Fluids

Question 1

If a person has iron deficiency anaemia, you should / should not transfuse red blood cells?

Answer 1

Should not

Question 2

Which fluids are routinely used in fluid resuscitation or maintenance

• crystalloids
• colloids

Answer 2

Crystalloids

Question 3

In a dehydrated patient, haematocrit will be high/low?

Answer 3

High

- less fluid so more blood

Question 4

In a dehydrated patient, urea will be high/low?

Answer 4

High

Question 5

2/3 of total body water is

• extracellular fluid
• intracellular fluid

Answer 5

Intracellular fluid

Question 6

daily electrolyte requirements:
how many mmol/kg/day of sodium
how many mmol/kg/day of potassium

Answer 6

1-2mmol/kg/day sodium

1mmol/kg/day potassium

Question 7

Clinical signs of dehydration

Answer 7

Dry mucous membranes
Decreased skin turgor
decreased cap refill time 
pulse: weak, tachy 
BP: hypotensive 
Urine: dark

Question 8

What is the first sign of dehydration

Answer 8

Postural hypotension

Question 9

Blood test findings in dehydrated patient

Answer 9

Increased Urea
Increased haematocrit
Hypernatraemia
Hypokalaemia

Question 10

Dehydrated patient will have hyponatraemia / hypernatraemia. Why?

Answer 10

Hypernatraemia

- less water so more sodium

Question 11

Fluid overloaded patient will have hyponatraemia / hypernatraemia. Why?

Answer 11

Hyponatraemia

- excessive drinking / IV fluids decreases the Na:H2O ratio

Question 12

Crystalloid fluids examples (4)

Answer 12

0.9% NaCl
Hartman’s solution
5% dextrose (glucose)
Ringers lactate

Question 13

Name the top 2 crystalloids for resuscitation?

Answer 13

0.9% NaCl

Hartman’s solution

Question 14

Which crystalloid fluid should you not use in resuscitation?

Answer 14

5% dextrose

- has no electrolytes

Question 15

Why are colloid fluids being used less frequently?

Answer 15

Not any better than crystalloids

Increased risk of anaphylaxis

Question 16

Name 2 types of synthetic colloids

Answer 16

Gelatine based “dextrans”

Starch based “gelofusin”

Question 17

Name 2 types of human protein solution colloids

Answer 17

Blood products
- FFP, platelets, packed red cells, cryoprecipitate

Human albumin solution

Question 18

If resuscitating a patient with a hyperkalaemia, which fluid should you AVOID giving them

Answer 18

Hartmans / ringers lactate

Question 19

If you give patient 500ml of fluid but they are still haemodynamically unstable, what do you do?

Answer 19

Crystalloid bolus of 500ml over 15 mins

Question 20

Give up to ___ L of fluid to try and make the patient haemodynamically stable

Answer 20

2L

Question 21

Name 2 ways in which you can increase the speed of infusion

Answer 21

Increase cannula size

Put pressure on the fluid bag

Question 22

What are the 2 components of ECF

Answer 22

Plasma

Interstitial fluid

Question 23

In which 3 sets of patients would you consider prescribing less fluids for resuscitation

Answer 23

Old/frail
cardiac failure
risk of refeeding syndrome

Question 24

Agitated patient who storms out the ward. What might be going on

Answer 24

Hypovolaemic shock

Question 25

a 70kg person needs XL of fluid for maintenance ?

Answer 25

2L

Question 26

How can you reverse pre-renal AKI

Answer 26

Give fluids

Question 27

Ways of monitoring fluid balance

Answer 27

Clinical examination: signs of dehydration? Blood tests: Vital signs: BP, HR Urine output

Question 28

Abdominal distention (ascites) suggests hypovolaemia / hypervolaemia?

Answer 28

Hypervolaemia

Question 29

Signs of hypovolaemia

Answer 29

``` Hypotension Tachycardia Increased CRT Cold peripheries Reduced urine output Increased resp rate Dry mucous membranes Reduced skin turgor ```

Question 30

giving an intravenous hypotonic solution (eg 5% dextrose) will result in the water flowing OUT OF/INTO the intravascular space

Answer 30

Out of the intravascular space and into the interstitial space

Question 31

What stays in the intravascular space longer - colloids - crystalloids

Answer 31

Colloids

Question 32

The NICE guidelines for urgent fluid resuscitation

Answer 32

An initial 500 ml fluid bolus over 15 minutes (“stat”), followed by reassessment with an ABCDE approach Repeat boluses of 250 – 500 mls of fluid if required, each time followed by a reassessment Seek expert help if the patient is not responding, particularly after 2 litres of fluid

Question 33

the rate of potassium infusion should not exceed X mmol/hour, as there is a risk of inducing an arrhythmia or cardiac arrest

Answer 33

10mmol/hour

Question 34

When are maintenance fluids typically used?

Answer 34

When patient is nil by mouth

Question 35

What does stat mean

Answer 35

As quickly as possible