Fluids teaching Dr Pickering Flashcards
Measurable ways to check fluid status
- Weight changes
- BP
- JVP
These are reproducible, can measure change
Carotid vs venous pulse
- Carotid - monophasic
- Jugular venous pulse - biphasic, double waveform flicker
How does JVP change if you have to measure it from someone lay flat instead of 45 degrees?
JVP will be higher if you can see it when someone is lying flat - not typically visible at this position
Colloid fluids - large molecules
- RBC
- Fresh frozen plasma
- Platelets
- Albumin
Examples of crystalloids
- 0.9% saline
- Dextrose
- Hartmanns
Two types of fluids
Colloids
Crystalloids
Adv of colloids
- Stay intravascularly
- So stay where you want them to
Dis adv colloids
- Reactions eg anaphylaxis
- Expensive
- Less readily available
Adv and disadv of crystalloids
Opposite of colloids
Requirements of someone per day fluid mls
25-30ml/kg/day
eg 70kg = 2L (3L if larger)
Sodium, K+ Cl- requirments per day
1mmol/kg/day
Glucose requirement per day
50-100g per day
What does 0.9% NaCl contain?
154mmol/L of Na
154 mmol/L Cl
What does Hartmans contain?
131 mmol/L Na
5 mmol/L K+
111mmol/L Cl
29 lactate
Summary fluid contents
How to treat acidosis?
Glive 0.9% saline - dilute it
For AKI what fluids do we prescribe?
0.9% saline
But if have HF may need diuretic instead if problem is overload
Define anuria
Less than 100mls urine produced per day
Define oliguria
100-400mls of urine produced per day
Normal urine output
600-1200mls per day
Define polyuria
More than 3L of urine per day
What to give in euvolaemic AKI?
- Look at urine output eg if 1200mls
- Give 1200mls + insensible losses (600-1000mls)
- so 1800mls for next 24hrs
What to give in hypervolaemic AKI?
- 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
