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SPC- Anaesthetics > Fluid Management > Flashcards

Fluid Management Flashcards

1
Q

What are some important intracellular solutes?

A

Potassium
Magnesium
Phosphate

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2
Q

What are some important extracellular solutes?

A

Sodium
Chloride
Bicarbonate

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3
Q

How can plasma osmolality be calculated approximately?

A

2[NA] + Glucose + Urea

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4
Q

What solutions are isotonic with the plasma?

A

0.9% Saline

5% Glucose in water

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5
Q

How much sodium chloride is in a litre of 0.9% saline?

A

150mmol/L

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6
Q

What is Hartmann’s solution?

A 
Sodium= 131mmol/L
Chloride= 111mmol/L
Lactate= 29mmol/L
Potassium= 5mmol/L
Calcium = 2mmol/L
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7
Q

What is the difference between colloids and crystalloids?

A

Colloids contain large molecular weight molecules which should stay within the intravascular space

Crystalloids contain ions which distribute around the body.

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8
Q

What should be used for resuscitation?

A

NICE recommend using crystalloids, and colloids have been found to have little extra benefit

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9
Q

Where is Hartmann’s solution commonly used?

A

Often in theatres

It has concentrations of ions which are more similar to physiological levels

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10
Q

What are some examples of colloids?

A

Albumin
Gelatin
Dextran

Often suspended in NaCl

Used in 1:1 ration for blood loss

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11
Q

What are some side effects of colloids?

A

Anaphylaxis to the molecules
Antithrombotic action
Deposit in the reticuloendothelial system to cause itching/pruritus

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12
Q

How should you examine to assess fluid status?

A 
JVP
Peripheral oedema
Pulmonary oedema
Mucous membranes
CRT
Blood pressure
Urine output
Skin turgor
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13
Q

What blood test results might you see in someone who is dehydrated?

A

Raised Hb (or if previously anemic may be normal)
Raised creatinine and urea if reduced renal perfusion
Raised sodium

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14
Q

What happens when you infuse fluid with sodium?

A

Sodium stays in the extracellular fluid and water stays with it so it can raise circulating volume (as the extracellular fluid is the fluid around cells (interstitial fluid) and the circulating volume.

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15
Q

What happens when you give someone 5% glucose solution?

A

Glucose is metabolised so this is effectively giving the person water. This will distribute in the bodies compartments so raises total body water.

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16
Q

When is dextrose solution indicated?

A

Dehydrated patients- as the glucose is metabolised and the water distributed around the bodies compartments, therefore raising total body water. It will not adequately increase circulating volume.

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17
Q

Where does 1L of 0.9% saline distribute to?

A

Sodium stays within the extracellular fluids and water stays with it.

This comprises of the interstitial fluid (around cells) and the circulating volume.

Distributes in a 2:1 ratio between interstitial fluid and circulating volume

Therefore giving 1 litre raises circulating volume by 333ml

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18
Q

Where does 0.9% saline distribute to?

A

Sodium stays in the extracellular fluid and water stays with it.

Therefore distributes to the interstitial fluid (around cells) and the circulating fluid (intr-vascular). This is in a 2:1 ration

A third of the volume of 0.9% NaCl therefore stays in the intravascular space

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19
Q

What ratio does 0.9% saline distribute between the interstitial fluid and the intravascular fluid?

A

2: 1

2 in interstitial fluid
1 in the intravascular fluid

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20
Q

Where does 5% dextrose distribute?

A

Everywhere so it increases the whole total body water.

It’s only indication is dehydration, and should never be used for resuscitation.

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21
Q

What should hypovolaemia be treated with?

A

Rapid infusion of isotonic (0.9% saline solution)

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22
Q

What should dehydration be treated with?

A

5% dextrose

NEVER FOR RESUS

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23
Q

If someone is NBM what maintenance fluids are required?

A

1.5mls/kg/hr

Otherwise they will become dehydrated

24
Q

What are the sodium electrolyte requirements?

A

2mmol/kg/day

A litre of normal saline normally replaces this (contains 150mmol in 0.9%)

25
Q

What are the potassium electrolyte requirements?

A

1 mmol/kg/day

So around 60 to 70 mmols in 24 hours.

NEVER GIVE POTASSIUM AS A BOLUS. Needs to be added to saline.

26
Q

What is the normal infusion rate for fluids on the wards?

A

100-125mls/hr for dextrose or saline

27
Q

How much potassium should be added per litre bag of 0.9% saline if potassium deficits?

A

20-40mmol KCL per litre of 0.9% saline

Reassess often with regular U+Es monitoring. VBGs can be used for rapid assessment.

28
Q

What is the fluid therapy for resuscitation?

A

ABC Approach for this as it’s a medical emergency

2000ml of 0.9% Saline via a wide bore cannula

(Or a litre of colloid)

29
Q

What is a complication of excess fluids?

