Fluids

Question 1

Routine maintenance requirements in an adult per day?

Answer 1

25-30ml/kg of water
1mmol/kg/day of Na, K and Cl
50-100g of glucose per day

up to a max weight of 100kg

Question 1

What fluid is used for resuscitation?

Answer 1

generally a balanced crystalloid e.g. Hartmanns is considered better because with 0.9% NaCl there is a risk of hyperchloraemic metabolic acidosis
exception is in rhabdomyolysis (and AKI/ CKD) where 0.9% saline would be preferred due to risk of hyperkalaemia

Question 2

Risk of resuscitation with 0.9% NaCl?

Answer 2

hyperchloraemic metabolic acidosis

Question 3

In resuscitation when is 0.9% NaCl preferred over Hartmanns?

Answer 3

when the patient has rhabdomyolysis, AKI or CKD and there is a risk of hyperkalaemia with Hartmanns

Question 4

Paediatric fluid requirements?

Answer 4

100ml/kg/day for the first 10kg
50ml/kg/ day for the next 10kg
20ml/kg/day for weight over 20kg
(holliday-segar formula)

Question 5

How much crystalloid do you give in resuscitation situation?

Answer 5

500 ml of crystalloid over less than 15 minutes (can be written as stat which means as quickly as the fluid can run through the cannula)
continue fluid bolus of 250-500ml until given over 2000ml, if still no response should be seeking expert help

Question 6

Maximum rate of potassium infusion per hr?

Answer 6

10 mmol/ hr (so if someone is getting 40mmol of potassium then they can only have this safely over 4hrs or more)

Question 7

How many mmil of Na and Cl in 1 litre of NaCl 0.9%?

Answer 7

154 mmol of both

Question 8

What can help reduce the risk of contrast nephropathy?

Answer 8

IV 0.9% NaCl

Question 9

Giving glucose as a fluid in stroke?

Answer 9

in stroke tight glycaemic control has not been shown to improve outcomes so as long as their glucose is 5-15 they can get 5% glucose as a fluid if that is what one would normally prescribe

Question 10

When deciding duration to give fluids over what is an important thing to consider?

Answer 10

Are you prescribing it as maintenance because the patient is nil by mouth/ poor intake but well
or are you prescribing it as replacement cause they are losing fluid

will affect duration

Question 11

In hypoglycaemia how much 10% glucose do you give over what duration?

Answer 11

150-200ml over 15 mins

Question 12

0.3% potassium chloride contains how many mmol/l?

Answer 12

40 mmol in 1000ml
20 mmol in 500ml

Question 13

0.15% potassium chloride contains how many mmol/l?

Answer 13

20mmol in 1000ml
10mmol in 500ml