Fluid Management Flashcards
What does a patient need IV fluid for (3)
Resuscitation
Maintenance (NBM)
Replacement (dehydration)
What to consider before giving IV
Aim of fluid Weight of pt Co-morbidities Why they're in hospital U+Es and kidney function
How much of body weight is fluid?
2/3
How much body fluid id Intra or Extracellular
Intracellular - 2/3
Extracellular -1/3
Of the Extracellular fluid, what is Intravascular or Interstitial
Intravascular - 1/5
Interstitial - 4/5
Why is fluid resuscitation difficult in Septic patients
Normal tight epithelial tissue junctions breakdown
Vascular permeability increases
Hydrostatic pressure increase and oncotic pressure decreases
More fluid leaves intravascular space and moves into the interstitium
Signs of fluid DEPLETION (7)
Dry mucous membranes Reduces skin turgor Reduced urine output Postural hypotension Increased CAP refill Tachycardia Hypotension
Signs of fluid OVERLOAD (3)
Raised JVP
Peripheral or sacral oedema
Pulmonary oedema
Daily fluid requirements
Water - 25 mL/kg/day Na+ - 1.0 mmol/kg/day K+ - 1.0 mmol/kg/day Cl- - 1.0 mmol/kg/day Glucose - 50 g/day
What are the 2 types of IV fluids
Crystalloids
Colloids
Features of Crystalloids
Cheap
Most common
Features of Colloids
High osmotic pressure
increase the intravascular volume faster
Contain PROTEINS with large molecular weight so remain in IV space
Why are colloids not used in resuscitation
Risk of anaphylaxis
Loss of tight endothelial junctions so proteins leak
Types of Crystalloids (3)
0.9% Saline
5% Dextrose
Hartmans
Features of 0.9% Saline
Isotonic - equilibrates between intra and interstitial space (25% remains intravascular)
Used for resuscitation and maintenance
Contains Na+ Cl- and H2O
K+ can be added
