IV fluids

Question 1

what kind of IV fluid is used for resuscitation?

Answer 1

crystalloid

Question 2

what kind of IV fluid is given to a patient if they are hypernatraemic?

Answer 2

dextrose

Question 3

what kind of IV fluid is given to a patient if they have chronic dehydration?

Answer 3

dextrose

Question 4

what kind of IV fluid is given if a patient is hyponatraemic?

Answer 4

crystalloid

Question 5

what’s the difference between dextrose and crystalloid fluids?

Answer 5

dextrose is isotonic therefore only used for maintenance or to correct low fluid status with normal electrolyte status
crystalloid is hypertonic as it has a high Na concentration and stays in the ECF therefore used for electrolyte deficits / resuscitation

Question 6

in what patients would plasma expanders IV fluid be used ?

Answer 6

patients with liver disease

it has a high album content

Question 7

what are the main questions you have to ask if you think the patient requires fluid?

Answer 7

what is my patients fluid status?
does my patient need fluid?
how much fluid do they need?
what type of fluid do they need?

Question 8

what is the presentation of a patient who is hypovalaemic?

Answer 8

pale 
no sweat 
tachycardia
hypotension 
tachypnoea 
oligouria 
flat veins 
nausea

Question 9

what is the presentation of a patient who is hypervalaemic?

Answer 9

sweat
tachycardia
hypertension 
tachypnoea 
veins distended 
warm and oedematous extremities
thirsty  
dilute urine (could also be oliguria/polyuric)

Question 10

what mechanism of fluids would you give if someone was hypovolaemic ?

Answer 10

resuscitation

rehydration fluid

Question 11

what treatment would you give if someone was hypervolaemic?

Answer 11

no fluids
diuretics if respect compromise
harm-filtration if septic

Question 12

what is the difference between osmolarity and osmolality?

Answer 12

osmolarity is the solute concentration per unit volume of solvent

osmolality is the solute concentration per mass of solvent

Question 13

what is tonicity?

Answer 13

measure of the osmotic pressure gradient between 2 solutes

Question 14

what are the 5 R’s when prescribing fluids?

Answer 14

resuscitation 
routine maintenance 
redistribution  
replacement 
reassessment

Question 15

what are clinical findings suggestive of hypervolaemia?

Answer 15

Breathing (B);
tachypnoea - RR >20
decreased oxygen saturations
bilateral lung crackles on auscultation

circulation (C);
hypertension
elevated JVP

Exposure (E);
increased urine output
weight gain
peripheral oedema

Question 16

what are clinical findings suggestive of hypovolaemia?

Answer 16

Breathing (B);
tachycardia
decreased oxygen saturations

Circulation (C);
hypotension
tachycardia 
non-visible JVP 
prolonged cap refill time 

Exposure (E);
increased losses from wounds and/or drains
decreased urine output <30ml/hr
sources of abnormal fluid loss i.e. diarrhoea, vomiting, rectal bleeding
weight loss

Question 17

what are the two main types of fluids used?

Answer 17

crystalloids - small particles

colloid - larger particles

Question 18

what are the risks associated with colloids?

Answer 18

risk of anaphylaxis

Question 19

when prescribing routine maintenance fluids, what are the daily fluid requirements?

Answer 19

1 mmol/kg sodium
1 mmol/kg potassium
25-30ml/kg water
50-100g glucose

Question 20

after what length of time does a patient require nasogastric fluids or enteral feeding for routine maintenance ?

Answer 20

when fluid maintenance it is required for more than 3 days

Question 21

give example of sources of abnormal fluid and electrolyte losses.

Answer 21

vomiting 
diarrhoea 
stoma output loss
wounds 
blood loss - malena, haematemesis 
urinary loss e.g. diabetes 
billiard drainage loss 
dehydration, sweating, fever

Question 22

give example of patients who have problems with fluid distribution and other complex issues.

Answer 22

gross oedema 
liver, renal or heart failure 
severe sepsis 
hyponatraemia/ hypernatraemia 
post op fluid retention or redistribution 
malnutrition and re-feeding syndrome