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MD4003 > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

Describe in what compartments a 70kg man’s total body water (42L) would be?

A
  • 28L intracellular fluid
  • 11L interstitial fluid (extracellular)
  • 3L plasma fluid (extracellular)
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2
Q

What are the possible causes for increased water loss via the urine?

A
  • Poorly controlled diabetes

- Diuretics

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3
Q

What are the possible causes for increased water loss via the GI tract?

A
  • Cholera
  • Vomiting
  • IBD
  • Laxatives
  • Bowel prep
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4
Q

What are the possible causes for increased water loss via the skin (sweat & insensible losses)?

A
  • Burns
  • Pyrexia
  • Long operation with bowel exposed to air
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5
Q

What are the possible causes for increased water loss via the respiratory system?

A
  • O2 ventilation dries up patient
  • Increased respiratory rate
  • Fever
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6
Q

List some symptoms of hypovolaemia?

A
  • Anxiety
  • Clammy skin
  • Confusion
  • Decreased urine output
  • Weakness
  • Pale skin
  • Rapid breathing
  • Sweating
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7
Q

List some symptoms of hypervolaemia?

A
  • Oedema
  • Headache
  • Cramps
  • Stomach bloating
  • Dyspnoea
  • Tachycardia
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8
Q

Fluid retention in sick patients with leaky capillaries can lead to what?

A
  • Ileus
  • Poor mobility peripheral oedema
  • Pressure sores
  • Pulmonary oedema
  • Poor wound healing
  • Anastomotic breakdown
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9
Q

What does excess chloride lead to?

A
  • Renal vasoconstriction

- Increased sodium and water retention (decreased urine)

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10
Q

Describe euvolaemic patients?

A
  • Veins are well filled
  • Extremities are warm
  • Blood pressure and heart rate are normal
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11
Q

Describe hypovolaemic patients?

A
  • Cool peripheries
  • Respiratory rate >20
  • Systolic BP <100mmHg
  • FEWS >/=5
  • HR >90bpm
  • Postural hypotension
  • Oliguria
  • Confusion
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12
Q

Describe hypervolaemic patients?

A
  • Oedematous
  • Inspiratory crackles
  • High JVP
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13
Q

What are the reasons for a patients not needing IV fluids?

A
  • Drinking adequately
  • Receiving adequate fluids via NG feed or TPN
  • Receiving large volumes with drugs or drug infusions or a combination
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14
Q

What is the treatment for hypervolaemia?

A
  • Fluid restriction

- Gentle diuresis

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15
Q

What are the reasons for a patient needing IV fluids?

A
  • Not drinking

- Lost/losing fluid

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16
Q

Why would a patient need maintenance fluids?

A
  • Patient does not have excess losses above sensible loss/urine
  • Patients having to fast over 8hrs
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17
Q

If a patient has no other intake, how much maintenance fluid would they need?

A

30ml/kg/24hrs

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18
Q

Why would a patient need replacement fluids?

A
  • If there are losses either previously or current

- This fluid is in addition to maintenance fluid

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19
Q

Why would a patient need resuscitation fluids?

A

If patient is hypovolaemic as a result of dehydration, blood loss or sepsis and requires urgent correction of intravascular depletion to correct the deficit

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20
Q

What fluid would you give for diabetic special circumstances?

A

0.18% NaCl/ 4% Glucose/ KCl with IV insulin

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21
Q

What should you remember when giving a head injury patient fluids?

A

Avoid fluids containing glucose

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22
Q

How should IV fluids be given if a patient is on fluids for over 6hrs or if the fluid contains potassium?

A

Via volumetric pump

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23
Q

What should you always remember when giving maintenance fluids?

A

NEVER give them at more that 100ml/hr

24
Q

What is the preferred maintenance fluid to prescribe?

A

0.18% NaCl/ 4% glucose with or without added potassium (20mmol) in 500ml

25
Q

What volume of maintenance fluid should you give frail elderly patients with renal impairment or cardiac failure / patients who are malnourished / at risk of refeeding syndrome?

A

20-25ml/kg/day

26
Q

What maintenance fluid should you give if the patient is at refeeding risk?

A

Pabrinex IV

27
Q

What fluid can be given to prevent starvation ketosis?

