Fluids and Fluid balance

Question 1

How can the anti diuretic hormone be affected when someone has had a major injury or surgery or severe illness?

Answer 1

Normal ADH - when BP is low RAS is activated - ADH is released alongside aldosterone, this acts to increase BP as blood vessels contact making them narrow. When someone is very unwell this mechanism can stop meaning there BP is now lower.

Question 2

How can the Renin Angiotensin system be affected if someone has had, major injury, surgery or severe illness?

Answer 2

Activated by failing renal perfusion, an increase in aldosterone which increases sodium and water retention, - this can stop working.

Question 3

What can decrease the need for fluid requirements?

Answer 3

Renal and Hepatic impairment
Cardiac failure
Head injury

Question 4

What can increase fluid requirements?

Answer 4

Vomiting/diarrhoea
High output stoma
Fistula
Burns

Question 5

When is fluid given?

Answer 5

To correct losses or maintain homeostasis
-Blood volume, fluid levels, organ perfusion and function.
-NBM
-Dehydration
-Excessive losses
-Heat stroke
-Excess diuretic use

Question 6

What are the consequence of giving fluids wrong?

Answer 6

*Electrolyte imbalance
*Peripheral oedema
*Pulmonary oedema
*Renal impairment
*Acid/base disturbance

Question 7

What are the signs and symptoms of dehydration?

Answer 7

Thirst, reduced skin elasticity, dry mucous membrane (eyes, mouth), decreased capillary refill time, altered consciousness, tachy, concentrated urine

Question 8

You have a patient who has lost weight, a low BP, Rapid/shallow breathing wih a weak but rapid pulse, urine output is reduced and concentrated, skin is less elastic, very thirsty and has a high temperature? what is this due to?

Answer 8

Fluid Depletion

Question 9

You have a patient who has gained weight, slightly raised blood pressure, has a moist cough, tachycardic, increased urine output, has oedema, what is the diagnosis?

Answer 9

Fluid overload

Question 10

What are examples of Crystalloid fluids?

Answer 10

0.9% Sodium chlorine
5% Glucose
Dextrose-saline
Hartmann’s

Question 11

What are the examples of Colloids?

Answer 11

Albumin
Dextran
Gelatin

Question 12

What is a colloid fluid?

Answer 12

Dispersions of large organic molecules in a carrier solution

Question 13

What is crystalloids fluids?

Answer 13

Solutions of small molecules in water, (ions Na and Cl) and/or glucose which is isotonic.

Question 14

What type of fluid is sodium chloride 0.9%?

Answer 14

Crystalloid
Isotonic, and distributes into the whole extracellular space (Intravascular and interstitial space)

Question 15

What type of fluid is 5% Glucose?

Answer 15

Crystalloid
Has some calorie content, distributes throughout the intravascular interstitial and intracellular compartments
-Glucose is primarily metabolised therefore does not cause plasma expansion

Question 16

When isn’t a patient for plasma expansion?

Answer 16

If they have a big loss of fluids

Question 17

What type of fluid is dextrose saline?

Answer 17

Crystalloid
Glucose and Sodium chloride
-Isotonic
Can have up to 3L over 24 hours
Not for long term use as it does not contain other electrolytes

Question 18

If a patient is requiring fluids for longer than 24/48 hours what should be used?

Answer 18

Hartmann’s - balanced salt solution
Crystalloid
-Used in the critically ill patients

Question 19

Where do colloid fluids stay?

Answer 19

Extracellular space

Question 20

When is Albumin used?

Answer 20

Colloids
Shock: Burns, Haemorrhage, Surgical losses and Trauma
-Quick and short term use

Question 21

What are synthetic colloids?

Answer 21

Dextrans - MW 7000 - it remains in circulation, is a long acting plasma expander
Gelatin Derivatives - Animal collagen

Question 22

What are the advantages of Crystalloids?

Answer 22

-Maintain osmotic gradient
-Widely available
-Low risk of ADR’s
-Inexpensive

Question 23

What are the advantages of colloids?

Answer 23

-Need less amounts of fluid, good for patients of FR
-Faster to give
-Longer half life
-Starches can reduce capillary leaks into interstitial space
-Lasts for 12 hours, can stick into insterstitial fluid for longer

Question 24

What is the disadvantage of crystalloids?

Answer 24

-Poor in maintaining oncotic pressure
-Short half life
-Very cheap

Question 25

What is the disadvantage of colloids?

Answer 25

-Maximum volume per day
-ADRs - itching
-Expensive

Question 26

What includes RBC, Platelets, WBC?

Answer 26

Whole blood

Question 27

What has platelets removed, concentrated RBC?

Answer 27

Packed cells

Question 28

What includes water, electrolytes, and clotting factors and given for a clotting defiency?

Answer 28

Plasma ‘FreshFrozenPlasma’

Question 29

What are the 5Rs regarding fluid replacement?

Answer 29

Resuscitation
Routine maintenance
Replacement
Redistribution
Reassessment

Question 30

In a resuscitation situation what fluids should be administered?

Answer 30

500ml bolus of crystalloid over 5 mins, sodium containing; NaCl 0.9&
-Repeat if needed up to 2L over 1 hour can be given

Question 31

What is the routine maintenace dose of fluid?

Answer 31

25-30ml/kg/day max 2.5: - use IBW if pt is obese

Question 32

When should a patients fluid requirements be reassessed?

Answer 32

Daily - monitor for adverse effects

Question 33

What can be fatal?

Answer 33

Potassium

Question 34

Can only be used by commercially diluted preparations, as I can make your heart stop, what am I?

Answer 34

Potassium

Question 35

Potassium is treated as a controlled drug True or False?

Answer 35

True

Question 36

How many hours of IV fluids can be prescribed at a time?

Answer 36

24 hours at a time, as requirement changes alot.