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Clincal - Renal > Fluids > Flashcards

Fluids Flashcards

1
Q

What are the daily fluid requirements for 70kg man?

A

2 - 2.5L over 24 hours

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2
Q

What are the normal daily fluid losses?

A

Urine - 1500ml

Stool - 200ml

Insensible losses -800ml

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3
Q

How is the daly fluid requirement met?

A

Food - 1000ml

Drink - 1500ml

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4
Q

When are IV fluids given?

A

If sufficient fluids cannot be maintained orally

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5
Q

What is the risk of cannula to give fluids?

How is this reduced?

A

MRSA infection

Remove cannula and resume oral fluid intake as soon as possible

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6
Q

What other fluid losses do you need to consider in a sick patient?

A

Drains

Fever

Diarrhoea

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7
Q

How can fluid balance be monitored?

A

Daily weighing

Fluid balance charts

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8
Q

What is the total body fluid in a 70kg man?

What fluid compartments does fluid go into?

A

Total body fluid = 42L (60% of body weight)

28L = intracellular 
14L = extracellular

Of the extracellular compartment, 1/3rd is intravascular (blood) 5L

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9
Q

What does a 5% dextrose solution contain?

What is it useful for?
What is it useless for?

A

Isotonic, but only contains a small amount of glucose so provides little energy

Useless for fluid resus
Suitable for maintaining hydration

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10
Q

Why is a 5% glucose solution useless for fluid resuscitation?

A

Only contains a small amount of glucose so provides little energy

The liver rapidly metabolises all the glucose leaving only water, which rapidly equilibrates throughout all the fluid compartments

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11
Q

Which solution is most appropriate for fluid resuscitation?

Why?

A

0.9% saline

Same Na+ concentration as plasma and is isotonic with plasma

Rapidly equilibrates throughout the extracellular compartment only, and takes longer to reach intracellular compartment than 5% glucose

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12
Q

Why is 0.9% saline useful for fluid resuscitation and for maintaining hydration?

A

Same Na+ concentration as plasma and is isotonic with plasma

Rapidly equilibrates throughout the extracellular compartment only, and takes longer to reach intracellular compartment than 5% glucose

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13
Q

What is the osmotic content of colloids?

A

High osmotic content similar to that of plasma

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14
Q

Where do colloid IV fluids tend to stay?

Why?

A

Remain in intravascular space for longer than other fluids, making them appropriate for fluid resuscitation but NOT for general hydration

Due to high osmotic content similar to that of plasma

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15
Q

What is the disadvantage of colloids?

A

Expensive

May cause anaphylactic reactions

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16
Q

What will effective fluid resus contain?

A

Combination of colloid and 0.9% saline

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17
Q

What IV fluid is used for hypoglycaemia?

A

Hypertonic glucose (10% or 50%)

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18
Q

What is the disadvantage of hypertonic glucose solution?

How is this risk minimised?

A

Irritant to veins, so care is needed

Infusion sites should be inspected regularly and flushed with 0.9% saline after use

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19
Q

Where is glucose with sodium chloride solution mainly used?

A

Paediatric setting

1/5th normal saline

20
Q

What is an alternative solution to 0.9% saline?

A

Hartmann’s solution

Contains Na+, Cl-, lactat, K+, HO3- and Ca2+

Some consider it more physiological than saline

21
Q

What are the signs of hypovolaemia?

A

Tachycardia

Postural drop in BP

Decreased capillary refill time

Decreased urine output

Cool peripheries

Dry mucus membranes

Decreased skin turgor

Sunken eyes

22
Q

What the signs of a fluid overloaded patient?

A

Raised JVP

Pitting oedema of sacrum, ankles or legs/abdomen

Tachypnoea

Bibasal crepitations

Pulmonary oedema on CXR

23
Q

What needs to be considered when there is increased fluid loss from the gut?

A

GI fluids are rich in K+ so increased fluid loss from the gut (diarrhoea, vomiting, high output stoma, intestinal fistula)

Will require increased K+ replacement

24
Q

What fluids should be given in liver failure?

A

Patients often have raised total body sodium, so use salt-poor albumin or blood for resuscitation and avoid 0.9% saline for maintenance

25
Q

What fluids should a patient in shock be given?

A

Colloid or 0.9% saline via large bore cannula

26
Q

What consideration do you need to give to the elderly/heart failure patient when giving fluids?

A

Prone to fluid overload so give IV fluids with care

27
Q

What fluids are given in acute blood loss?

A

Resuscitate with colloid or 0.9% saline with large bore cannula until blood is available

28
Q

What is the concern about K+ replacement in a renal patient?

A

K+ may be retained in renal failure, beware giving too much IV

29
Q

What solutions can K+ ions be given with?

A

5% glucose or 0.9% saline

30
Q

Why is Hartman’s solution rarely used?

A

Due to low K+ content

Would have to give a lot to meet daily requirements

31
Q

What are the daily ion requirements?

A

25-30ml/kg per day of water

1mmol/kg/day of Na+, K+ and Cl-

50-100g/day of glucose

32
Q

How can you assess fluids in a patient?

A

Ask the patient

Fluid balance chart - not very reliable unless patient has catheter

Look at JVP

33
Q

How can you administer K+?

A

As KCL 20 or 40mmol

Can be mixed with 0.9% saline of 5% dextrose

34
Q

How much sugar does 5% dextrose have?

A

50g

Isomolar solution

35
Q

How much Na+ does 0.9% saline contain?

A

154mmol Na+

And

154mmol Cl-

36
Q

How many hours would you give bags of fluid over if you wanted to give 3L over 24 hours?

A

8 hours

37
Q

What is suitable fluids for a healthy 54year old NBM for 24 hours?

A

2 x 1L 5% dextrose

And

1L 0.9% saline and 40mmol KCL

38
Q

How much fluid would an elderly patient need?

A

2L

39
Q

Why are patients in severe asthma attacks given fluid?

A

Unable to drink which can result in thick mucus

Thick mucus can block the airways and lead to worsening symptoms

40
Q

What fluids would a patient with a perforated peptic ulcer require?

A

Acute blood loss, may have peritonitis and leak fluid. They will be taken to surgery shortly so need adequate fluid for surgery.

General anaesthetic can cause vasodilation

Will require 4L of fluid over 24 hours

1L 0.9% saline + 1L 5% dextrose and 40mmol KCL + 1L 0.9% saline + 1L5% dextrose and 40mmol KCL

41
Q

What effect does general anaesthetic have on the vasculature?

A

Dilation

Can result in low BP

42
Q

When are fluid bolus’s given?

A

To raise BP rapidly

500ml over 15mins

E.g. sepsis patient

43
Q

What can cause a large mass in the pelvis?

How is this managed?

A

Blocked bladder - could be due to prostate

Will require catheter - monitor urine output

Replace lost fluids

44
Q

What should you do with diuretic medication when giving fluids?

A

Stop medications e.g. furosemide

Monitor for clinical signs of fluid overload

45
Q

What may rampiril cause?

A

K+ retention

Clincal - Renal (5 decks)

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