IV Fluid Therapy

Question 1

Which type of solution is best to use for fluid resuscitation?

Answer 1

Crystalloid

Question 2

Which type of crystalloid is best for fluid resuscitation?

Answer 2

Balanced crystalloid

(e.g. Hartmann’s)

Question 3

What is the problem with using excessive amounts of 0.9% NaCl?

Answer 3

Hyperchloraemic metabolic acidosis

Question 4

In which cases would 0.9% NaCl resuscitation be preffered over the use of Hartmann’s solution or another balanced crystalloid and why?

Answer 4

Rhabdomyolysis

AKI/CKD

Risk of initial hyperkalaemia

Question 5

What are the 5Rs associated with IV fluid prescribing?

Answer 5

1. Resuscitation
2. Routine maintenance
3. Replacement
4. Redistribution
5. Reassessment

Question 6

How can fluid resuscitation be defined?

Answer 6

Re-establishing haemodynamic instability by restoring intravascular volume

Question 7

What does the term replacement refer to in terms of IV fluid prescribing?

Answer 7

Providing daily maintenance requirements and replacement of any ongoing abnormal losses

Question 8

In order to maintain routine maintenance, how can IV fluid solutions be altered to match electrolyte requirements?

Answer 8

Scaling down and adding 5% glucose solution to make up the volume

Question 9

What is the recommended doseage of sodium cholride and potassium per Kg per day?

Answer 9

1mmol/Kg/day

Question 10

In which case would human albumin solution be used as a last resort?

Answer 10

Patients with severe sepsis

(this is a colloid with risks of anaphylaxis)

Question 11

Why does ascites occur?

Answer 11

There is hypoalbuminaemia so water leaves the vessels as there is loss of oncotic drag and gathers in the tissues

Question 12

Which process does human albumin solution go through before it is used in the blood?

Answer 12

Therapeutic plasma exchange

(removal of autoantibodies)

Question 13

What are the four main types of blood products?

Answer 13

1. Packed red cells
2. Platelets
3. Fresh frozen plasma
4. Cryoprecipitate

Question 14

In a major haemorrhage, what is the first thing that should be given immediately?

Answer 14

O^- blood

(until crossmatch has found compatible blood type)

Only the aspects which are deficient should be given e.g. packed red cells only

Question 15

What should be done in a patient why is dry and has hyponatraemia?

Answer 15

0.9% NaCl

(cautiously, regular electrolyte monitoring)

Question 16

How is SIADH defined?

Answer 16

1. Hyponatremia
2. 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

Question 17

Why does SIADH cause euvolaemia, yet hyponatraemia?

Answer 17

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

Question 18

What can happen if serum sodium concentration is corrected too quickly?

Answer 18

Neurological dmaage affecting pons in midbrain

Osmotic demyelination occurs

Question 19

In severe hyponatraemia (e.g. Na < 120mmol/L) what is the recommended therapy?

Answer 19

100ml of 3% saline over 10-15 minutes