Fluid resuscitation

Question 1

What are the 4 algorithms for IV fluid therapy?

Answer 1

1. Assessment
2. Fluid resuscitation
3. Routine maintenance
4. Replacement and redistribution

Question 2

What is involved in the assessment part of IV fluid therapy?

Answer 2

1. Using A-E approach, assess if patient is hypovolaemic
   –YES = fluid resus
   –NO = assess likely fluid / electrolyte needs (2)
2. History, examination, monitoring, lab assessments. Assess patient’s ability to meet their fluid/electrolyte needs orally/enterally
   –YES = ensure needs are met
   –NO = 3
3. Does the patient have complex fluid/electrolyte replacement / abnormal distribution issues?
   –YES = replacement and redistribution
   –NO = routine maintenance

Question 3

What are the steps in fluid resuscitation (Algorithm 2)?

Answer 3

NB already confirmed patient is hypovolaemic
1. Initiate treatment = identify cause + give 500ml fluid bolus in <15 min
2. Reassess with A-E approach
–If in shock - escalate
–If improving, offer routine maintenance or optimise nutrition and hydration orally

Question 4

What are the steps in routine maintenance (Algorithm 3)?

Answer 4

1. Give maintenance IV fluids
   -25-30 ml/kg/d water
   -1 mol/kg/day Na, K, Cl
   -50-100 g/day glucose

Question 5

What are the steps in replacement and redistribution (Algorithm 4)?

Answer 5

1. Check for main causes:
   -Existing deficit/excess = dehydration, fluid overload, hyper-/hypokalaemia
   -Ongoing abnormal losses = vomiting, billiary drainage loss, high/low volume ideal stoma loss, diarrhoea, blood loss, fever/dehydration, polyuria
   -Redistribution issues = oedema, severe sepsis, hyper-/hyponatraemia, renal/cardiac/liver impairment
2. Add / subtract from routine maintenance depending on the cause

Question 6

What benefits does giving Hartman’s have?

Answer 6

-Good for maintenance fluids as it contains potassium

Question 7

What patients should you avoid giving Hartman’s to?

Answer 7

CKD patients

Question 8

What patients should you avoid giving dextrose to?

Answer 8

-Diabetes patients