Fluids, Nutrition Flashcards
daily minimum urine output, sodium, potassium intake
Minimum UO = 0.5ml/kg/hr = ~30ml/hour
Na requirement = 1.5-2mmol/kg/day = 100mmol/day
K requirement = 1mmol/kg/day = 60mM/day
example fluid regimes (NBM)
3L dex-saline with 20mM K+ in each bag
• 1L normal saline + 2L dex with 20mM K+ in each bag
• Each bag over 8h = 125ml/h
sources of fluid losses post op
Vomiting and Diarrhoea NG tube Drains Fever Tachypnoea High-output stomas
central venous pressure depends on what?
preload
cardiac output
sensitive measure of volume status
Parkland burns + fluid formula
4 x SA% affected x weight kg
give half of the fluids calculated over first 8 hours
other half following 16
for use with Hartmann’s
assessing fluid status
Hx: balance chart, surgery, other losses, thirsty
• Impression: drowsy, alert
• Inspection: drips, drains, stomas, catheters, CVP
IV volume § CRT § HR § BP lying and standing § JVP • Tissue perfusion § Skin turgor § Oedema: ankle, pulmonary, ascites § Mucus membranes • End-organ § UO, ↑U+Cr § Consciousness § Lactate
U+Es
when should potassium replacement be avoided?
first 24 hours post op
PS use urine output to guide fluids, often only need 2L post op day 1 not 3L
what type of fluid do you avoid in renal / cardiac failure patients?
high sodium
use 5% dextrose
bowel obstructed patients and fluids
high loss of fluid and electrolyte
likely to need a lot more than normal
base off U+Es and urine
high output stoma
if 1L + a day, should be around 700ml
if too much, try loperamide/codeine (?)
reduced urine output post op
Post-renal § Commonest cause § Blocked / malsited catheter § Acute urinary retention • Pre-renal: hypovolaemia • Renal: NSAIDs, gentamicin • Anuria usually = blocked or malsited catheter • Oliguria usually = inadequate fluid replacement
checking for blocked catheter
try to flush 50ml saline and draw back (?)
complications of NG tube
nasal trauma
malposition
aspiration
4 complications of non-oral feeding
feed intolerance - diarrhoea
electrolyte imbalance
aspiration
refeeding syndrome
7 indications of parenteral nutrition
prolonged obstruction / ileus high output fistula short bowel syndrome severe Chron's severe malnutrition severe pancreatitis unable to swallow
