IV Fluid prescribing in adults

Question 1

Types of fluids

Answer 1

crystalloids: solutions of small molecules in water (e.g. sodium chloride, Hartmann’s, dextrose)

Colloids: solutions of larger organic molecules (e.g. albumin, Gelofusine)

Question 2

which type of fluid are commonly use and why?

Answer 2

crystalloids cos colloids carry risk of anaphylaxis

Question 3

commonly use fluid (5)

Answer 3

Sodium chloride 0.9% (Normal saline)
Hartmann’s solution
Sodium chloride 0.18% / Glucose 4%
5% Dextrose

Question 4

which are the isotonic fluids and which are the hypotonic fluids

Answer 4

isotonic fluids:
NaCl 0.9%
hartmann’s

hypotonic fluids:
NaCl 0.18% / glucose 4%
5%dextrose

Question 5

What are the purpose of prescribing IV fluids?

Answer 5

Resuscitation
Routine maintenance
Replacement
Redistribution
Reassessment

Question 6

What is the cause of having IV fluids?

Answer 6

Dehydration
fluid loss
hypovolemia

Question 7

management for resuscitation fluids

Answer 7

• initial 500ml bolus of crystalloid solution (e.g NaCl 0.9%/Hartmann’s solution) over less than 15 minutes.
• reassess the patient using the ABCDE approach
• ongoing hypovolaemia give a further 250-500 ml bolus of a crystalloid solution, then reassess
• max fluid of 2000 ml of fluid (4 times fo 500ml)
  –> seek expert help

*if elderly/have HF or RF then give 250ml

Question 8

What could be the reason of a pt with normovolaemic but show signs of shock?

Answer 8

so appears to have other shock like
cardiogenetic
septic shock, anaphylactic shock, and neurogenic shock
obstructive shock

Question 9

when will pt need routine maintenance fluids?

Answer 9

when pt is haemodynamically stable but unable to meet their daily fluid requirements via oral or enteral routes

Question 10

what are the daily maintenance fluid requirements?

Answer 10

25-30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride and
approximately 50-100 g/day of glucose to limit starvation ketosis (however note this will not address the patient’s nutritional needs)

Question 11

what amount of fluid you can prescribe with elderly pt, renal impairment or cardiac failure and malnourished patients?

Answer 11

20-25 ml/kg/day

Question 12

in general maintenance how much you give ?

Answer 12

1000ml over 8-10hrs