fluid, while those with heart failure should receive less fluid to avoid pulmonary oedema.
What are the electrolyte concentrations in plasma for sodium (Na+)?
135-145 mmol/l.
What are the electrolyte concentrations in plasma for chloride (Cl-)?
98-105 mmol/l.
What are the electrolyte concentrations in plasma for potassium (K+)?
3.5-5 mmol/l.
What are the electrolyte concentrations in plasma for bicarbonate (HCO3-)?
22-28 mmol/l.
What is the risk associated with using large volumes of 0.9% saline?
Increased risk of hyperchloraemic metabolic acidosis.
Fluid therapy in adults
When is intravenous fluid therapy required in children?
Intravenous fluid is generally required if the child is > 10% dehydrated, or if the child is 5-10% dehydrated and oral or enteral rehydration is not tolerated or possible.
What is the recommended rehydration method for children less than 10% dehydrated?
Oral rehydration is adequate, if tolerated, in the majority of those less than 10% dehydrated.
What are the 24-hour fluid requirements for children under 10 kg?
100 mL/kg
What are the 24-hour fluid requirements for children between 10-20 kg?
100 mL/kg for the first 10 kg, and 50 mL/kg for each 1 kg body weight over 10 kg.
What are the 24-hour fluid requirements for children over 20 kg?
100 mL/kg for the first 10 kg, 50 mL/kg for each 1 kg body weight between 10-20 kg, and 20 mL/kg for each 1 kg body weight over 20 kg. (max. 2 litres in females, 2.5 litres in males)
What is the routine fluid type used in fluid therapy for children?
The fluid type routinely used is 0.9% sodium chloride + 5% dextrose. Potassium is added as required.
Fluid therapy in children
