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Week 12 - Nephrology and urology > Fluid management > Flashcards

Fluid management Flashcards

1
Q

What is the ratio of fluid distribution in the body?

A
  • 2/3 is intracellular

* 1/3 is extracellular

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2
Q

What is the main electrolyte in the intracellular fluid?

A

Potassium

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3
Q

What are the main ions in the extracellular fluid?

A

In the interstitium: sodium and chloride

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4
Q

What is the normal intake?

A

20-30ml/kg/day

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5
Q

What is the normal output?

A

Total loss approx 2l a day

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6
Q

What are the fluid intakes?

A
  • Drinking - 1.5l
  • Food -0.5l
  • Metabolic - 0.5l
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7
Q

What are the fluid losses?

A
  • Urine - 1.5l
  • Respiration - 0.4l
  • Sweating - 0.5l
  • Faeces - 0.1l
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8
Q

What are the three broad categories of things that can go wrong with fluid balance?

A
  • Imbalance between input and output
  • Redistribution of fluid
  • Osmolar problems
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9
Q

What are the things causing excess loss?

A
  • Vomiting
  • Diarrhoea
  • Stoma
  • Drains
  • Fever
  • Polyuria - diuretics, metabolic problem
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10
Q

What is the main electrolyte of the gastric fluid?

A

Cl

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11
Q

What is the main electrolyte of the bile?

A

Na

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12
Q

Which electrolytes are lost due to diarrhoea?

A
  • Na
  • K
  • HCO3-
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13
Q

What electrolytes are lost via colostomy?

A
  • Na
  • K
  • Cl
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14
Q

What is 3rd space loss?

A

Fluid is lost into the extracellular space

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15
Q

What is serum osmolarity a measure of?

A
  • The concentration of small diffusible ions

* Na, K, glucose and urea

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16
Q

What is osmotic pressure?

A

Ions exert a pressure which causes water to move across the cell membrane from weaker to stronger solutions until the concentration of solutes is equal on both sides

17
Q

What is the risk of osmolar problems?

A
  • Cerebral oedema
  • Water moves from ECF to ICF in acute hyponatraemia
  • Water moves out of the brain if sodium is corrected too quickly
18
Q

What are the 3 different aims of IV fluid management?

A
  1. Maintenance - daily fluid replacement i.e. If NBM
  2. Replacement - replace ongoing loss
  3. Resuscitation - to correct intravascular or extravascular volume deficit
19
Q

What are the 5 questions you should ask yourself before prescribing fluid?

A
  1. Is the patient dry, wet or euvolaemic]
  2. Do they need IV fluid
  3. Why?
  4. how much?
  5. What type
20
Q

What is a typical history of someone with fluid depletion?

A
  • Abnormal losses

* Diuretic therapy

21
Q

What is the typical history of someone with fluid overload?

A
  • Heart failure

* Renal failure

22
Q

What are the symptoms of fluid depletion?

A
  • Thirst
  • Dry mouth
  • Dry skin
  • Dark urine
  • Postural dizziness
23
Q

What are the signs of fluid overload?

A
  • Hypertension
  • Increased JVP
  • 3rd heart sound
  • Oedema
24
Q

What are the symptoms of fluid overload?

A
  • Breathlessness

* Swollen ankles

25
Q

What are the signs of fluid depletion?

A
  • Reduced skin turgor
  • Dry mouth
  • Dry axillae
  • CRT>2 seconds
  • Postural hypotension
  • Tachycardia
  • Tachpnoea
26
Q

What are the lab test of someone with fluid depletion?

A

•UEs - high urea?

27
Q

What are the lab tests for fluid overload?

A

Serum albumin

28
Q

What monitoring should be carried out when someone has an altered volume status?

A
  • BP
  • Heart rate
  • Response to fluid challenge
  • Urine output
  • Fluid balance
  • Daily weight
  • CVP - central venous pressure
29
Q

What are the categories of IV fluid?

A
  • Crystalloids
  • Colloids
  • Blood products
30
Q

What are the crystalloids?

A
  • Saline
  • Dextrose
  • Balanced - Hartmanns or Ringers lactate
  • Sodium bicarbonate
31
Q

What are the colloids?

A

•Gelofusion or starch based fluid

32
Q

What are the blood products?

A
  • Pakced red cells
  • Platelets or fresh frozen plasma
  • human albumin solution
33
Q

Where does colloid go?

A

Intravascular

34
Q

Where does saline and Hartmanns go?

A

Intravascular and interstitial

35
Q

Where does dextrose go?

A
  • Intravascular
  • Interstitial
  • Intracellular
36
Q

Which IV fluid is most reflective of plasma?

A

Hartmanns

37
Q

What are the signs of hypovolaemic shock?

A
  • Hypotension
  • Tachycardia
  • Peripherally cool
  • Capillary refill >2
  • NEWS >5
  • Passive leg raising suggests fluid responsiveness
38
Q

What are the usual fluids used for resuscitation?

A
  • Saline or Hartmanns

* Give as a bolus

Week 12 - Nephrology and urology (14 decks)

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