Fluid Therapy

Question 1

how would you work out how much maintenance fluid a person requires on a daily bases in terms of water and electrolytes?

Answer 1

25-30ml/kg/day water
1mmol/kg/day of potassium, sodium and chloride
50-100g/day of glucose to limit starvation ketosis

Question 2

what volume of water does an 80kg patient require over a 24hr period, for example?

Answer 2

2 litres

25-30 ml/kg/day

Question 3

what is the risk if large volumes of 0.9% saline are given to a patient?

Answer 3

increased risk of hyperchloraemic metabolic acidosis

Question 4

in what patients should Hartmann’s not be used?

Answer 4

patients with hyperkalaemia

Question 5

what is Hartmann’s solution also called?

Answer 5

compound sodium lactate

Question 6

what does a fluid challenge involve?

Answer 6

giving 500ml crystalloid fluid over <15 mins

keep giving bolus of fluid up to 2L and seek expert help if getting no response

Question 7

when giving patients fluids what do you need to regularly measure?

Answer 7

U&Es

Question 8

give 3 examples of crystalloid fluids

Answer 8

0.9% sodium chloride (with or without KCl) which is also known as saline.
5% glucose (with or without KCl).
Hartmann’s solution

Question 9

what ions does Hartmann’s solution contain?

Answer 9

sodium, potassium, calcium, chloride, bicarbonate

Question 10

give 2 examples of what colloids contain which means the fluid remains in the intravascular space

Answer 10

gelatin or

albumin

Question 11

which fluid is typically used for fluid resuscitation?

Answer 11

normal saline (NaCl 0.9%)

Question 12

what is typically the maximum rate of a potassium infusion?

Answer 12

10mmol/hr

but make sure to refer to trust guidelines

Question 13

what is the infusion rate in ml/hr of a typical adult pt needing maintenance fluids?

Answer 13

100ml/hr

Question 14

when administering fluids, what is it important to measure?

Answer 14

U&Es to be able to adjust fluid type appropriately.
renal function.
fluid status - to know whether fluids are still needed

Question 15

whenever you are prescribing fluids you need to be clear bout what you are treating. what are the 5 R’s of fluid therapy?

Answer 15

resuscitation
replacement
routine maintenance
redistribution
reassessment

Question 16

what fluids should you use for resucitation fluids and why?

Answer 16

Hartmanns or NaCl because they are isotonic so will remian in intravascular compartment for longer

Question 17

what are the 4 steps in calculating maintenance fluids?

Answer 17

1. weight pt or find out pt weight
2. calculate 24hr fluid volume in ml (25-30ml x weight (kg))
3. work out rate in ml/hr - 24hr fluid volume/24h
4. work out sodium and potassium requirements to choose type of fluid

Question 18

what size bags do fluids come in and do you have to prescribe each bag separately?

Answer 18

500ml and 1,000ml

yes, prescribe each bag separately

Question 19

what are the 3 different amounts of potassium a bag can contain?

Answer 19

0,
20mmol
40mmol

Question 20

what is the max rate for potassium infusion?

Answer 20

10mmol/h

Question 21

can you add extra potassium to hartmanns?

Answer 21

no

Question 22

how often should you assess fluid requirements?

Answer 22

every 24hrs

Question 23

what is a good routine maintenance regimen? what should you remember to add?

Answer 23

0.9%Nacl then 5% dextrose in 1:2 ratio.

remember to add K+

Question 24

what fluids should be sued for 24-48hrs perioperatively?

Answer 24

hartmanns

Question 25

if a pt is hypobolaemic due to bleeding, what are the ideal fluids to use for replacment?

Answer 25

blood

Question 26

what is a good fluid to give someone who has been vomiting severely?

Answer 26

0.9% NaCl - it’s ok to give continually as pt is usually depleted in both Na and Cl.
give potassium replacement too

Question 27

what would too much 0.9% NaCl fluids show on ABG

Answer 27

hyperchloraemic metabolic acidosis