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PSA > Fluids > Flashcards

Fluids Flashcards

1
Q

How many L of fluid are there in a 70kg man?

A

42L

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2
Q

what % of fluid is in the intracellular compartment?

A

65% - 28L in 70kg man

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3
Q

what % fluid is in the extracellular compartment?

A

35% - 14L in 70kg man

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4
Q

what % of extracellular fluids are interstitial?

A

75% - 10.5L

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5
Q

what % of extracellular fluids are intravascular?

A

25% - 3.5L

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6
Q

what ion determines the distribution of water between the intra and extracellular compartments?

A

sodium

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7
Q

what are 3 characteristics of intracellular compartment?

A

high potassium conc
low sodium conc
intracellular solute conc is pretty constant

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8
Q

what are 2 features of extracellular fluids?

A

high sodium conc
low potassium conc

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9
Q

how many ml of water is released from metabolism a day approx?

A

400ml

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10
Q

what is the average fluid maintenance requirements of an adult with no extra losses?

A

2-2.5L per day

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11
Q

how many ml of water /kg should an adult have per day?

A

25-30 ml/kg/day

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12
Q

how much sodium, potassium and chloride should an adult have maintenance per day?

A

1 mmol/kg/day

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13
Q

what is the minimum glucose required for maintenance for an adult for one day?

A

50-100g/day of glucose to prevent starvation ketosis

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14
Q

what is the minimum urine output to aim for in adults?

A

0.5 ml/kg/h

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15
Q

what are approx GI losses per day?

A

100 ml/day

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16
Q

what are average insensible losses per day?

A

500-800ml /day

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17
Q

sweating leads to loss of which electrolyte?

A

sodium

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18
Q

what electrolytes are lost in diarrhoea?

A

sodium
potassium
bicarb

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19
Q

what electrolytes are lost in vomiting?

A

potassium
chloride
hydrogen

leads to hypercholraemic metabolic alkalosis

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20
Q

How many mmol of sodium and chloride are there in normal saline?

A

Sodium - 154
Chloride - 154

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21
Q

how much glucose is there in 5% glucose solution?

A

50g/litre

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22
Q

what is in Harmann’s solution?

A

sodium - 131
chloride - 111
potassium - 5
lactate - 29
calcium - 2
glucose - 0

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23
Q

what is the other name for hartmanns solution?

A

compound sodium lactate

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24
Q

how much sodium, chloride and glucose is in NaCL 0.18% and glucose 4%?

A

sodium - 30
chloride - 30
glucose - 40g/litre

25
Q

what is in gelofusine?

A

154 mmol - sodium
124 - chloride

26
Q

what are 8 signs of hypovolaemia?

A

absent/low JVP
decreased skin turgor
dry mucous membranes
low BP
oligouria/anuria
orthostatic hypertension
peripheral shutdown/prolonged CRT
shock
tahcycardia

27
Q

what are 8 signs of hypervolaemia?

A

cough +/- frothy sputum
Pleural/peritoneal fluid accumulation
hypertension
peripheral oedema
pulmonary oedema
dyspnoea
raised JVP
S3/4 heart sounds
tachycardia

28
Q

wha are crystaloids?

A

solutions of mineral salts

29
Q

what are colloids?

A

solutions of larger water insoluble molecules like complex carbohydrates or gelatins

30
Q

How do isotonic solutions act?

A

stay almost entirely in extracellular compartment

0.9% sodium chloride

31
Q

How do hypertonic solutions act?

A

draw fluid out of cells by increasing plasma tonicity

sodium chloride 3%, mannitol

32
Q

how do hypotonic solutions act?

A

lower serum osmolarity and are not commonly used

NaCl 0.45%

33
Q

How does 1L of Normal saline distribute?

A

100% to extracellular compartment
25% to intravascular compartment
75% to interstitial compartment

34
Q

how does 1L of 5% glucose distribute?

A

distributes across all body compartments

2/3rds intracellular
1/3rd extracellular

80ml intravascular, 254ml interstitial

35
Q

How do colloids work?

A

increase osmotic force across capillary membrane drawing fluids from interstitial to intravascular compartment

36
Q

How is 1L of colloid distributed?

A

100% stays in intravascular compartment

37
Q

what is shock?

A

organ hypoperfusion to the extent that cellular metabolic demands are not met

38
Q

what is distributive shock?

A

systemic vasodilation leads to decreased organ perfussion

39
Q

what are 3 causes of distributive shock?

A

sepsis
anaphylaxis
neurogenic shock

40
Q

what is the most common type of shock?

A

hypovolaemic shock

41
Q

what is grade 1 hypovolaemic shock?

A

15% - 750ml

mild tachycardia, slow cap refill (3s at 10% volume loss)

42
Q

what is grade 2 hypovolaemic shock?

A

15-30% loss, 750-1500ml

cool peripheries, tachycardia, decreased pulse pressure, delayed cap refill (5s)

may have catechloamine increased BP and anxiety

43
Q

what is grade 3 hypovolaemic shock?

A

30-40% volume loss, 1500-2000ml

marked tachycardia and tachypnoea
decresaed systolic BO, narrow pulse pressure, oliguria, low volume pulse, postural drop, confusion/agitation

44
Q

what is grade 4 hypovolaemic shock?

A

40-50% loss, 2000-2500ml

low GCS, unconscious
minimal/no urine
thready pulse
very tachy, very low BP, cold skin

45
Q

what are 6 indicators a patient may need urgent fluids?

A

systolic <100mmHg
HR >90
CRT >2s or cold peripheries
RR >20
NEWs >5
Passive leg raise suggests fluid responsive

46
Q

what is cardiogenic shock?

A

relative or absolute reduction in cardiac output due to a primary cardiac disorder

47
Q

what are 3 signs of cardiogenic shock?

A

circulatory collapse due to pump failure
raised JVP
Cardiac arrhythmias

48
Q

what are 4 causes of cardiogenic shock?

A

ischaemic
heat failure
arrhythmia
cardiomyopathy

49
Q

what is obstructive shock?

A

when there is a physical impedance to blood flow

50
Q

what are 2 causes of obstructive shock?

A

PE
cardiac tamponade

51
Q

what is the passive leg raise test?

A

lift patients legs check Obs - should improve in volume depleted patients and return to normal when they are positioned normally

52
Q

what are the 5 Rs of IV fluid prescribing?

A

Resuscitation
Routine Maintenance
Replacement
Redistribution
Reassessment

53
Q

what weight should be used to calculate maintenance fluids?

A

ideal body weight

54
Q

what is the IV fluid prescription according to body weight?

A

25-30 ml/kg/day

55
Q

what are 2 complications of fluid overload?

A

dilutional hyponatraemia
pulmonary oedema

56
Q

how can nitrates improve fluid overload?

A

causes reduction in preload

need BP monitoring if IV

57
Q

what are the 4 Ds of fluid therapy?

A

Drug - most appropriate fluid?
Dose - is quantity calculated appropriately
Duration - Start documented
De-escalation - stop date documented

58
Q
A

PSA (10 decks)

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