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
specific scenarios: hyponatraemia if the patient is dry
give 0.9% NaCl carefully monitoring there U’s and E’s
if hyponatraemic but euvolaemic
consider SIADH as the diagnosis and do a paired serum and urine osmolarity
if SIADH is the correct diagnosis
restrict water to less than one litre a day and treat underlying cause
if hyponatrameic and fluid overloaded
water restriction and consider diuretic use if symptomatically overloaded with monitoring of Us and Es
correct of hyponatramaeia goal of treatment
is to raise the sodium concentration by 4-6 mEq/litre in a 24 hour period
in patients who require emergency theory for hyponatraemia
the goal of raising sodium concncetration by 4-6mEq/litre should be achieved within 6 hours or less and then after this sodium levels should be kept constant
in the treatment of hyponatraemia every effort should be made to ensure that
the rise in serum sodium is less than 9mEq/litre within any 24 hour period due to the risk of a devastating osmotic demyelination condition occurring called central pointing myelinolysis
patients who are at the highest risk of osmotic demyelination
those with serum sodium concentration of less than 105mEq/litre, those with hypokalaemia,alcoholism, malnutrition and liver disease
severe hyponatramia
sodium less than 120mmol/litre requires emergency therapy with hypertonic saline
hypertonic saline is indicated in the following situations
- patients with symptomatic hyponatramia such as seizures and altered conscious level
- patients with acute hyponatrameia even with mild symptoms due to the risk of osmotically drive water flow across the blood brain barrier causing life-threatening cerebral oedema which causes brain herniation
- symptomatic patients with post-operative hyponatramia or hyponatramia cause by an intra-cranial pathology as brain herniation can occur
emergency treatment of hyponatraemia
100ml of 3% NaCL over 10-15 minutes
