Fluids teaching Dr Pickering

Question 1

Measurable ways to check fluid status

Answer 1

• Weight changes
• BP
• JVP

These are reproducible, can measure change

Question 2

Carotid vs venous pulse

Answer 2

• Carotid - monophasic
• Jugular venous pulse - biphasic, double waveform flicker

Question 3

How does JVP change if you have to measure it from someone lay flat instead of 45 degrees?

Answer 3

JVP will be higher if you can see it when someone is lying flat - not typically visible at this position

Question 4

Colloid fluids - large molecules

Answer 4

• RBC
• Fresh frozen plasma
• Platelets
• Albumin

Question 5

Examples of crystalloids

Answer 5

• 0.9% saline
• Dextrose
• Hartmanns

Question 6

Two types of fluids

Answer 6

Colloids
Crystalloids

Question 7

Adv of colloids

Answer 7

• Stay intravascularly
• So stay where you want them to

Question 8

Dis adv colloids

Answer 8

• Reactions eg anaphylaxis
• Expensive
• Less readily available

Question 9

Adv and disadv of crystalloids

Answer 9

Opposite of colloids

Question 10

Requirements of someone per day fluid mls

Answer 10

25-30ml/kg/day

eg 70kg = 2L (3L if larger)

Question 11

Sodium, K+ Cl- requirments per day

Answer 11

1mmol/kg/day

Question 12

Glucose requirement per day

Answer 12

50-100g per day

Question 13

What does 0.9% NaCl contain?

Answer 13

154mmol/L of Na
154 mmol/L Cl

Question 14

What does Hartmans contain?

Answer 14

131 mmol/L Na
5 mmol/L K+
111mmol/L Cl
29 lactate

Question 15

Summary fluid contents

Answer 15

Question 16

How to treat acidosis?

Answer 16

Glive 0.9% saline - dilute it

Question 17

For AKI what fluids do we prescribe?

Answer 17

0.9% saline

But if have HF may need diuretic instead if problem is overload

Question 18

Define anuria

Answer 18

Less than 100mls urine produced per day

Question 19

Define oliguria

Answer 19

100-400mls of urine produced per day

Question 20

Normal urine output

Answer 20

600-1200mls per day

Question 21

Define polyuria

Answer 21

More than 3L of urine per day

Question 22

What to give in euvolaemic AKI?

Answer 22

• Look at urine output eg if 1200mls
• Give 1200mls + insensible losses (600-1000mls)
• so 1800mls for next 24hrs

Question 23

What to give in hypervolaemic AKI?

Answer 23

• Look urine output - eg 2L
• Think about insensible losses (600-1000mls)
• So losing 2.6-3L daily
• Give less than this so 1.5-2L maybe

If very overloaded consider diuretics