Fluid prescribing in adults

Question 1

What fluids are used for resuscitation?

Answer 1

• Glucose 5%
• Sodium chloride 0.9%

Question 2

What fluids are used for maintenance?

Answer 2

• NaCl 0.9% 1000ml (150mmol Na)
• Glucose 5% 1000ml (50g glucose)

Question 3

What is normal saline?

Answer 3

Sodium chloride 0.9%

Question 4

What suggests resus fluids?

Answer 4

Signs of hypovolaemia
- HR >90
- Hypotension (sys <100)
- Non visible JVP
- Decreased GCS
- Fluid loss

Question 5

What is the initial management of a hypovolemic/shocked patient?

Answer 5

1. Resuscitation fluids - 500ml bolus over <15 mins (NaCl 0.9% or Hartmann’s solution)
2. Reassess the patient - if still hypovolemic give a further 250-500 ml bolus
3. This can be repeated up to 2000ml of fluid

Question 6

When are maintenance fluids required?

Answer 6

If pt is haemodynamically stable but is unable to meet daily requirements via oral or enteral routes
- NBM
- Vomiting/losses
- Surgery

Question 7

What are the normal daily fluid intake and electrolyte requirements?

Answer 7

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

Question 8

When should you adopt a more cautious approach to fluid prescribing?

Answer 8

• Elderly patients (20-25 ml/kg/day)
• Pts with renal impairment
• Pts with HF
• Malnourished patients at risk of referring syndrome

Question 9

Before prescribing maintenance fluids, what else do you have to consider?

Answer 9

• Existing fluid deficit/excesses - estimate these and add/subtract from maintenance fluids
• Ongoing losses - estimate and add to maintenance fluids

Question 10

How much glucose does a) 5% dextrose contain and b) Sodium chloride 0.18%/Glucose 4%?

Answer 10

a) 50g/L
b) 40g/L

Question 11

Which of the crystalloid solutions used from fluid maintenance contains potassium?

Answer 11

Hartmann’s solution

Question 12

How much sodium is in NaCl 0.9%?

Answer 12

150mmol/L

Question 13

How much potassium is in 0.15% and 0.3% KCl?

Answer 13

• 0.15% = 20 mmol/L
• 0.3% = 40 mmol/L

Question 14

What’s the minimum time KCl 0.3% and KCl 0.15% can be given?

Answer 14

• 0.3% - 4hrs
• 0.15% - 2hrs

Question 15

When should Glucose 5% be used with caution?

Answer 15

• Patients with impaired glucose tolerance (DM, renal failure, sepsis, trauma, shock)
• Severe malnutrition - refeeding
• Thiamine deficiency - risk of severe lactic acidosis
• Patient with ischaemic stroke or severe traumatic brain injury

NOTE - avoid within first 24hrs following head trauma

Question 16

What fluid is given for emergency resuscitation?

Answer 16

NaCl 0.9% 500ml 15 mins

Question 17

What fluid is given for emergency hypoglycaemia?

Answer 17

Glucose 20% 100ml 15 mins

Question 18

What fluid is given for emergency hypokalaemia?

Answer 18

NaCl 0.9% / KCl 0.3% 1000ml 4 hrs

Question 19

What fluid is given for emergency hypercalcaemia?

Answer 19

NaCl 0.9% 1000ml 4 hrs

Question 20

What fluid is given for maintenance fluids without deficits or losses?

Answer 20

• 25-30ml/kg/24hr water
• 1mmol/kg/24hr Na and K
• 50-100g/24hr glucose

(aim 1000ml 8-12 hr)

Question 21

What fluid is given for maintenance fluids with deficits or losses?

Answer 21

• Minimum 30ml/kg/24hr water
• Ensure electrolytes replaced

(aim 1000ml 4-6 hr)