A

Hyperchloremic acidosis-

Too much chlorine is given in the saline

30
Q

Why is Hartmans/Ringer’s Lactate favoured for postoperative fluid therapy?

A

It contains concentrations of ions that are similar to physiological levels and therefore reduces the risk fo hyperchloraemic acidosis

5% Dextrose and dextrose/saline combination are generally not recommended for post surgery patients

31
Q

What are the NICE recommended guidelines for maintenance fluid replacement?

A

25-30 mls/kg/day of water
1 mmol/kg of potassium, sodium and chloride
50-100 g/day of glucose

e.g. for an 80 kg Patient:
2 litres of water
80 mmol of potassium

32
Q

When might acute fluid resuscitation be required?

A

Hypovolaemia

May be due to:
Bleeding
Severe diarrhoea and vomiting
Burns
Sepsis

Typically 2 litres of 0.9% saline given

33
Q

How needs maintenance fluids?

A

Patients unable to meet their own requirements

E.g. Bowel Obstruction, Perioperative

Replace 25-30ml/kg of water, 1 mmol/kg of Na, K and 50-100g/day of glucose

34
Q

What are the three types of crystalloids?

A

Hartmans
0.9% Saline
5% Dextrose

35
Q

How much sodium and how much chloride is in a 1 litre bag of hartmann’s?

A

154 mmol of sodium and chloride is found in 1 litre of 0.9% sodium

Some bags contain 20-40mmol of potassium

36
Q

What are and how much of each constituent is in a litre Hartmann’s Solution?

A 
131 mmol Sodium
5 mmol of potassium
2 mmol of calcium
111 mmol of chloride
29 mmol of bicarbonate

All are per litre.

Note these are very close to physiological levels. Hartmans is commonly used in theaters and post operatively.

37
Q

What do colloids contain?

A

Large molecules that remain within the extravascular space- thought to be better for increases intravascular fluid

38
Q

What is risk of colloids?

A

Risk of anaphylaxis reactions

39
Q

Are colloids or crystalloids recommended for resus?

A

Crystalloids are now recommended as colloids are thought to offer no additional benefit.

40
Q

What blood products are available?

A

Packed red cells
Platelets
Fresh Frozen Plasma

41
Q

When is in fresh frozen plasma?

A

Contains plasma proteins and clotting factors. Stored frozen and must be defrosted before use.

42
Q

When is human albumin solution used?

A

Given for paracentesis when draining ascites, as there can be massive fluid shifts leading to haemodynamic instability

43
Q

When do NICE recommend FFP should be used?

A

Significant haemorrhage but not major haemorrhage.

APTT or PT >1.5

44
Q

What is cryoprecipitate?

A

Concentrated clotting factors that is given for clinically significant haemorrhage
Indication is fibrinogen <1.5g/L
Use in emergencies for known haemophiliacs
Use for DIC, Liver failure

Also prophylactic use in patients undergoing major surgery with fibrinogen less than 1g/L

45
Q

What is the fibrinogen level when cryoprecipitate should be given?

A

1.5g/L or less

46
Q

When should prothrombin complex concentrate be used?

A

Emergency reversal of anticoagulation in patients with severe bleeding or head injury with suspected intracranial bleed.

47
Q

What is the definition of major haemorrhage?

A

Loss of whole blood volume in 24 hours
Loss of 50% of circulating blood volume in 3 hours or less
Blood loss of 150ml/minute

Normal blood volume is around 5 litres or 7% of total adult body weight

48
Q

What should be done for major haemorrhage?

A

Activate major haemorrhage protocol and follow guidelines

49
Q

What needs to be included for fluid prescribing?

A 
Date and time
Fluid type
Any additives
Volume
Rate of delivery
Sign it off

Remember to cross off if replacing a prescription

50
Q

What do you need to do before attaching a fluid bag to the cannula?

A

Flush the cannula to check it’s patent

51
Q

Where can the drops per ml be found on giving sets?

A

On the fluid giving set bag

Normally 20 drops = 1ml

52
Q

What is a fluid challenge for resus

A

500ml over 15 minutes

If elderly or cardiac problems 250mls over 15 minutes

53
Q

What is used for fluid resuscitation?

A

0.9% Saline-

Avoid rapid potassium replacement. Should be replaced no faster than 10 mmol per hour

Therefore avoid any 0.9% Saline with added potassium.

54
Q

When are maintenance fluids used?

A

To replace ongoing fluid losses in patients unable to maintain adequate oral intake.

55
Q

What do NICE recommend as the volume of IV fluids to replace for maintenance in patients?

A

25-30 ml/kg/day

But closely monitor U&Es and adjust fluid accordingly

56
Q

How much sodium per day do adults generally require?

A

2mmol/kg

57
Q

How much potassium per day do adults generally require?

A

1 mmol/kg

SPC- Anaesthetics (7 decks)

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