Intravenous fluids

Question 1

How much water do we need each day?

Answer 1

25-30ml/kg/day

Question 2

How much sodium do we need per day?

Answer 2

1mmol/kg/day

Question 3

How much potassium do we need per day?

Answer 3

1mmol/kg/day

Question 4

How much glucose do we need per day?

Answer 4

50-100g/day

Question 5

What are the 2 main factors for body water content?

Answer 5

Fat vs muscle content

Age

Question 6

What 4 questions must be asked before administering IV fluid?

Answer 6

Patient’s volume status?
Does the patient need fluids?
How much fluid do they need?
Types of fluid

Question 7

What are the 3 levels of fluid volume status?

Answer 7

Hypovolaemic
Euvolaemic
Hypervolaemic

Question 8

What are features of a euvolaemic patient?

Answer 8

Feels well, not thirsty
Veins well filled
Warm extremities
Mild sweat
Normal blood pressure and heart rate
Normal urine

Question 9

What are features of a hypovolaemic patient?

Answer 9

Nauseous and thirsty
Flat veins
Cool peripheries
No sweat
Low or postural blood pressure with high heart rate
Concentrated oliguria
Responds to SLR

Question 10

What are features of a patient who is hypervolaemic?

Answer 10

Breathless, not thirsty
Veins distended
Warm and oedematous extremities
Sweaty
High BP and HR
Dilute urine - oliguric or polyuric

Question 11

What do you need to consider when working out water deficit?

Answer 11

Catheters
Drains
Input charts
Vomit bowls
Sputum pots
Stool charts and stoma losses

Question 12

What are examples of insensible water losses?

Answer 12

Sepsis - sweat
Ventilation
Open wounds
Burns
Bleeding

Question 13

What is fluid resuscitation?

Answer 13

IV fluids given to restore circulation in hypovolaemia

Question 14

What are the 4 types of fluid given?

Answer 14

Resuscitation
Routine maintenance
Replacement
Redistribution

Question 15

What is the normal plasma osmolarity?

Answer 15

298 MOSML/L

Question 16

What is tonicity?

Answer 16

Effective osmolarity

Question 17

What determines tonicity and therefore water distribution?

Answer 17

Particles that are restricted to one compartment ie can’t pass membranes

Question 18

What is the main extracellular fluid tonicity influencer?

Answer 18

Sodium

Question 19

What is the main intracellular fluid tonicity influencer?

Answer 19

Potassium

Question 20

What are symptoms of cell swelling?

Answer 20

Raised ICP
Compromised cerebral blood flow
Herniation

Question 21

What are symptoms of cell shrinkage?

Answer 21

Intracranial haemorrhage

Venous sinous thrombosis

Question 22

What are crystalloid fluids used for?

Answer 22

ECF expansion

Question 23

When are colloids used?

Answer 23

Anaphylaxis
Coagulopathy
Renal failure

Question 24

What is the highest rate of fluid that can be given for maintenance?

Answer 24

100ml/hr

Question 25

How much maintenance fluid should be given each day?

Answer 25

30ml/kg/24 hours

2400mls per day at most

Question 26

What fluid should be given for maintenance?

Answer 26

0.18%NaCl/4%glucose/0.3%KCl

Question 27

After how long fasting should a patient be put onto maintenance fluid?

Answer 27

6 hours

Question 28

How much fluid should be replaced after loss?

Answer 28

The same amount that was lost

Question 29

What fluid should be used for replacement?

Answer 29

Plasmalyte 148

Question 30

What type of fluid should be given for resuscitation?

Answer 30

Colloid