Fluids

Question 1

If hypernatremic or hypoglycaemic give…

Answer 1

5% dextrose

Question 2

If has ascites, give…

Answer 2

Human-albumin solution (HAS) to maintain osmotic pressure

Question 3

If shocked with BP<90, give…

Answer 3

Gelofusine (a colloid) as it has high osmotic content so stays intravascularly

Question 4

If shocked from bleeding, give…

Answer 4

Blood transfusion, but a colloid first if not available

Question 5

Adults require how many litres of fluid over 24 hours?

Answer 5

3L

Question 6

Older adults require how many litres of fluid in 24 hours?

Answer 6

2L

Question 7

How much potassium is generally required in 24 hours?

Answer 7

40mmol KCl a day with normal K level. Put 20mmol in 2 bags

Question 8

What phrase can be used to remember adequate electrolyte maintenance in general?

Answer 8

2 sweet and 1 salty. 2 bags 5% dextrose and 1 bag normal saline.

Question 9

If giving fluids due to reduced urine output, what must be remembered?

Answer 9

Check bladder is not palpable and they are not in retention.

Question 10

What kind of AKI if urea rise is higher than creatinine rise?

Answer 10

Pre-renal

Question 11

What kind of AKI if urea rise smaller than creatinine rise and bladder or hydronephrosis not palpable?

Answer 11

Intrinsic

Question 12

What kind of AKi if urea rise larger than creatinine rise and bladder or hydronephrosis maybe palpable?

Answer 12

Post-renal

Question 13

Causes of pre-renal AKI?

Answer 13

Dehydration or shock, e.g. sepsis, blood loss

Renal artery stenosis

Question 14

Causes of intrinsic AKI

Answer 14

INTRINSIC
Ischaemia (due to pre-renal, causing acute tubular necrosis)
Nephrotoxic antibiotics (especially gentamicin, vancomycin and tetracyclines)
Tablets (ACEI, NSAIDS)
Injury (rhabdomyolysis)
Negatively birefringent crystals (gout)
Syndromes (glomerulonephridites)
Inflammation (vasculitis)
Cholesterol emboli

Question 15

Causes of post-renal AKI?

Answer 15

In lumen - stone or sloughed papilla
In wall: tumour (renal cell, transitional cell), fibrosis
External pressure: benign prostatic hyperplasia, prostate cancer, lymphadenopathy, aneurysm

Question 16

Nephrotoxic antibiotics?

Answer 16

Gentamicin, vancomycin and tetracyclines