IV fluids Flashcards

1
Q

What are the 4 questions we have to ask when prescribing fluid?

A

1) What is my patient’s fluid status?
2) Do they need IV fluid?
3) How much fluid?
4) What type of fluid?

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2
Q

What do we look at when assessing fluid status?

A
  • Airway e.g. on a ventilator
  • Breathing (signs of pulm oedema)
  • Circ (signs of fluid overload e.g. raised JVP)
  • Disability
  • Extremities (skin turgor, temp & mucous membranes)

Also vitals e.g. HR & BP

Urine

Sweat

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3
Q

How do we recognise hypovolaemia?

A
  • Thirsty
  • Flat veins
  • Cool peripheries
  • Not sweating
  • Low or postural BP (maybe dizzy)
  • Tachycardic
  • Concentrate oliguria
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4
Q

What are the signs of hypervolaemia?

A
  • Breathless
  • Distended veins
  • warm, oedematous extremeties
  • Sweating
  • High BP & HR
  • Dilute polyuria
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5
Q

Be aware”

A

A patient may have signs of hyper or hypovolaemia for a different reason
E.g. just because a patient has pulm oedema doesn’t mean they’re fluid overloaded
Also a euvolaemic or hypervolaemic patient could have cold fingers as well

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6
Q

What are the different types of fluids in terms of purpose?

A

Resuscitative (very rapid bolus for shock patients)
Routine maintenance (Saline for patient’s who can’t drink)
Replacement (fluid tailored to replace electrolytes)

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7
Q

How do we determine how much fluid they need?

A

Work out the water deficit from intake and output:

  • Input chart
  • Catheters & Drains
  • Vomit bowels & sputum pots
  • Stool charts & stoma losses
  • Estimate insensible losses e.g. sweat, ventilation, wounds, burn an bleeding
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8
Q

What are the different physical types of fluids?

A

Dextrose
Crystalloids e.g. normal saline or hartmann’s
Plasma expanders

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9
Q

What is dextrose used for?

A
Chronically dehydrated (need fluid that moves into other compartments)
Hypernatraemic patients (can't have crystalloids)
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10
Q

What are crystalloids used for?

A

Acute dehdyration, AKI & Resus.

It’s good for restoring fluid/blood volume because it remains in the ECF

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11
Q

What do we use plasma expanders for?

A

Shown to be no better than crystalloids for resus but can be useful with blood for haemorrhage

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12
Q

Difference between diffusion & osmosis?

A

Diffusion is when solute moves through a permeable membrane from high to low conc.

Osmosis is when water moves through a solute impermeable membrane from high to low conc

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13
Q

Difference between osmolarity and osmolality?

A

Osmolarity = solute conc per unit volume of solvent

Osmolality = Solute conc per unit mass of solvent

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14
Q

Difference between osmolarity and tonicity?

A

Osmolarity takes into account all solutes in the solvent including ones that can cross the membrane and so don’t apply osmotic pressure

Tonicity is only a measure of those solutes that can’t cross the SPM so exert osmotic pressure, ergo its a measure of osmotic pressure

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