Fluid Management

Question 1

Describe the fluid/electrolyte distribution in cells

Answer 1

• 63% intracellular fluid (mainly K+)
• 30% extracellular fluid in interstitium (mainly Na+Cl)
• 7% extracellular fluid in the plasma

Question 2

Describe what problems can lead to an fluid imbalance in the body

Answer 2

Altered input:
- inadequate hydration
- overhydration

Altered output:
- vomiting
- diarrhoea
- stoma
- drains
- fever
- polyuria

poor output: oliguria

Question 3

Describe what 3rd space losses are with its clinical relevance

Answer 3

• redistribution of fluid eg. malnourishment, osmolar imbalances
• can result in the movement of fluid from the intracellular space into the interstitium
• clinical relevance: hypotonic interstitial space (hyponaturaemia) can cause the movement of water intracellularly into the brain = cerebral oedema

Question 4

What are the symptoms and signs of fluid depletion?

Answer 4

• symptoms: thirst, dry mouth, dry skin, dark urine, postural dizziness
• signs: reduced skin turgor, dry mouth and axillae, CRT >2sm postural hypotension, tachycardia, tachypnoea

Question 5

What are the symptoms and signs of fluid overload?

Answer 5

• symptoms: breathlessness, swollen ankles
• signs: hypertension, increased JVP, 3rd heart sound, pulmonary/peripheral oedema

Question 6

What are the 3 types of IV fluid and where do they distribute?)

Answer 6

• crystalloids (saline - dextrose - all compartments, balanced solutions eg. Hartmanns - intravascular and interstitial, NaHCO3)
• colloids = intravascular space
• blood products (packed red cells, platelets, fresh frozen plasma, human albumin solution)