IV fluid prescribing Flashcards
the 5 R’s
- Rescucitation
- Replacement
- routine maintenance
- Redistribution
- Re-assessment
what fluids should be used for initial resucitation
crystalloid fluids
which crystalloid fluid should be used for initial rescuctiation
balanced crystalloid fluid (haramtns solution or ringers lactate)
why is a balance crystalloid fluid used
because if you use 0.9% NaCl there is a risk of hyperchloraemic metabolic alkalosis
when should you use 0.9% NaCl in rescuctiaiton
in patients with rhabdomyolysis, acute kidney injury or chronic kidney disease due to the risk of hyperkalaemia
fluid resuscitation definition
re-establishing haemodynamic stability by restoring intra-vascular volume
fluids used in resuscitation
balanced crystalloid (hart mans solution or ringers lactate) or crystalloid solution (0.9% NaCl)
fluid replacement definition
provides daily maintenance and replaces any on-going losses
fluids used for fluid replacement
balances crystalloid or crystalloid
routine maintenance definition
provides daily maintenance requirements
fluids used for routine maintenance
0.18% NaCl/ 4% dextrose, 5% dextrose, 0.45% NaCl
Vomiting and nasogastric tube loss can cause
a hypochloraemic (hypokalaemic) metabolic alkalosis which requires potassium and chloride replacement
pure water loss
fevered dehydration can cause a potential hypernatramia
hartmans solution
contains mostly sodium and chloride contains small amount of potassium, bicarbonate pre-curse (lactate) and calcium
lactated ringers
contains sodium, chloride small amount of potassium, calcium and bicarbonate precursor (lactate)
0.9% NaCl
contains only sodium and chloride (154mmol/litre of each)
0.45% NaCl
Contains only sodium and chloride (77mmol/litre of each)
0.18% NaCl/ 5% dextrose
contains 31mmol/litre of sodium and chloride in 222 mol/litre of glucose
5% dextrose contains only
277mmol/litre of glucose only
colloid fluids
consider human albumin solution (4-5%) only in patients with severe sepsis
20% albumin is
hyperoncoct,100ml will expand to approximately 400ml in 25 minutes
20% albumin is used in
large volume paracentesis
- 100ml every 3litres if normal renal function
- 100ml every 2 litre if renal dysfunction
blood producrs
- FFP
- red blood cells
- platelets
- cryoprecipitate
massive haemorrhage protocol
send urgent blood samples (FBC, coagulation scree, cross match, fibrinogen, U+E, calcium) blood bank will send 4 units of red cells, 4 units of FFP, 1 unit of plasma