IV FLUIDS! Flashcards
When is monitoring fluid balance helpful?
Sepsis
Fluid balance issues - D+V, HF, kidney disease
Surgical patients
Patients requiring fluid restriction (1.5L/day usually)
What would you call it when a patient has an unusually low amount of extracellular fluid?
Hypovolaemia/fluid depletion
What are clinical signs of hypovolaemia?
Blood pressure <100mmHg systolic Tachycardia (HR >90bpm) CRT prolonged Cold peripheries Tachypnoea Reduced skin turgor Reduced urine output Sunken eyes Thirsty
What are clinical signs of fluid overload?
Peripheral oedema
Pulmonary oedema - SOB, reduced oxygen saturations
Raised JVP
Increased body weight from baseline
Clinical indications for IV fluids?
Hypotension
Fluid replacement - vomiting and diarrhoea
Maintenance fluids - NBM
What are the types of IV fluids?
Crystalloids - water with added salts and glucose
Colloids - contain large molecules that stay in the intravascular space for longer.
What does a 1L bag of 0.9% saline contain?
1L water
154mmol sodium
What does a 1L bag of Hartmann’s solution contain?
1L water 131mmol sodium 111mmol chloride 5mmol potassium 2mmol calcium 29mmol lactate - helps to buffers solution reducing risk of acidosis
What does a 1L bag of plasmalyte contain?
1L water 140mmol sodium 98mmol chloride 5mmol potassium 1.5mmol magnesium 27 moll acetate - buffer 23 mmol gluconate - buffer
What is an example of a colloid?
Human albumin solution, often used in decompensated liver disease.
Often prescribed for patients in gastroenterology with an ascitic drain to maintain protein levels.
What is tonicity?
Osmotic gradient across two different membranes.
What is a normal serum osmolality?
275-295mmOsm/kg
What kind of fluid is 5% dextrose?
A hypotonic crystalloid infusion.
Which fluids can be used for fluid resuscitation?
0.9% Saline, Hartmann’s solution or Plasmalyte 148
When would you seek senior help when treating a patient in shock?
If the patient hasn’t responded to 2L of fluid
What is the fastest rate you can infuse potassium?
No faster than 10mmol/hour as there is a chance you will induce arrhythmia or cardiac arrest.
Any faster than this would be carefully monitored by a specialist and delivered through a central line.
How much water is required in a patient in a day
25-30ml/kg
How much sodium, potassium and chloride is required in a patient a day?
1mmol/kg sodium potassium and chloride.
How much glucose is required in a patient a day?
50-100g a day of glucose to prevent ketosis.
This is to purely stop ketosis, not meet nutritional requirements.
What is the ideal body weight?
This is the body weight that is used in patients, especially when they are overweight as this avoids excessive prescriptions.
What is the ideal fluid to meet the potassium requirements of a patient on maintenance fluids.
0.18% sodium chloride with 5% dextrose with 27mmol/L added potassium. This mixture is available as a ready made solution.
More than 2.5L of this solution increases the risk of hyponatraemia as this is hypotonic.
Daily monitoring is required including their fluid status, fluid balance chart and daily U+E’s.
