IV fluid prescribing

Question 1

5Rs for when to prescribe IV fluids

Answer 1

resuscitation
routine maintenance
replacement
redistribution
reassessment

Question 2

When might a patient need immediate fluid resus?

Answer 2

hypovolaemic shock

Question 3

What is shock?

Answer 3

inadequate perfusion to tissues

Question 4

What are clinical signs of shock?

Answer 4

low SBP (<100mmHg)
tachycardia (>90bpm)
tachypnoea (>20rpm)
delayed CRT
cool peripheries
high or deteriorating EWS
response to PLR (passive leg raise)
confusion/decreased LOC

Question 5

What type of fluids should be used for initial fluid resuscitation?

Answer 5

crystalloids that contain sodium or a balanced solution
(NaCl or Hartmann’s)

Question 6

How should a fluid bolus be given?

Answer 6

500ml over 15mins
further boluses as clinically needed

Question 7

When is NaCl the preferred fluid?

Answer 7

contains no potassium so preferred when risk of hyperkalaemia (AKI, rhabdomyolysis)

chloride can be depleted in some causes of hypovolaemia (eg. vomiting)

Question 8

Sodium daily maintenance requirements

Answer 8

~1-2mmol/kg/day

Question 9

Potassium daily maintenance requirements

Answer 9

~1-2mmol/kg/day

Question 10

Chloride daily maintenance requirements

Answer 10

~1-2mmol/kg/day

Question 11

Glucose daily maintenance requirements

Answer 11

50-100g/day

Question 12

Water daily maintenance requirements

Answer 12

25-30ml/kg/day

Question 13

What should you consider when prescribing IV fluid as replacement therapy?

Answer 13

what is being lost?
how much?
is any being replaced orally/enterally?
what needs to be replaced IV?

Question 14

How can fluid be lost?

Answer 14

vomiting
NG tube
pure water loss = fever, dehydration, hypernatraemia)
biliary drainage
diarrhoea
high output stoma
urinary
pancreatic drain/fistula

Question 15

When can human albumin solution be used for fluid resuscitation?

Answer 15

in patients with severe sepsis

Question 16

What does FFP contain?

Answer 16

all the soluble coagulation factors

Question 17

What does cryoprecipitate contain?

Answer 17

fibrinogen
factors VIII + XIII
Von willebrand factor

Question 18

When is cryoprecipitate used?

Answer 18

when patients have used up all their fibrinogen (eg. DIC + massive transfusion)

Question 19

If patient is hyponatraemic and hypovolaemic, how should they be managed?

Answer 19

salt and water depleted
normal saline cautiously
regular U&E monitoring

Question 20

If patient is hyponatraemic and euvolaemic, how should they be managed?

Answer 20

possible SIADH
paired urine + sodium osmolality when off diuretic + IV fluids
SIADH treatment = fluid restriction (usually <1L/day)

Question 21

If a patient is hyponatraemic and overloaded, how should they be managed?

Answer 21

water excess
water restrict
consider diuretics if symptomatic overload
correction of sodium should be slow

Question 22

AKI causes

Answer 22

sepsis + hypoperfusion
toxicity - drugs
obstruction
primary renal disease

Question 23

AKI complications

Answer 23

hyperkalaemia
acidaemia
pulmonary oedema

Question 24

When is hyperoncotic human albumin solution used?

Answer 24

large volume paracentesis
hepatorenal syndrome