Fluids

Question 1

fluid types (4)

Answer 1

you need 30ml/kg per hr
1mmol/kg/24hr (Na and K) forget about Cl for simplicity sake
50-100g glucose in 24hr

Na replacement can be less exact but K replacement needs to be exact - dont replace K faster than 10mmol/h
1 options if K is low for replacement
1. potassium chloride 0.3% (40mmol) minimum 4h
2. potassium chloride 0.15% (20mmol) minimum 2hr
note the potassium doesn’t come on its own - it is mixed - sodium chloride 0.9%/potassium chloride 0.3% 1000ml, or glucose 5% / potassium chloride 0.15% 1000ml

Question 2

emergency resus fluid

Answer 2

500mL 0.9% saline 15minutes

Question 3

emergency hypoglycaemia fluid

Answer 3

100mL glucose 20% 15 minutes

Question 4

emergency hypokalaemia fluid

Answer 4

sodium chloride 0.9% potassium chloride 0.3% 1000mL 4hr

Question 5

emergency hypercalcaemia

Answer 5

sodium chloride 0.9% 1000ml 4hr

Question 6

maintanance fluids without deficits or losses

Answer 6

25-30mL / kg / 24hr water
1mmol/kg/24hr (Na and K) forget about Cl for simplicity sake
50-100g glucose in 24hr

aim for around 1000mL in 8-12hr

Question 7

maintenance fluids WITH deficits or losses i.e., Na, K, diarrhoea vomitting

Answer 7

So when you give maintenance for fluid losses you are giving maintenance and replacement but this does not mean give your standard 2/2.5L maintenance + more fluid for losses, you are saying my maintenance will account for losses, so instead of doing 30ml//kg/hr , if you have their weight or urine output/losses you use this to work out their maintenance amount (mL) and then you hypothesise about electrolyte needs based off how much electrolytes are lost via each route (i.e., NG tube lots of Na and K and Cl)

Plus replacement you might want to give a bit faster

Question 8

Answer 8

Question 9

why dont you give dextrose for resus? And why are colloids often reserved for after the acute phase/what is worrying about giving them acutely.

Answer 9

if vessels are leaky the albumin will leak out and make cellular oedema worse

Question 10

when to avoid dextrose?

Answer 10

brain injury - causes oedema

Question 11

risks of colloids

Answer 11

anaphylaxis and AKI

Question 12

HYPOMAGNESIA mx?

Answer 12

if <0.5… IV 20 mmol magnesium sulfate in 100 ml - 250ml of 0.9% sodium chloride or 5% glucose over 3-4 hours.

If having IV fluids can add 20mmol
magnesium to 500ml or 1L bag of
compatible fluid and give IV over 3 to
24 hours.
If patient also has hypokalaemia
generally give magnesium first; do not
combine magnesium and potassium in
the same bag.

≥0.5 - <0.7 mmol/l
no oralaccess- Prescribe 8mmol magnesium in 100ml
compatible fluid IV over 2 hours
if oral access available = prescribe regular magnesium aspartate 10mmol
sachets one twice a day

Question 13

fluid resus rate for kids ?

Answer 13

10-20ml/kg over LESS THAN 10 minutes NOT 15 MINUTES ! (so 10 minutes, 5 minutes, 2 minutes)

IF THEY NEED 40-60mL/Kg and remains unresponsive then critical care is sought

can give them anything with sodium in the range 131-154 ( saline, plasma-lyte, ringers lactate,