Fluids

Question 1

What are the Rs of fluids?

Answer 1

Reasons to give fluids

Resuscitation
Routine maintainance
Replacement
Redistribution 
Reassessment

Question 2

What are the fluid compartments

Answer 2

2/3 = intracellular fluid

1/3 = extracellular fluid

• 1/5 = plasma
• 4/5 = interstitium

Question 3

What is the normal daily requirement of water?

Answer 3

25 ml/kg/day

Question 4

What is the normal daily requirement of glucose?

Answer 4

50g/day

Question 5

What is the normal daily requirement of electrolytes?

Answer 5

1mmol/kg/day

Question 6

Signs of hypovolaemia (fluid deplete)

Answer 6

Dry mucous membranes
Reduced skin turgor
Decreased urine output
Orthostatic hypotension
Confusion

Question 7

Signs of hypervolaemia (fluid overload)

Answer 7

Shortness of breath
Raised JVP
Pitting oedema

Question 8

What are crystalloids?

Answer 8

Electrolytes

Small molecules - diffuse across membranes

Question 9

What are colloids?

Answer 9

Larger molecules - do not readily cross capillary walls

High colloid osmotic pressure

Question 10

What do you give for resuscitation fluids?

Answer 10

500ml STAT

Hartmanns or NaCl 0.9%

Question 11

What do you give for maintenance fluids?

Answer 11

Can give Hartmanns

Or

• 500ml saline with 20mmol/L K over 8 hours
• 1L 5% dextrose with 20mmol/L K over 8 hours
• 1L 5% dextrose with 20mmol/L K over 8 hours

Question 12

Tell me about 0.9% saline

Answer 12

Moves 75% into interstitial fluid and 25% plasma

Risks

• hyperchloraemic acidosis
• fluid overload

Question 13

Tell me about 5% dextrose

Answer 13

Hypotonic

Equal distribution - glucose metabolised so water spreads

Not great for increasing plasma volume

Question 14

Tell me about Hartmanns

Answer 14

Contains

• sodium
• chloride
• potassium
• bicarbonate
• calcium
• lactate

Most similar to plasma

Cannot be used alone for maintainence