IV fluid prescribing

Question 1

what are the 5 Rs of fluid prescribing

Answer 1

1. resuscitation
2. routine maintenance
3. replacement
4. redistribution
5. reassessment

Question 2

what is shock

Answer 2

inadequate perfusion to tissues

Question 3

hypovolaemic shock vs cardiogenic shock

Answer 3

hypo - severe blood or other fluid loss makes the heart unable to pump enough blood to the body
cardio- the inability of the heart to pump sufficient blood for the needs of the body

Question 4

what type of fluids should be used for initial fluid resuscitation

Answer 4

crystalloids e.g. 0.9% NaCl, hartmann’s solution

dont use starch-based colloids

Question 5

what is the most common colloid

Answer 5

human albumin

Question 6

what are colloids

Answer 6

high-molecular-weight molecules suspended in crystalloid carrier solution and do not freely distribute across the extracellular fluid compartments

Question 7

what can excessive NaCl result in

Answer 7

hyperchloaremic metabolic acidosis

Question 8

what kind of solution cannotbe used to resuscitate a pt

Answer 8

hyperkalemic

Question 9

what are routine maintenance fluids used for

Answer 9

to provide the bare minimum electrolytes needed for 2-3 day’s function –> does not replace nutrition

Question 10

how much dextrose presevents starvation/ketoacidosis for 1 day

Answer 10

1L 5% dextrose

Question 11

what fluid combination is best for routine maintenance

Answer 11

2L 0.18% NaCl, 4% dextrose + 40mmol KCl

i.e. contains NaCl, Dextrose and KCl

Question 12

how should glucose given be calculated (fluid prescribing)

Answer 12

according to body weight

Question 13

what blood products are available

Answer 13

1. human albumin
2. packed red cells
3. platelets
4. fresh frozen plasma
5. cyroprecipitate

Question 14

in whom should human albumin solution be considered

Answer 14

only in pts w severe spesis

Question 15

what are the 2 types of human albumin solution

Answer 15

1. hyperoncotic (20% albumin)
2. isotonic (4.5%) - this is usually used

Question 16

when might hyperoncotic

Answer 16

1. hepatorenal syndrome
2. large volume paracentesis

Question 17

what is 4.5% human albumin solution used for

Answer 17

theraputic plasma exchange

Question 18

what is fresh frozen plasma used to replace

Answer 18

clotting factors e.g. in liver disease, DIC, major haemorrhage protocol

Question 19

what is cyroprecipitate

Answer 19

a concentrated solution of clotting components that precipitate out at a low temp

Question 20

what clotting components are found in cyroprecipitate

Answer 20

1. fibrinogen
2. factors VIII
3. factor XIII
4. von WIllebrand Factor

Question 21

what must be given prior to blood according to the protocol

Answer 21

fluid

Question 22

outside the 5 Rs, when might fluids be given (3)

Answer 22

1. hyponateaemia (hypovolemic)
2. diabetic emergencies
3. renal failure

Question 23

causes of AKI + immediate actions (4)

Answer 23

STOP - AKI
S - Sepsis and hypoperfusion -> bolus fluids, stop anti hypertensives, infection/sespsis screen
T - Toxicity -> get full DH, stop nephrotoxic drugs
O - Obstruction -> renal tract imaging
P - Primary renal disease -> urine dipstick, bloods (CK, CRP, FBC etc.), renal immunes screenm myeloma screen

Question 24

5 complications of AKI

Answer 24

1. hyperkalemia
2. acidaemia
3. pulomary oedema
4. euraemic encephalopathy
5. pericarditis

Question 25

pulomnary oedema mgx (due to AKI - 4)

Answer 25

1. sit pt up right
2. O2 15L non-rebreather mask
3. IV GTN
4. furosemide (if stable)