Fluids + Oxygen Flashcards
For which conditions do you give dextrose instead of saline?
Hypernatraemic
or
Hypoglycaemic
What fluid bolus do you give if HR high /BP low?
500ml bolus over 15 minutes > then reassess
Max. 2 L this way
What do you give when low UO, but no obstruction?
1L over 2-4hours > reassss
What do you givee for maintainance fluid?
1L Nacl + 40mmol K+ over 8-12h
What is daily requirement of fluid per day (as formula)?
25-30 mL/kg/day
Adjust for frailty, body size, renal/cardiac function and current body status
What are requirements of glucose per day?
50-100g/day»_space; 1L of 5% dextrose is 50g of glucose»_space; enough for one day
What is potassium requirement you need to give per day
60mmol
More specifically: 1mmol/kg/day
How does K+ come in bags?
It comes in bags of 20 or 40
what is the highest K+ concentration you can put in 1L saline
40 mmol/L (more than this causes irritation)
What is the max K+ concentration you can give per hour
10mmol/h
20mmol/h with monitoring (more than this will cause arrythmia)
Give example of standard daily fluid regimen
8 hourly 1L saline + 40mmol K+
8 hourly 1L saline + 20mmol K+
8 hourly 1L 5% dextrose + 20mmol K+
Adults need 3L over 24 hours.
Fluid management for HYPOnatraemia
Fluid restrict
SLOW IV normal saline
Risk of cerebral pontine myelinolysis if replaced too quickly
Fluid management for HYPERnatraemia
Slow IV normal saline
Risk of replacing quickly: cerebral oedema
When a patient is recovering from an AKI, what does it mean if heir urine output increases beyond their fluid input?
Patients may enter a ‘polyuric phase’ - urine output exceeding 200 mL/h should always prompt consideration of this phenomenon.
Calculate how much the patient is losing per hour e.g. 1L lost every 4 hours and match the fluid input accordingly.
Don’t forget to correct for electrolyte abnormalities at the same time
When is FFP given?
Used to correct deranged clotting (where PT/APTT is >1.5 times the normal)
What are the main indications of using sodium chloride over hartmans/ compound sodium lactate solution?
Usually in sodium depletion, which can arise from such conditions as
* gastro-enteritis
* diabetic ketoacidosis
* ileus
* and ascites
* And prefered in head injury: hyper-osmolar therefore reduced likelyhood of cerebral oedema
But: risk of hyperchloraemic acidosis
What are usual dails fluid requirements in the adult?
(Volume, Electrolytes and urine output)
Fluids: 25-30 ml/kg water (~2-3L IV)
Electrolytes: 1mmol/kg NA, CL, K+
Urine output: 0.5mg/kg/h
What are contraindications to the administration of Hartman’s?
- Liver failure - cannot metabolise lactate
- Hyperkalaemia - renal failure
What would be a common maintenance fluid prescription for a healthy adult?
Usually 1 salty 2 sweet (some argue 2 salty 1sweet) + Potassium
= 8hrl bags with 20mmol K+ per bag
What is the maintenance requirement of potassium for a patient with a normal potassium level?
Aim for between 40-80 mmol/ day (1mmol/kg/day)
What is the maximum rate of infusion of potassium?
Maximum rate of delivery: 10mmol/h (or 20mmol/h in ICU)
When should you replace potassium orally, and when should you think about IV replacement?
2.6 - 3.4: Oral replacement
if < 2.5: IV replacements
- 40mmol of Potasssium in 1L = 0.3%
- 20mmol of Potassium in 1L = 0.15%
What are some contraindications to thrombophrophylaxis in hospital?
Acute bleeding risk (including recent ischaemic stroke)
What are contraindications to compression stockings?
Peripheral arterial disease
When is BiPAP useful?
COPD and atelectasis
When is CPAP useful?
Heart failure and obstructive sleep apnoea
When are venturi masks useful?
In patients dependent on hypoxic respiratory drive (e.g. COPD) as fixed amount of O2 will be given
Fluids for emergency resus
sodium chlroide 0.9% 500ml 15 min (10 mins also okay)
Fluids for emergency hypoglycaemia
glucose 20% 100ml 15 mins
Fluids for emergency hypokalaemia
sodium chloride 0.9% / potassium chloride 0.3% 1000ml 4hour
Fluids for emergency hypercalaemia
sodium chloride 0.9% 1000ml 4 hr
Maintenance fluids w/o losses
25-30 ml/kg/24hr water
1mmol Na Cl K
50-100g glucose
8-12 hrs 1000ml
Maintanence fluids with losses
30 ml/kg/24hr water
ensure electrolytes replaced
4-6hrs
Hyperkalaemia mx in children
soluble insulin (0.3–0.6 units/kg/hour in neonates and 0.05–0.2 units/kg/hour in children over 1 month)
with glucose 0.5–1 g/kg/hour (5–10 mL/kg of glucose 10%; 2.5–5 mL/kg of glucose 20% via a central venous catheter may also be considered).
Algorithm for deciding type of IV fluids by indication in infants
What is the routine maintenance fluid for a child (>28 days old)?
For a child (>28 days of age), first line maintenance fluid is usually isotonic crystalloids + 5% glucose (e.g. 0.9% sodium chloride + 5% glucose).
What is the routine maintenance fluid for a neonate?
No critical illness: 10% dextrose +/- additives
Critical illness (e.g. infantile respiratory distress syndrome, meconium aspiration): seek expert advice (use fluids with no/minimal sodium initially)
Equation to calculate 24 hour routine maintenance fluid amount in children
100 ml/kg/day for the first 10kg of weight
50 ml/kg/day for the next 10kg of weight
20 ml/kg/day for weight over 20kg
For neonates: calculated according to day of life:
Birth to day 1: 50-60 ml/kg/day
Day 2: 70-80 mL/kg/day
Day 3: 80-100 mL/kg/day
Day 4: 100-120 mL/kg/day
Days 5-28: 120-150 mL/kg/day
What are the maintenance fluid requirements for neonates (<28 days)?
Birth to day 1: 50-60 ml/kg/day
Day 2: 70-80 mL/kg/day
Day 3: 80-100 mL/kg/day
Day 4: 100-120 mL/kg/day
Days 5-28: 120-150 mL/kg/day
Resus in children
standard bolus of 10 mL/kg over <10 minutes
Fluid: 0.9% sodium chloride or Hartmann’s
Risk with rapid correction of severe hyponatraemia
central pontine myelinolysis
Risk with rapid correction of severe hypernatraemia
cerebral oedema
Children on IV fluids should have what checked once daily?
U&Es
Glucose
