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Emergency Medicine > Fluids > Flashcards

Fluids Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Types of crystalloid fluids

A

5% dextrose, 0.18% saline with 4% dextrose, 0.9% saline, Hartmann’s, 0.45% saline with 4% dextrose

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2
Q

What are the two main types of fluids

A

Crystalloids and colloids

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3
Q

What is 5% dextrose used for

A

Hypotonic on its own, used in severe hypoglycaemia

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4
Q

What does 0.9% sodium chloride do

A

Replaces salts in the intravascular spaces

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5
Q

What does Hartmann’s do

A

More physiological to blood so stays mostly in extracellular space

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6
Q

What are the main components of crystalloid fluids

A

Water with some additives

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7
Q

What are the main components of colloid fluids

A

Water which contain bigger molecules, which do not readily cross semi-permeable barriers

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8
Q

Examples of colloids

A

Gelofusin, albumin, blood

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9
Q

Complications of fluids

A

Volume overload, cerebral oedema, electrolyte disturbances, renal toxicity

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10
Q

When fluids need to be prescribed

A

Maintenance, electrolyte replacement, resuscitation, drug administration

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11
Q

What are the 5 R’s of fluids

A

Resus, rountine maintenance, replacement, redistribution, reassessment

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12
Q

When is resus used

A

Acute cases, to correct fluid deficit - haemorrhage, sepsis, burns, severe D&V

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13
Q

When is maintenance used

A

Replace ongoing fluid loss, indequate PO intake - peri-op patients, bowel obstruction

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14
Q

What are factors which maintenance volume depends on

A

Age, weight, co-morbidities, clinical state, medications, anticipated time NBM

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15
Q

What fluid is used for resus

A

Normal saline 250-500ml bolus stat

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16
Q

What is euvolaemic hyponatraemia

A

Normal body sodium with increase in total body water

17
Q

What is hypovolaemic hyponatraemia

A

Decrease in total body water with greater decrease in total body sodium

18
Q

What is hypervolaemic hyponatraemia

A

Increase total body sodium with greater increase in total body water

19
Q

Causes of hypovolaemic hyponatraemia

A

Diuretic use, heart failure

20
Q

What are the risks of fast correction in chronic hyponatraemia

A

Risk of pontine demyelination

21
Q

Causes of normovolaemic hypernatraemia

A

Usually iatrogenic

22
Q

Causes of hypovolaemic hypernatraemia

A

Diabetes insipidus, osmotic diuresis (such as DKA)

23
Q

What is hypovolaemic hypernatraemia

A

Small volumes of concentrated urine associated with fluid loss.

24
Q

Causes of increased excretion of K+

A

Diuretics, endocrine causes such as Cushings and steroids, RTA, hypomagnesaemia, vomiting

25
Q

Causes of increased cellular uptake of K+

A

Salbutamol and insulin most notable - associated with DKA management

26
Q

Chronic causes of hyperkalaemia

A

CKD most common, diabetes, aldosterone insufficiency, diet

27
Q

Acute causes of hyperkalaemia

A

AKI, DKA, rhabdolyolysis, tumour lysis (post chemo) and medication (less common)

28
Q

ECG findings of hyperkalaemia

A

Peaked T waves, P wave flattening, PR prolonged, bradyarrhythmias, conduction blocks, QRS abnormalities

29
Q

Management of hypokalaemia

A

Oral or IV - slow infusion as part of maintenance regime

30
Q

Management of hyperkalaemia

A

Always treat cause, calcium gluconate 10ml 10% binds K+ and works in few mins, insulin and salbutamol shift K+ intracellularly, K binders are slow acting

31
Q

Causes of pseudo hyponatraemia

A

Hypertriglyceridaemia, high protein, hyperglycaemia, sorbitol/glycine

32
Q

Causes of water > soluble intake

A

Psychogenic polydipsia, beer potomania, low solute diet

33
Q

Causes of hypovolaemia, non-renal aetiology

A

GI losses, reduced PO intake, previous diuretic use

34
Q

Causes of hypovolaemia renal involvements

A

Renal salt wasting, current diuretic use, vomiting

35
Q

Causes of euvolaemic hyponatraemia

A

SIADH, adrenal insufficiency, hypothyroidism

36
Q

Causes of oedematous state

A

Heart failure, cirrhosis, nephrotic syndrome

37
Q

General criteria for DDAVP clamp

A

At risk for sodium over-correction, risk of cerebral osmotic demyelination

38
Q

Symptoms of severe hyponatraemia

A

Seizure, delirium, coma, herniation, neurogenic pulmonary oedema

Emergency Medicine (17 decks)

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