IV fluid therapy

Question 1

What are our daily requirements?

Answer 1

Water
o 1.5ml/kg/hr (1.5-2.5L/day)

Sodium
o 1mmol/kg/24hr

Potassium
o 1mmol/kg/24hr

Other cations – calcium (1000mg) and magnesium (350mg)

Anions – chloride (750-900mg) and phosphate (700mg)

Glucose
o 50g/day

Question 2

What causes fluid loss?

Answer 2

• Diarrhoea and vomiting
• Stomas and fistulas
• Hyperventilation
• Fever
• Inappropriate urinary loss
• Diabetes
• Haemorrhage
• Sepsis
• Drugs

Question 3

What causes fluid overload?

Answer 3

• Iatrogenic
• Cardiac failure
• Renal failure
• Increased ADH secretion

Question 4

When are IV fluids prescribed?

Answer 4

When needs cannot be met by oral or enteral routes

Question 5

What are crystalloid solutions?

Answer 5

• Can pass freely through semi-permeable membrane

Question 6

What are colloid solutions?

Answer 6

• Larger molecules
• Exert colloid oncotic pressure
• Don’t readily pass-through semipermeable membranes

Question 7

Which fluid can cause anaphylactic reactions?

Answer 7

Colloids

Question 8

What are the indicators that show a patient may need urgent fluid resuscitation?

Answer 8

• Systolic BP <100mmHg
• HR >90 BPM
• CRT >2s
• RR >20
• NEWS ≥5

Question 9

What is fluid resuscitation?

Answer 9

500ml of crystalloid (containing sodium in the range 130-154 mmol/L) over <15mins

Question 10

How do you reassess a patient after giving fluid resuscitation?

Answer 10

ABCDE

Question 11

After giving 2L of fluid resuscitation, what do you do?

Answer 11

See whether patient needs more or whether you need expert help

Question 12

What is routine maintenance?

Answer 12

Used to replace normal daily fluid and electrolyte balance:
• 25-30 ml/kg/day water
• 1 mmol/kg/day sodium, potassium, chloride
• 50-100 g/day glucose

Question 13

What is preferred when maintenance needs are > 3 days

Answer 13

Nasogastric and enteral feeding

Question 14

What is replacement and redistribution?

Answer 14

Looking for existing fluid or electrolyte deficits or excesses

Question 15

What can cause fluid/electrolyte deficits or excesses?

Answer 15

• Dehydration
• Fluid overload
• Hyperkalaemia/hypokalaemia

Question 16

What can cause ongoing fluid/electrolyte losses?

Answer 16

• Vomiting and NG tube loss
• Biliary drainage loss
• High/low volume ileal stoma loss
• Diarrhoea/excess colostomy loss
• Ongoing blood loss
• Sweating, fever, dehydration
• Pancreatic/jejunal fistula
• Urinary loss (post AKI polyuria)

Question 17

What can cause redistribution and other complex issues?

Answer 17

• Gross oedema
• Severe sepsis
• Hypernatraemia/hyponatraemia
• Renal, liver and/or cardiac impairment
• Post-operative fluid retention and redistribution
• Malnourished and refeeding issues

Question 18

What can large volumes of 0.9% saline cause?

Answer 18

Increased risk of hyperchloremic metabolic acidosis

Question 19

What solution should not be used in patient with hyperkalaemia?

Answer 19

Hartmann’s

- Contains potassium

Question 20

In patients with HF, how would you go about fluid resuscitation?

Answer 20

Fluid challenges

• Boluses of 250ml
• Monitor patient’s response

Question 21

How do you replace fluid loss in polyuria after an AKI?

Answer 21

Match hourly urine output - 50ml

Question 22

How do you go about fluid resuscitation in children?

Answer 22

20ml/kg over less than 10 minutes

Question 23

How do you go about fluid maintenance in children?

Answer 23

1st 10kg = 100ml/kg
2nd 10kg = 50ml/kg
Subsequent kg = 20ml/kg