IV fluid prescribing Flashcards
5Rs for when to prescribe IV fluids
resuscitation
routine maintenance
replacement
redistribution
reassessment
When might a patient need immediate fluid resus?
hypovolaemic shock
What is shock?
inadequate perfusion to tissues
What are clinical signs of shock?
low SBP (<100mmHg)
tachycardia (>90bpm)
tachypnoea (>20rpm)
delayed CRT
cool peripheries
high or deteriorating EWS
response to PLR (passive leg raise)
confusion/decreased LOC
What type of fluids should be used for initial fluid resuscitation?
crystalloids that contain sodium or a balanced solution
(NaCl or Hartmann’s)
How should a fluid bolus be given?
500ml over 15mins
further boluses as clinically needed
When is NaCl the preferred fluid?
contains no potassium so preferred when risk of hyperkalaemia (AKI, rhabdomyolysis)
chloride can be depleted in some causes of hypovolaemia (eg. vomiting)
Sodium daily maintenance requirements
~1-2mmol/kg/day
Potassium daily maintenance requirements
~1-2mmol/kg/day
Chloride daily maintenance requirements
~1-2mmol/kg/day
Glucose daily maintenance requirements
50-100g/day
Water daily maintenance requirements
25-30ml/kg/day
What should you consider when prescribing IV fluid as replacement therapy?
what is being lost?
how much?
is any being replaced orally/enterally?
what needs to be replaced IV?
How can fluid be lost?
vomiting
NG tube
pure water loss = fever, dehydration, hypernatraemia)
biliary drainage
diarrhoea
high output stoma
urinary
pancreatic drain/fistula
When can human albumin solution be used for fluid resuscitation?
in patients with severe sepsis
What does FFP contain?
all the soluble coagulation factors
What does cryoprecipitate contain?
fibrinogen
factors VIII + XIII
Von willebrand factor
When is cryoprecipitate used?
when patients have used up all their fibrinogen (eg. DIC + massive transfusion)
If patient is hyponatraemic and hypovolaemic, how should they be managed?
salt and water depleted
normal saline cautiously
regular U&E monitoring
If patient is hyponatraemic and euvolaemic, how should they be managed?
possible SIADH
paired urine + sodium osmolality when off diuretic + IV fluids
SIADH treatment = fluid restriction (usually <1L/day)
If a patient is hyponatraemic and overloaded, how should they be managed?
water excess
water restrict
consider diuretics if symptomatic overload
correction of sodium should be slow
AKI causes
sepsis + hypoperfusion
toxicity - drugs
obstruction
primary renal disease
AKI complications
hyperkalaemia
acidaemia
pulmonary oedema
When is hyperoncotic human albumin solution used?
large volume paracentesis
hepatorenal syndrome
