Fluids

Question 1

what is the normal water, electrolytes (NA, K, CL) and glucose needed for maintenance in a normal human?

Answer 1

• 25-30 mg/kg/day water
• 1 mmol/kg/ day Na, CL, K
• 50-100g per day glucose

Question 2

how much glucose does a 5% glucose contain?

Answer 2

• 5 grams/ 100ml

Question 3

name some suitable maintenance fluids?

Answer 3

• sodium chloride (0.18%) in 4% glucose with added K+

- 5% glucose, 0.9% sodium chloride with added K+ (2:1 ratio)

Question 4

what fluids do you give for resuscitation?

when should you request senior help?

Answer 4

• 500ml hartmanns/ 0.9% saline over 15 mins

- after giving 2 litres of fluid

Question 5

what is the principle of fluid redistribution?

Answer 5

• third space losses in cardiac, renal or hepatic failure (ascites or oedema)

Question 6

what should happen in those with fluid redistribution?

what should happen to patients with fluid redistribution who have are ill?

Answer 6

• fluid intake should be reduced so third space losses are not exacerbated
• despite positive fluid balance, massive fluid resuscitation may be needed to avoid multiple organ dysfunction

Question 7

What are the 5Rs in fluid management?

Answer 7

• Resuscitation, Routine maintenance, Replacement, Redistribution, Reassessment

Question 8

What is the principle of replacement and reassessment?

Answer 8

• Replacement: maintenance fluids will need to be increased to replace excess loss e.g. in diarrhoea, vomiting, GI fistula etc
• Reassessment: Monitoring to minimise risk of adverse events such as fluid overload, hypovolaemia and electrolyte disturbance