Fluids

Question 1

What are the main indications of using sodium chloride over hartmans/ compound sodium lactate solution?

Answer 1

Usually in sodium depletion, which can arise from such conditions as

• gastro-enteritis
• diabetic ketoacidosis
• ileus
• and ascites
• And prefered in head injury: hyper-osmolar therefore reduced likelyhood of cerebral oedema

But: risk of hyperchloraemic acidosis

Question 2

What are usual dails fluid requirements in the adult?
(Volume, Electrolytes and urine output)

Answer 2

Fluids: 25-30 ml/kg water (~2-3L IV)
Electrolytes: 1mmol/kg NA, CL, K+
Urine output: 0.5mg/kg/h

Question 3

What are contraindications to the administration of Hartman’s?

Answer 3

1. Liver failure - cannot metabolise lactate
2. Hyperkalaemia - renal failure

Question 4

What would be a common maintenance fluid prescription for a healthy adult?

Answer 4

Usually 1 salty 2 sweet (some argue 2 salty 1sweet) + Potassium

= 8hrl bags with 20mmol K+ per bag

(in the PSA they usually like 80kg males to 80mmol K+ over 24h)

Question 5

What is the maintenance requirement of potassium for a patient with a normal potassium level?

Answer 5

Aim for between 40-80 mmol/ day (1mmol/kg/day)

Question 6

What is the maximum rate of infusion of potassium?

Answer 6

Maximum rate of delivery: 10mmol/h (or 20mmol/h in ICU)

Question 7

When should you replace potassium orally, and when should you think about IV replacement?

Answer 7

2.6 - 3.4: Oral replacement
if < 2.5: IV replacements

• 40mmol of Potasssium in 1L = 0.3%
• 20mmol of Potassium in 1L = 0.15%

Question 8

What are some contraindications to thrombophrophylaxis (anticoagulation medicines) in hospital?

Answer 8

Acute bleeding risk (including recent ischaemic stroke)

Question 9

What are contraindications to compression stockings?

Answer 9

Peripheral arterial disease