Fluid Management

Question 1

Which ion is in high concentration in intracellular fluid?

Answer 1

Potassium

Question 2

Which ions are in high concentration in interstitial fluid?

Answer 2

Sodium

Chloride

Question 3

What is the normal level of daily water intake?

Answer 3

20-30 ml/kg/day

Question 4

What is the normal fluid output per day?

Answer 4

2 litres a day

Question 5

How can fluid/electrolyte balance go wrong?

Answer 5

Imbalance between input and output

Redistribution of fluid Osmolar problems

Question 6

Why might there be an imbalance between input and output of fluid/electrolytes?

Answer 6

Patient is unable to eat (drowsy, fasting obstruction)
Medicines (laxatives, diuretics)
Excess losses (diarrhoea, vomiting, polyuric, pyrexial)

Question 7

Different amount of fluid/electrolyte is lost dependent on where it is lost from. T/F?

Answer 7

True

Question 8

Describe the predicted loss of sodium, potassium, chloride, bicarbonate and fluid loss from gastric secretions?

Answer 8

Some sodium, potassium and bicarbonate and lots of chloride and fluid loss

Question 9

Describe the predicted loss of sodium, potassium, chloride, bicarbonate and fluid loss from bile secretions?

Answer 9

Lots of sodium and chloride loss
Mild bicarbonate loss
Some potassium and volume loss

Question 10

Describe the predicted loss of sodium, potassium, bicarbonate and fluid loss from diarrhoea secretions?

Answer 10

Mild-severe sodium loss
Lots of potassium and bicarbonate loss
Variable fluid loss

Question 11

Describe the predicted loss of sodium, potassium, chloride and fluid loss from colostomy secretions?

Answer 11

Moderate sodium, potassium and chloride loss

Variable fluid loss

Question 12

What is normal serum osmolarity?

Answer 12

280-300mOsm/kg

Question 13

What is serum osmolarity?

Answer 13

A measure of the serum concentration of small diffusible ions (mainly sodium, potassium, glucose and urea)

Question 14

What is the risk of correcting acute hyponatraemia too quickly?

Answer 14

Cerebral oedema

Question 15

What are the symptoms of fluid depletion?

Answer 15

Thirst
Dry mouth
Dry skin
Dark urine
Postural dizziness

Question 16

What are the symptoms of fluid overload?

Answer 16

Breathlessness

Swollen ankles

Question 17

What are the signs of fluid depletion?

Answer 17

Reduced skin turgor
Dru mouth
Dry axillae
Capillary refill time >2 seconds
Postural hypotension
Tachycardia
Tachypnoea

Question 18

What are the signs of fluid overload?

Answer 18

Hypertension
Increased JVP
3rd heart sound
Pulmonary / peripheral oedema

Question 19

When should routine fluid maintenance be used?

Answer 19

Patients who are not drinking, unable to drink or having to fast for 8-12 hours

Question 20

What is fluid replacement used for?

Answer 20

Treat deficits or ongoing losses not needed urgently for resuscitation

Question 21

Give examples of crystalloids?

Answer 21

Saline (0.9% is standard)
Balanced solutions (Hartmann’s, Ringer’s lactate)
Dextrose (5% is standard)
Sodium bicarbonate (on expert advice only

Question 22

Give examples of colloids?

Answer 22

Gelofusion

Starch based fluids

Question 23

Give examples of blood products?

Answer 23

Packed red cells
Platelets or fresh frozen plasma
Human albumin solution

Question 24

When is resuscitation required?

Answer 24

When there are clinical signs of hypovolaemia:
Hypotension, tachycardia, peripherally cold, capillary refill time >2 seconds, NEWS >5 and passive leg raising suggesting fluid responsiveness

Question 25

Give examples of specific situations in which there are complex fluid and electrolyte redistribution issues requiring senior help?

Answer 25

Gross oedema
Severe sepsis
Hyponatraemia
Hypernatraemia
Renal/liver/cardiac impairment
Post operative fluid retention and retribution
Malnourishment/feeding issues