IV FLUIDS!

Question 1

When is monitoring fluid balance helpful?

Answer 1

Sepsis

Fluid balance issues - D+V, HF, kidney disease

Surgical patients

Patients requiring fluid restriction (1.5L/day usually)

Question 2

What would you call it when a patient has an unusually low amount of extracellular fluid?

Answer 2

Hypovolaemia/fluid depletion

Question 3

What are clinical signs of hypovolaemia?

Answer 3

Blood pressure <100mmHg systolic
Tachycardia (HR >90bpm)
CRT prolonged
Cold peripheries
Tachypnoea
Reduced skin turgor 
Reduced urine output 
Sunken eyes
Thirsty

Question 4

What are clinical signs of fluid overload?

Answer 4

Peripheral oedema
Pulmonary oedema - SOB, reduced oxygen saturations
Raised JVP
Increased body weight from baseline

Question 5

Clinical indications for IV fluids?

Answer 5

Hypotension
Fluid replacement - vomiting and diarrhoea
Maintenance fluids - NBM

Question 6

What are the types of IV fluids?

Answer 6

Crystalloids - water with added salts and glucose

Colloids - contain large molecules that stay in the intravascular space for longer.

Question 7

What does a 1L bag of 0.9% saline contain?

Answer 7

1L water

154mmol sodium

Question 8

What does a 1L bag of Hartmann’s solution contain?

Answer 8

1L water
131mmol sodium
111mmol chloride
5mmol potassium
2mmol calcium 
29mmol lactate - helps to buffers solution reducing risk of acidosis

Question 9

What does a 1L bag of plasmalyte contain?

Answer 9

1L water 
140mmol sodium 
98mmol chloride
5mmol potassium
1.5mmol magnesium 
27 moll acetate - buffer 
23 mmol gluconate - buffer

Question 10

What is an example of a colloid?

Answer 10

Human albumin solution, often used in decompensated liver disease.

Often prescribed for patients in gastroenterology with an ascitic drain to maintain protein levels.

Question 11

What is tonicity?

Answer 11

Osmotic gradient across two different membranes.

Question 12

What is a normal serum osmolality?

Answer 12

275-295mmOsm/kg

Question 13

What kind of fluid is 5% dextrose?

Answer 13

A hypotonic crystalloid infusion.

Question 14

Which fluids can be used for fluid resuscitation?

Answer 14

0.9% Saline, Hartmann’s solution or Plasmalyte 148

Question 15

When would you seek senior help when treating a patient in shock?

Answer 15

If the patient hasn’t responded to 2L of fluid

Question 16

What is the fastest rate you can infuse potassium?

Answer 16

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.

Question 17

How much water is required in a patient in a day

Answer 17

25-30ml/kg

Question 18

How much sodium, potassium and chloride is required in a patient a day?

Answer 18

1mmol/kg sodium potassium and chloride.

Question 19

How much glucose is required in a patient a day?

Answer 19

50-100g a day of glucose to prevent ketosis.

This is to purely stop ketosis, not meet nutritional requirements.

Question 20

What is the ideal body weight?

Answer 20

This is the body weight that is used in patients, especially when they are overweight as this avoids excessive prescriptions.

Question 21

What is the ideal fluid to meet the potassium requirements of a patient on maintenance fluids.

Answer 21

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.