Fluid Management Flashcards

1
Q

What are the fluid compartments of the body?

A
  • Roughly 2/3 body weight is made up of water
  • Of this 2/3 is found within cells
  • 80% of the remaining third is found in interstitial fluid
  • Only 20% is in plasma
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2
Q

Explain input and output in the body

A

Input

  • Only 60% fluid intake is from enteral fluids
  • The rest is from food and metabolism

Output

  • Fluid loss from non-urine sources are called Insensible Losses
  • In unwell patients insensible losses will increase
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3
Q

Explain the daily requirements of fluids

A

Average Daily Requirements in Health (NICE Guidelines)

  • Water
    • 25-30ml/kg per day
  • Glucose
    • 50-100 grams per day
  • Potassium
    • 1mmol/kg per day
  • Sodium
    • 1mmol/kg per day
  • Chloride
    • 1mmol/kg per day
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4
Q

What are the types of fluid?

A
  • Crystalloid – Normal saline, glucose, hartmann’s
    • Contains simple ionic/crystalline molecules
    • Can easily pass across semi permeable membrane
    • Water follows by osmosis
  • Colloid – Blood products, Human Albumin Solution
    • Contains larger molecules e.g. proteins
    • Unable to pass across semi-permeable membrane
    • Can increase oncotic pressure
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5
Q

How to assess fluid status?

A
  • Clinical Assessment
  • Daily input/output chart
  • Daily weights
  • Urea and Electrolytes
    • Na+
    • K+
    • Cl-
    • Urea
    • Creatinine
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6
Q

Explain fluid depletion and fluid overload signs

A
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7
Q

What are the types of shock?

A

Shock = low BP

  • Hypovolaemic
    • Low blood volume
  • Distributive
    • Sepsis
    • Anaphylaxis
  • Cardiogenic
    • Heart cant pump properly
  • Obstructive
    • PE

more info

Hypovolaemic – loss of blood or fluid

Distributive – fluid in wrong place I.e. anaphylaxis, sepsis, third space losses

Cardiogenic – related to heart pumping

Obstructive – obstruction in heart or great vessels e.g. pe

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8
Q

Fluid management in surgery

A
  • Patients are often NBM prior to surgery and require appropriate maintenance fluids
  • Intra-operative loss e.g. blood
  • Increased GI losses – these losses are often high in potassium
  • Sepsis
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9
Q

Explain fluid prescribing

A
  • What is the goal of fluid prescribing
  • Resuscitation
  • Bolus needed urgently
  • Maintenance
    • To maintain if e.g. nil by mouth
  • Replacement
    • Loss of fluids and needs to be replaced
  • Weight and Size of patient?
    • Older smaller patient needs less
  • Co-morbidities?
    • E.g heart failure
  • Clinical context?
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10
Q

Explain fluid resuscitation

A
  • If patients are shocked and hypotensive there is poor perfusion of tissues
  • This can lead to ischaemia and organ failure
  • The aim of resuscitation fluids is to restore intravascular volume
  • Usually use Crystalloid fluid e.g. 0.9% Sodium Chloride, Hartmann’s Solution
  • In usually healthy patients - 500mls STAT
    • In heart failure, elderly or frail consider giving 250mls
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11
Q

Explain maintenance fluids

A
  • If patient is euvolaemic we can calculate maintenance fluids aiming for the average requirements over 24 hours.
  • Regimes will never provide exactly the right amount of electrolytes

EXAMPLE

EXAMPLE - 70kg person

Bag 1:

500mL of 0.9% saline with 20mmol/L K+ over 8 hours

All of Na+, ~1/3rd of K+, and 1/4 of water

Bag 2:

1L of 5% dextrose with 20mmol/L K+ over 8 hours

1/3 of K+, 1/2 of their water and glucose

Bag 3:

500mL of 5% dextrose with 20mmol/L K+ over 8 hours

Remaining 1/3 of K+, 1/4 of water and glucose

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12
Q

What are the bags of fluid?

A
  • Hartmann’s
  • 0.9% NaCl
  • 5% Dextrose

Bags come in:

  • 250mls
  • 500mls
  • 1000mls

K+ can be added into:

  • 0.9% NaCl
  • 5% Dextrose

as 20mmol or 40mmmol of K+

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