IV Fluids Flashcards
What is the third space?
Areas of the body that do not normally contain fluid and where fluid collection is not functional or desirable eg. ascites, pulmonary effusion etc.
NB- patients can display both signs of hypovolaemia and fluid overload
Examples of crystalloids
0.9% sodium chloride (“normal saline”) 5% dextrose 0.18% sodium chloride in 4% glucose Hartmann’s solution Plasma-Lyte 148
Examples of colloids
Human albumin solution
Isotonic solutions
0.9% saline
Hartmann’s
Plasma-Lyte
NB- used in fluid resuscitation
Hypotonic solutions
5% dextrose
0.18% sodium chloride
NB- risk of hyponatraemia
Hypertonic solutions
3% saline
Guidelines for fluid resuscitation
An initial 500 ml fluid bolus over 15 minutes (“stat”), followed by reassessment with an ABCDE approach
Potassium replacement
The rate of potassium infusion should not exceed 10 mmol/hour
Guidelines for maintenance IV fluids
ie. NBM before surgery or during bowel obstruction
25 – 30 ml / kg / day of water
1 mmol / kg / day of sodium, potassium and chloride
50 – 100 g / day of glucose (this is to prevent ketosis, not to meet their nutritional needs)
The fluid of choice is- 1 Litre 0.18% sodium chloride in 4% glucose with 27 mmol/l potassium
Complications of excess IV fluids
Hyponatraemia (with hypotonic solutions)
Hypokalaemia (if potassium is not included)
Other electrolytes, e.g., calcium or magnesium
Dilution of haemoglobin and haematocrit (red blood cells in the blood) causing anaemia
Dilution of clotting factors, platelets and fibrinogen causing coagulopathy (clotting problems)
Best maintenance fluids for surgical patients
Hartmann’s solution or Plasma-Lyte 148 as they are balanced, isotonic solutions. They are less likely to cause hyponatraemia than hypotonic solutions
Best maintenance fluids for surgical patients
Hartmann’s solution or Plasma-Lyte 148 as they are balanced, isotonic solutions. They are less likely to cause hyponatraemia than hypotonic solutions
Drugs requiring brand names
Inhalers Insulin Psychiatric drugs Epilepsy drugs Modified release products 5-aminosalicylic acids Narrow therapeutic ranges (guys with large dongles totally make perfect internet connections)
Gentamicin Warfarin Lithium Digoxin Theophylline Digoxin Phenytoin Insulin Ciclosporin
What medication can be prescribed alongside fluids to help increase BP (especially in older patients)
Noradrenaline/norepinephrine- vasoconstriction
What medication can be prescribed alongside fluids to help increase BP (especially in older patients)
Noradrenaline/norepinephrine- vasoconstriction
