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Systems: Specialities AB > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

Diffusion

A
  • Movement of solute from high concentration to low concentration
  • Membrane has to be solute permeable
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2
Q

Osmosis

A

Movement of water from high concentration to low concentration
-Membrane has to be solute impermeable

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3
Q

Osmolarity

A

The measure of solute concentration per unit volume of solvent

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4
Q

Osmolality

A

The measure of solute concentration per unit mass of solvent

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5
Q

Tonicity

A

The measure of the osmotic pressure gradient between 2 solutions

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6
Q

Where is osmolality the same?

A

In the ICF and the ECF

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7
Q

What is the normal fluid make up of a 70kg man?

A
  • 42L of water
  • 2/3 (28L) intracellular
  • 1/3 (14L) extracellular of which only 20% (3L) is intravascular
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8
Q

Give examples of cells present in the blood.

A
  • Platelets
  • RBC
  • WBC
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9
Q

What are our basic requirements per day?

A

Water
25-30ml/kg/day

Sodium
1mmol/kg/day

Potassium
1mmol/kg/day

Glucose
50-100g/day

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10
Q

What are the 4 questions which will help you administer fluid correctly?

A
  • What is my patients volume status?
  • Does my patient need IV fluids?
  • How much fluid do they need?
  • What types of fluid do they need?
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11
Q

How do you determine your patient’s volume status?

A
  • Airway
  • Breathing
  • Circulation
  • Disability
  • Extremities
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12
Q

What are the signs of euvolaemia?

A
  • Feels well, not Thirsty
  • Veins well filled
  • Warm extremities
  • Mild sweat
  • Normal BP and HR
  • Normal Urine
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13
Q

What does someone who is euvolaemic need?

A

No fluids (unless electrolyte deplete or low BP)

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14
Q

What are the signs of hypovolaemia?

A
  • Feels nauseous, thirsty
  • Flat veins
  • Cool peripheries
  • No sweat
  • Low or postural BP and high HR
  • Concentrate oliguria
  • Responds to SLR
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15
Q

What does someone who is hypovolaemia need?

A
  • Resuscitaion fluids (if low BP)
  • Rehydration fluids
  • ‘Plug the leak’
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16
Q

What are the signs of hypervolaemia?

A
  • Feels breathless, not thirsty
  • Veins distended
  • Warm and oedematous extremities
  • Sweaty
  • High BP and High HR
  • Dilute urine (could be oliguric or polyuric)
17
Q

What does someone who is hypervolaemic need?

A
  • No more fluids
  • Possibly diuretics (if respiratory compromise)
  • Haemofiltration (if anuric)
18
Q

What can complicate things?

A
  • Low oncotic pressure (low protein/albumin)

- Heart failure

19
Q

How can low oncotic pressure complicate things?

A
  • Low Albumin or protein can cause oedema in dehydrated patients due to loss of intracapilliary fluid.
  • Tend to be oedematous, but behave hypovolaemic (Low BP, high HR, thirsty)
20
Q

How can heart failure complicate things?

A

-Can cause oedema and low BP but still require diuresis due to high circulating volume caused by RVP

21
Q

How can you tell how much fluid your patient needs?

A

Work out the water deficit

  • Catheters, drains
  • input charts
  • Vomit bowls
  • Sputum pots
  • Stool charts ad stoma losses
22
Q

What insensible losses are there?

A
  • Sepsis (sweat)
  • Ventilation
  • Open wounds
  • Burns
  • Bleeding
23
Q

What is the normal loss due to insensible factors per day?

A
  • No solute loss

- 400-800mls water loss

24
Q

What are the 5Rs of fluid types?

A
  • Resuscitation
  • Routine maintenance
  • Replacement
  • Redistribution
  • Reassessment
25
Q

Resuscitation fluids

A

IV fluids urgently to restore circulation with hypovolaemia

26
Q

Routine maintenance fluids

A

IV fluids if cannot take orally or enterally to meet patient maintenance requirements

27
Q

Replacement fluids

A

Some don’t need urgent IV resuscitation but do need IV ADDITIONAL to maintenance to correct existing deficit or ongoing abnormal EXTERNAL losses e.g. diarrhoea, fever

28
Q

Redistribution fluids

A

Some patients have abnormal INTERNAL fluid redistribution or abnormal fluid handling, particularly with sepsis, or major illness, cardiac, liver or renal disease e.g. tissue oedema, GI tract/ thoracic / peritoneal collection

29
Q

What are the features of dextrose?

A
  • Total body water
  • Moves through all compartments (not useful in blood volume expansion)
  • Zero sodium load, isotonic
30
Q

What is dextrose not useful in?

A
  • Resuscitation

- Low albumin

31
Q

What is dextrose useful in?

A
  • Chronic dehydration

- Hypernatraemia

32
Q

What are the features of crystalloids?

A
  • Utilitarian, come in various combinations
  • Remain in ECF
  • Usually high Na load- can cause problems over time
33
Q

What are crystalloids useful in?

A
  • Acute dehydration
  • AKI
  • Resuscitation
34
Q

What are crystalloids not useful in?

A
  • Long term maintenance

- Hypernatraemic patients

35
Q

What are the features of plasma expanders?

A
  • Colloid, stays exclusively in IVS
  • Trials show no better than crystalloid in resuscitation
  • IV Albumin sometimes used in Cirrhosis
  • Remember Blood and TPN are also colloids
36
Q

What are plasma expanders useful in?

A
  • Liver patients

- Select intra-operative

37
Q

What are plasma expanders not useful in?

A

Everything else really

Systems: Specialities AB (19 decks)

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