IV Fluids

Question 1

Reasons

Answer 1

Resuscitation
Maintenance
Replacement

Question 2

What are insensible losses?

Answer 2

Losses from non-urine sources are termed insensible losses; insensible losses will rise in unwell patients, who may be febrile, tachypnoeic, or having increased bowel output. These factors should be taken into account when deciding how much fluid a patients needs replacing.

Question 3

What happens in terms of insensible losses when a patient gets better?

Answer 3

vascular permeability returns to baseline state.

Question 4

How to assess fluid status?

Answer 4

Dry mucous membranes and reduced skin turgor
Decreasing urine output (should target >0.5 ml/kg/hr)
Orthostatic hypotension
In worsening stages: Increased capillary refill time
Tachycardia
Low blood pressure

Raised JVP
Peripheral or sacral oedema
Pulmonary oedema

Question 5

Monitoring fluid status

Answer 5

fluid input-output chart and daily weight chart

Us and Es

Question 6

Daily electrolyte requirements

Answer 6

Water: 25 mL/kg/day
Na+: 1.0 mmol/kg/day
K+: 1.0 mmol/kg/day
Glucose: 50g/day

Question 7

Fluid Challenge

Answer 7

The fluid challenge should be either 250ml or 500ml over 15-30mins, depending on the patient’s size and co-morbidities.

Question 8

What are third space losses?

Answer 8

Third-space losses refer to fluid losses into spaces that are not visible, such as the bowel lumen (in bowel obstruction) or the retroperitoneum (as in pancreatitis).

Question 9

Electrolyte imbalances

Answer 9

dehydration (­high urea:creatinine ratio and high ­PCV), vomiting (low K+, low Cl–, and alkalosis), or diarrhoea (low K+ and acidosis)

Question 10

Crystalloids vs colloids

Answer 10

Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules.
(most fluids Hartmanns, Saline, dextrose)
Colloids contain larger insoluble molecules, such as gelatin; blood itself is a colloid
(most common albumin and blood)