IV Fluid Therapy Flashcards
Which type of solution is best to use for fluid resuscitation?
Crystalloid
Which type of crystalloid is best for fluid resuscitation?
Balanced crystalloid
(e.g. Hartmann’s)
What is the problem with using excessive amounts of 0.9% NaCl?
Hyperchloraemic metabolic acidosis
In which cases would 0.9% NaCl resuscitation be preffered over the use of Hartmann’s solution or another balanced crystalloid and why?
Rhabdomyolysis
AKI/CKD
Risk of initial hyperkalaemia
What are the 5Rs associated with IV fluid prescribing?
- Resuscitation
- Routine maintenance
- Replacement
- Redistribution
- Reassessment
How can fluid resuscitation be defined?
Re-establishing haemodynamic instability by restoring intravascular volume
What does the term replacement refer to in terms of IV fluid prescribing?
Providing daily maintenance requirements and replacement of any ongoing abnormal losses
In order to maintain routine maintenance, how can IV fluid solutions be altered to match electrolyte requirements?
Scaling down and adding 5% glucose solution to make up the volume
What is the recommended doseage of sodium cholride and potassium per Kg per day?
1mmol/Kg/day
In which case would human albumin solution be used as a last resort?
Patients with severe sepsis
(this is a colloid with risks of anaphylaxis)
Why does ascites occur?
There is hypoalbuminaemia so water leaves the vessels as there is loss of oncotic drag and gathers in the tissues
Which process does human albumin solution go through before it is used in the blood?
Therapeutic plasma exchange
(removal of autoantibodies)
What are the four main types of blood products?
- Packed red cells
- Platelets
- Fresh frozen plasma
- Cryoprecipitate
In a major haemorrhage, what is the first thing that should be given immediately?
O- blood
(until crossmatch has found compatible blood type)
Only the aspects which are deficient should be given e.g. packed red cells only
What should be done in a patient why is dry and has hyponatraemia?
0.9% NaCl
(cautiously, regular electrolyte monitoring)
How is SIADH defined?
- Hyponatremia
- Hypo-osmolality
Due to inappropriate, continued secretion or action of the ADH
This is despite normal or increased plasma volume, which results in impaired water excretion
Why does SIADH cause euvolaemia, yet hyponatraemia?
ADH causes recruitment of aquaporin channels into the collecting ducts of the nephons
Water is reabsorbed
Since blood pressure is normal, salt is passed by the kidneys as not absorbed because the RAAS is not switched on
What can happen if serum sodium concentration is corrected too quickly?
Neurological dmaage affecting pons in midbrain
Osmotic demyelination occurs
In severe hyponatraemia (e.g. Na < 120mmol/L) what is the recommended therapy?
100ml of 3% saline over 10-15 minutes
