Intravenous fluid

Question 1

What is diffusion?

Answer 1

Movement of solute from high concentration to low concentration
The membrane must be solute permeable

Question 2

What is osmosis?

Answer 2

Movement of water from high concentration to low concentration
The membrane must be solute impermeable

Question 3

What is osmolarity?

Answer 3

The measure of solute concentration per unit volume of solvent

Question 4

What is osmolality?

Answer 4

The measure of solute concentration per unit mass of solvent

Question 5

What is tonicity?

Answer 5

The measure of the osmotic pressure gradient between two solutions

Question 6

How is the fluid in the body split up into the different compartments?

Answer 6

2/3 of the fluid within the body is in the intracellular space. The remaining third is split into 20% in the plasma and 80% in the interstitial space.

Question 7

How much water is required by an adult daily?

Answer 7

25-30 ml/kg

Question 8

How much sodium is required by an adult daily?

Answer 8

1mmol/kg

Question 9

How much potassium is required by an adult daily?

Answer 9

1mmol/kg

Question 10

How much glucose is required by an adult daily?

Answer 10

50-100g

Question 11

What basic questions should you ask yourself during fluid assessment?

Answer 11

1. What is my patients volume status?
2. Does my patient need IV Fluids?
3. How much fluid do they need?
4. What types of fluid do they need?

Question 12

How is a patient’s volume status established?

Answer 12

ABCDE approach to find cause of fluid challenge and treat it

Question 13

What are the characteristics of a euvolaemic patient?

Answer 13

Feels well, not Thirsty
Veins well filled
Warm extremities
Mild sweat
Normal BP and HR
Normal Urine

Question 14

What are the requirements of a euvolaemic patient?

Answer 14

No fluids

Question 15

What are the characteristics of a hypovolaemic patient?

Answer 15

Feels nauseous, thirsty
Flat veins
Cool peripheries
No sweat
Low or postural BP and high HR
Concentrate oliguria
Responds to SLR

Question 16

What are the requirements of a hypovolaemic patient?

Answer 16

Resuscitation fluids (if low BP)
Rehydration fluids

Question 17

What are the characteristics of a hypervolaemic patient?

Answer 17

Feels breathless, not thirsty
Veins distended
Warm and oedematous extremities
Sweaty
High BP and High HR
Dilute urine (could be oliguric or polyuric)

Question 18

What are the requirements of a hypervolaemic patient?

Answer 18

No more fluids
Possibly diuretics (if respiratory compromise)
Haemofiltration (if anuric)

Question 19

How does presentation of patients with a low oncotic pressure or heart failure contradict their fluid status?

Answer 19

Low albumin or protein can cause oedema in dehydrated patients due to a lack of intracapillary fluid. These patients tend to be oedematous, with a low blood pressure, high heart rate and thirst.

Question 20

How should fluids be given to patients?

Answer 20

If oral route is viable, use it before giving intravenous fluid

Question 21

How is the volume of fluid required decided?

Answer 21

Water deficit is calculated based on the following:
Catheters, drains
Input charts
Vomit bowls
Sputum Pots
Stool charts and stoma losses
Insensible losses (sweating, ventilation, open wounds, burns and bleeding)

Question 22

What are the five R’s of fluid management?

Answer 22

Resuscitation
Routine management
Replacement
Redistribution
Reassessment

Question 23

What is dextrose useful in?

Answer 23

Chronic dehydration

Hypernatraemia

Question 24

What are crystalloids useful in?

Answer 24

Acute dehydration
AKI
Resuscitation

Question 25

What are plasma expanders useful in?

Answer 25

Liver patients

Select intra-operative