A

50-100g glucose in 24hrs

28
Q

What can occur in patients with upper GI losses?

A

Hypochloraemia (loss of Cl)

29
Q

What can cause hyponatraemia?

A
  • Large GI losses
  • Too much fluid
  • SIADH
  • Chronic diuretic use
30
Q

What is the possible treatment for hyponatraemia?

A

0.9% NaCl or fluid restriction and frequent U&E’s

31
Q

How should you give replacement potassium fluid?

A
  • In maintenance fluid
  • Give upto 40mmol in 100ml bags via a central line at 25-50ml/hr
  • Must be given by pump
  • Give Kay-Cee-L/ Sando-K orally if possible
32
Q

What can lead to potassium loss?

A

Diarrhoea

33
Q

How should you replace fluid/electrolytes?

A

By adding up all the losses over the previous 24hrs and give this volume as Plasmalyte 148

34
Q

What fluid should you prescribe for upper GI/bile losses?

A

0.9% NaCl with KCl

35
Q

What fluid contains lactate?

A

Hartmann’s solution

36
Q

What fluid contains acetate & gluconate?

A

PlasmaLyte 148

37
Q

What 2 fluids should you use in urgent resuscitation?

A
  1. PlasmaLyte 148

2. Colloid (Gelaspan/Albumin)

38
Q

When should you only give Albumin?

A

Severe sepsis

39
Q

What fluids should you prescribe for severe blood loss?

A
  • Initially use colloid / PlasmaLyte 148 until blood/clotting factors arrive
  • Use O negative blood for torrential bleeding
  • Severely septic patents with circulatory collapse may need inotropic support in a critical care area
40
Q

In what scenarios should you consider critical care referral?

A
  • GCS = 8 or falling
  • O2 saturation <90% on 60% O2 or higher
  • PaCO2 > 7kPa unresponsive to NIV
  • Persistent hypotension and/or oliguria unresponsive to 2000ml fluid/ or concern over cardiac function
  • Metabolic acidosis: base deficit -8 or worse, bicarbonate <18mmol/l, lactate >3mmol/l and not improving in 2hrs
  • Aggressive/agitated patients whose treatment (oxygen,IV therapy) is compromised due to agitation
41
Q

What coagulates blood products?

A

Calcium

42
Q

What type of fluid should you give a patient if you want to draw fluid out of the intracellular space and into the extracellular space (cerebral oedema)?

A

Hypertonic solution

43
Q

What is a colloid fluid?

A

Protein based and has allergenic potential

44
Q

Give 3 examples of colloid fluids?

A
  1. Blood
  2. Hydrolysed gelatin
  3. 4.5% Albumin
45
Q

What is crystalloid fluids?

A

Aqueous solutions of mineral salts or other water-soluble molecules

46
Q

Give 5 examples of crystalloid fluids?

A
  1. Normal saline (NaCl)
  2. 5% Dextrose
  3. 0.18% NaCl/ 4% Dextrose
  4. Hartmann’s
  5. Plasmalyte
47
Q

Who are at risk of fluid overload?

A
  • Heart failure
  • Hepatic failure
  • Renal failure
  • Excess fluid prescribing
48
Q

When would you prescribe parenteral nutrition fluids?

A

Used to provide complete fluid, electrolyte and nutritional needs for patients who cannot eat or drink for an extended time

49
Q

What is the average loss of fluid via urine?

A

~1500ml

50
Q

What is the average loss of fluid via faeces?

A

~100ml

51
Q

What is the average loss of fluid via sweat?

A

50mls

52
Q

What is the average loss of fluid via insensible losses?

A

~900ml

53
Q

What is the total body loss of fluid on average in a day?

A

~2550ml

54
Q

What happens if the total body sodium falls?

A

Osmolality (tightly regulated) stays the same and the total volume falls (including plasma volume)

55
Q

What are compensatory mechanisms really linked to?

A
  • Low volume (low GFR, stimulation of JGA)

- High volume (increased GFR and release of ANP)

56
Q

What syndrome is typical of hyperaldosteronism?

A

Conn’s syndrome

57
Q

What 2 things can Conn’s syndrome lead to?

A
  1. Hypertension from increased fluid volume

2. Hypokalaemia

MD4003 (22 decks)

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