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Urinary system > Fluid replacement therapy > Flashcards

Fluid replacement therapy Flashcards

1
Q

Outline the distribution of body fluids in males

A
  • 40% total body mass solids
  • 60% total body mass fluids
  • 2/3 ICF
  • 1/3 ECF
  • 75% ECF is interstitial fluid
  • 25 % ECF is plasma
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2
Q

Outline the distribution of body fluids in females

A
  • 45% total body mass solids
  • 55% total body mass fluids
  • 2/3 ICF
  • 1/3 ECF
  • 75% ECF is interstitial fluid
  • 25 % ECF is plasma
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3
Q

What is the total body water of a newborn baby?

A
  • 75%
  • Makes them more vulnerable to dehydration
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4
Q

What is the total body water in the elderly?

A

-45%

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5
Q

Does ECF differ between the blood plasma and interstitial fluid?

A
  • No
  • Nothing prevents ions diffusing between the compartments
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6
Q

Why does the composition of ECF differ from the composition of ICF?

A
  • Due to cell membranes
  • Na+ is main cation of ECF
  • K+ is main cation of ICF
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7
Q

Why might patients need IV fluids?

A
  • Nil by mouth
  • Malfunctioning gastrointestinal tract
  • Dehydration
  • Fluid losses
  • Abnormal electrolytes
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8
Q

Which fluids should you give to a patient?

A
  • Maintenance fluids
  • Replace any additional fluid lost too
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9
Q

Why can’t we just give a patient pure water as an IV fluid?

A
  • Water is too hypotonic compared to plasma
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10
Q

How do we give a patient a ‘drink of water’ through IV fluids?

A
  • Prescribe 5% dextrose
  • Osmolarity of 278 MOSM/Kg
  • Isotonic to plasma so water distributes proportionately across body compartments and reduces their osmolarity
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11
Q

What happens to the glucose in 5% dextrose solution?

A
  • Taken up by cells rapidly
  • Used for metabolism
  • If infusion rate is greater than uptake and metabolism, patient can become hyperglycaemic
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12
Q

Why is dextrose not suitable for a haemorrhaging patient?

A
  • Not enough water makes it into the intravascular compartment
  • This is because water distributes proportionately across all body compartments
  • Only 1/12 of total infusion volume will make it into intravascular compartment
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13
Q

Which IV fluids will only go into the ECF?

A
  • 0.9% saline (contains Na+ and Cl-)
  • Hartman’s
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14
Q

Why is Hartman’s solution ideal for fluid resus?

A
  • Contains Na+, Cl-, K+, Ca2+, lactate
  • Iso-osmotic to plasma
  • Maintains osmolarity as well as volume
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15
Q

What is a combination bag?

A
  • Contains dextrose solution and saline/Hartman’s
  • Dextrose acts to reduce osmolarity of all compartments
  • Saline remains in ECF only
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16
Q

Why do hospitalised patients’ fluid requirements differ from non-hospitalised people?

A
  • Reduced free water excretion (hyponatraemia)
  • Increased water and salt retention (volume overload)
17
Q

What causes hospitalised patients to retain more water than healthy patients?

A
  • Vasopressin due to non osmotic stimuli e.g. drugs (morphine), pain, nausea
  • No excessive sweating
  • RAAS and catecholamines due to stress response
  • Reduced caloric expenditure
18
Q

What are the NICE guidelines for maintenance fluids?

A
  • 25-30 mL/kg/day of water
  • 1 mmol/kg/day of K+, Na+ and Cl-
  • 50-100g of glucose per day
19
Q

What are the NICE guidelines for fluid resuscitation?

A
  • Fluid bolus of 500ml of crystalloids (saline or Hartman’s) is given
  • Expert help required for patients given >2000ml of crystalloids but still needing fluid resus
20
Q

When would you give resuscitation fluids?

A
  • Systolic BP <100 mmHg
  • HR >90 bpm
  • Capillary refill time >2 seconds or cold peripheries
  • Resp rate >20 breaths per minute
  • NEWS score >5
  • Passive leg raises suggest fluid responsiveness
21
Q

When would you prescribe maintenance fluids?

A
  • Patient is haemodynamically stable but unable to meet daily fluid requirements via oral or enteral routes
  • Fluids should be administered during daytime hours to minimise disturbance to sleep
22
Q

What is the electrolyte constitution of gastric juice?

A
  • 14 mmol/L K+
  • 20-60 mmol/L Na+
23
Q

What is the electrolyte constitution of diarrhoea?

A
  • 30-70 mmol/L K+
  • 20-80 mmol/L HCO3-
24
Q

What fluid would you prescribe to a patient suffering from dehydration?

A
  • Saline 0.9%
  • Increases ECF only
25
Q

What would you happen to the fluid compartments of a patient who has not urinated for several hours?

A
  • ECF would expand and its osmolarity would decrease
  • Water would move to ICF to balance osmolality of ECF
  • ICF osmolality also decreases until a new equilibrium is reached
26
Q

What would you happen to the fluid compartments of a patient who is haemorrhaging?

A
  • ECF loses volume but its osmolality does not change
  • Water does not move out of ICF to compensate
27
Q

What would you happen to the fluid compartments of a patient who has diarrhoea and vomiting?

A
  • ECF loses volume and its osmolality increases (pt can’t drink enough to replace water lost)
  • Water moves from ICF to ECF to balance change in osmolality
  • Osmolality of both compartments increases
  • New equilibrium is reached
  • Want to give dextrose and Hartman’s/saline
28
Q

If you’re prescribing dextrose and saline, what should the ratios be?

A
  • 2 dextrose : 1 saline/Hartman’s

Urinary system (22 decks)

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