Fluids Flashcards
If a person has iron deficiency anaemia, you should / should not transfuse red blood cells?
Should not
Which fluids are routinely used in fluid resuscitation or maintenance
- crystalloids
- colloids
Crystalloids
In a dehydrated patient, haematocrit will be high/low?
High
- less fluid so more blood
In a dehydrated patient, urea will be high/low?
High
2/3 of total body water is
- extracellular fluid
- intracellular fluid
Intracellular fluid
daily electrolyte requirements:
how many mmol/kg/day of sodium
how many mmol/kg/day of potassium
1-2mmol/kg/day sodium
1mmol/kg/day potassium
Clinical signs of dehydration
Dry mucous membranes Decreased skin turgor decreased cap refill time pulse: weak, tachy BP: hypotensive Urine: dark
What is the first sign of dehydration
Postural hypotension
Blood test findings in dehydrated patient
Increased Urea
Increased haematocrit
Hypernatraemia
Hypokalaemia
Dehydrated patient will have hyponatraemia / hypernatraemia. Why?
Hypernatraemia
- less water so more sodium
Fluid overloaded patient will have hyponatraemia / hypernatraemia. Why?
Hyponatraemia
- excessive drinking / IV fluids decreases the Na:H2O ratio
Crystalloid fluids examples (4)
0.9% NaCl
Hartman’s solution
5% dextrose (glucose)
Ringers lactate
Name the top 2 crystalloids for resuscitation?
0.9% NaCl
Hartman’s solution
Which crystalloid fluid should you not use in resuscitation?
5% dextrose
- has no electrolytes
Why are colloid fluids being used less frequently?
Not any better than crystalloids
Increased risk of anaphylaxis
Name 2 types of synthetic colloids
Gelatine based “dextrans”
Starch based “gelofusin”
Name 2 types of human protein solution colloids
Blood products
- FFP, platelets, packed red cells, cryoprecipitate
Human albumin solution
If resuscitating a patient with a hyperkalaemia, which fluid should you AVOID giving them
Hartmans / ringers lactate
If you give patient 500ml of fluid but they are still haemodynamically unstable, what do you do?
Crystalloid bolus of 500ml over 15 mins
Give up to ___ L of fluid to try and make the patient haemodynamically stable
2L
Name 2 ways in which you can increase the speed of infusion
Increase cannula size
Put pressure on the fluid bag
What are the 2 components of ECF
Plasma
Interstitial fluid
In which 3 sets of patients would you consider prescribing less fluids for resuscitation
Old/frail
cardiac failure
risk of refeeding syndrome
Agitated patient who storms out the ward. What might be going on
Hypovolaemic shock
a 70kg person needs XL of fluid for maintenance ?
2L
How can you reverse pre-renal AKI
Give fluids
Ways of monitoring fluid balance
Clinical examination: signs of dehydration?
Blood tests:
Vital signs: BP, HR
Urine output
Abdominal distention (ascites) suggests hypovolaemia / hypervolaemia?
Hypervolaemia
Signs of hypovolaemia
Hypotension Tachycardia Increased CRT Cold peripheries Reduced urine output Increased resp rate Dry mucous membranes Reduced skin turgor
giving an intravenous hypotonic solution (eg 5% dextrose) will result in the water flowing OUT OF/INTO the intravascular space
Out of the intravascular space and into the interstitial space
What stays in the intravascular space longer
- colloids
- crystalloids
Colloids
The NICE guidelines for urgent fluid resuscitation
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
the rate of potassium infusion should not exceed X mmol/hour, as there is a risk of inducing an arrhythmia or cardiac arrest
10mmol/hour
When are maintenance fluids typically used?
When patient is nil by mouth
What does stat mean
As quickly as possible
