Fluids

Question 1

Indications a patient may require fluid resuscitation:

Answer 1

Systolic BP <100mmHg
Heart rate >90bpm
Capillary refill >2s or Cool peripheries
Respiratory rate >20bpm
NEWS ≥5
If observations improve with a passive leg raise, this indicates a fluid bolus is likely needed

Question 2

Fluid resuscitation

Answer 2

Fluid bolus of 500mL crystalloid over <15 minutes
Reassess using ABCDE approach
Further fluid boluses (up to 2000mL) may be required

Question 3

Normal daily fluid maintenance requirements:

Answer 3

25-30mL/kg/day water
1mmol/kg/day sodium
1mmol/kg/day potassium
1mmol/kg/day chloride
50–100g/day glucose to limit ketosis

Question 4

Crystalloid vs colloid

Answer 4

Crystalloid = solution containing small molecules e.g. sodium, chloride
Colloid = solution containing larger molecules e.g. albumin

Question 5

Consider prescribing a smaller fluid bolus if

Answer 5

*Elderly
*Renal impairment or cardiac failure
*Malnourishment or at risk of refeeding syndrome

Question 6

red flags for paediatric dehydration

Answer 6

Appears unwell or deteriorating
Altered responsiveness
Sunken eyes
Reduced skin turgor
Tachycardia
Tachypnoea

Question 7

Acute fluid resuscitation in children

Answer 7

Boluses in paediatrics are given at 10-20ml/kg at a time
The fluid used is 0.9% sodium chloride
10ml/kg boluses should be used when treating children who are in heart failure or are trauma victims DKA
Estimate of fluid deficit = Weight (Kg) x % dehydration x 10

Question 8

Paediatric Maintenance fluid requirements

Answer 8

100ml/kg for first 10kg bodyweight
50ml/kg for second 10kg bodyweight
20ml/kg for every kg above 20kg bodyweight

Electrolyte requirements;
Sodium: 2-4mmol/kg/day
Potassium: 1-2mmol/kg/day