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Y3 Lecture weeks > IV fluids > Flashcards

IV fluids Flashcards

1
Q

Fluid distribution among bod compartments

A

67% intracellular

33% extraellular

*Intravascular is only 6% of the whole body compartment

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2
Q

Routine maintenance fluids- how much?

A

25-30 ml/kg/ day

*2-3 L for most people

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3
Q

What’s Na+ requirement a day?

A

1-2 mmol/day

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4
Q

What’s K+ requirement/day ?

A

1 mmol/day

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5
Q

What’s Cl- requirement per day?

A

1-1.5 mmol/day

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6
Q

What conditions require more fluids?

A
  • vomiting
  • diarrhoea
  • diuresis
  • bleeding
  • burns
  • hyperthermia
  • sepsis
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7
Q

Signs of volume depletion (dehydration)

A
  • thirst
  • dry mucous membranes
  • skin turgor
  • sunken eyes
  • capillary refill time
  • weight loss
  • tachycardia
  • hypotension (particularly postural)
  • organ hypoperfusion
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8
Q

What happens in postural hypotension?

A

When a person stands up BP falls too much

*normally BP should increase upon standing

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9
Q

Signs of volume overload

A
  • probable hypertension (possible hypotension)
  • raised JVP
  • weight gain
  • tachycardia
  • oedema (peripheral, pulmonary, ascites)
  • end organ damage
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10
Q

What is the best method to give fluids to the patient?

A

always aim for oral - the ideal way

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11
Q

What are crystalloids composed of?

A

Solutions of water + electrolytes

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12
Q

Can crystalloids move across semi-permeable membrane?

A

They can cross semi-permeable membrane -> can move between fluid compartments quickly/freely

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13
Q

Examples (3) of crystalloid fluids

A
  • dextrose
  • saline
  • Ringer’s Lactate (Hartmann’s)
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14
Q

What are properties of normal saline?

A

Normal saline = 0.9%

Components: Cl-, Na+ and water

  • cheapest and most commonly used
  • used in fluid resuscitation
  • replaces Na+ and Cl-
  • only small proportion remains intravascularly (it moves the compartments)
  • no calorie content
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15
Q

Dextrose

  • components
  • use of 5%
  • use of 70%
  • use
  • caution
A

Dextrose = sugar + water

  • 5% and 10% used commonly
  • 50% and 70% - used only in ITU (given through central line due to irritation to small peripheral veins)
  • used for maintenance fluids (not for resuscitation) *unless in hypoglycaemic episode
  • caution: Diabetes Mellitus
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16
Q

Ringer’s Lactate (aka Hartmann’s)

  • components
  • what are the advantages
A
  • Na + 130 mmol/l
  • Cl - 109 mmol/l
  • K+ 4 mmol/l
  • Ca 1.5 mmol/l
  • lactate

These are physiological and isotonic

17
Q

Colloids

  • components
  • do they cross semi-permeable membrane
  • effect on plasma
A

Colloids

  • Components: high molecular weight molecules
  • These are less able to cross semi- permeable membrane
  • They exert oncotic pressure -> fluid is pulled into the veins -> plasma expansion
18
Q

What are colloids useful in?

A

Colloids are useful in resuscitation when we try to raise BP

They exert oncotic pressure -> fluid is pulled into the veins -> plasma expansion

19
Q

Gelatins

  • most commonly used
  • composition
  • risk
  • use
A

Gelatins

Most common: Gelofusine

Composition: bovine collagen, sodium and chloride (densly packed molecules)

Risk: anaphylaxis, bleeding risk, prothrombotic

Use: peri-arrest situation, very unwell + hypotension -> to increase BP

20
Q

Examples of colloids

A
  • gelatin
  • hydroxyethyl starches

*these are plasma expanders

21
Q

Hydroxyethyl starches

  • what they are
A

Hydroxyethyl starches -> colloids

  • very large, semi-synthetic molecules - similar to glycogen
  • they have large molecules = oncotic pressure -> can pull fluids intra vascularly

Use: fluid resuscitation, to replace intravascular volume

*usually used in critically ill patient/ ITU

22
Q

Adverse effects of use of Hydroxyethyl starches

A
  • accumulation in interstitial spaces -> deposits in peripheral tissues (large molecules) -> pruritis / irritation of the skin
  • coagulation problems
  • anaphylaxis
  • possible cause of renal impairment
23
Q

What’s the best fluid to administer if someone is bleeding?

A

blood

24
Q

When to use human albumin solution?

A

In a person with very low albumin

This may be due to: liver failure, nephrotic syndrome if we want to increase the albumin and therefore BP

*but we treat the cause usually

25
Q

When do we use Fresh Frozen plasma, cryoprecipitate?

A

FFP, cryoprecipitate = clotting factors

  • bleeding
  • DIC
  • OD of direct oral anticoagulants
26
Q

What’s the aim of fluid resuscitation?

A

To keep fluid intravenously (in intravascular space)

27
Q

What is usually given for fluid resuscitation in sepsis?

A

Hartmann’s or normal Saline (0.9%)

28
Q

In fluid resuscitation, can we use colloids on their own?

A

No, we use colloids in conjunction with crystalloids

29
Q

Do fluids require a prescription?

A

Yes! Just like any other drugs

Include on prescription:

  • type of fluid
  • volume to be administrated
  • time and date to start
  • rate of fluid administration
30
Q

What IV fluid management plan should include details of?

A

*that is according NICE guidelines, but rarely happens in reality

  • fluid and electrolyte prescription over the next 24 hours
  • assessment and monitoring plan
  • assessment of risks, benefits and harms of IV fluids
31
Q

Potential complications of fluid mismanagement

A
  • hypovolaemia (before fluid administration)
  • pulmonary oedema
  • hyponatraemia
  • hypernatraemia
  • peripheral oedema
  • hyperkalaemia
  • hypokalaemia
32
Q

What daily assessments (monitoring) are required if the patient is continuing to receive IV fluids?

A
  • clinical fluid status
  • laboratory values (haem, urea, creatinine, electrolytes)
  • fluid balance charts
  • twice weekly weight measurement

*long term IV fluid therapy - may require less monitoring but must be specified in IV fluid management plan

33
Q

What monitoring is required in patients receiving IV fluids containing Cl >120 mmol/l?

A

Daily chloride bloods

34
Q

NICE guidelines for Resuscitation

A
  • ABCDE
  • identify cause of the deficit
  • give bolus of 500 ml of crystalloid
  • reassess patient: further bolus of 250-500 mls crystalloid, expert help, continuous reassessment and ABCDE
35
Q

Can tetrastarch be used for fluid resuscitation?

A

NO !!!

36
Q

When to consider resuscitation with human albumin?

A

Only in patients with severe sepsis (resuscitation with human albumin 4-5%)

Y3 Lecture weeks (65 decks)

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