Post-op fluids

Question 1

‘Additional losses’ in the surgical patient are also very important, e.g. from ?? tubes, ?, ?, third space losses etc.

The ‘third space’ in the body is cavities where fluid does not normally collect and is not readily ?, e.g. the ? tract, ?, and ?.

Answer 1

NG
drains
stomas
exchangeable
GI
peritoneum
pleura

Question 2

As the patients in hospital are ill, we usually estimate that the average adult
will require ?L /day.
- Sodium (?mmol/kg/day) and Potassium (?mmol/kg/day) are also lost and
require replacing (generally around ?mmol of potassium and ?mmol of
sodium per day).

Answer 2

3
2
1
60
100

Question 3

On the wards, a ‘1 ? 2 ?’ regimen is commonly used for adult patients with no significant comorbidity;
o lL ? with ?mmol ? over 8h.
o lL ? with ?mmol ? over 8h.
o lL ? with ?mmol ? over 8h.
ALWAYS check ? before prescribing any fluids.

Answer 3

salty sweet
saline 20 kcl
5% dextrose 20 kcl
5% dextrose 20 kcl
u+E's

Question 4

For more precise estimation of maintenance fluids, the Alder-Hey paediatric regimen can be safely used in all ages and body weights;

?ml/kg/day for first ?kg (?ml/kg/hr).
?ml/kg/day for second ?kg (?ml/kg/hr).
?ml/kg/day for third/remaining ?kg (?ml/kg/hr).

NICE guidance suggests that ?ml/kg/day is also an acceptable volume.

Answer 4

100, 10, 4
50, 10, 2
25, 10, 1

30

Question 5

Generally patients with ? require more fluids, with a general rule being to add ?% for each degree of ?.
If a patient can resume ? intake ?h post-operatively, ? fluids are routinely
required.

Answer 5

pyrexia
10
fever
oral
1-2
no

Question 6

Dehydration

Mild: ?, lack of ?, tiredness.
Moderate: dry ?, decreased ?, ? eyes and ? cramps.
Severe: ?, disorientation, ?, tachypnoea, low ?.

Answer 6

headache
energy
mouth
alertness
sunken
mm
confusion
tachycardia
BP

Question 7

A ? ? ? should always be in place with ?inputs/outputs in patients at risk of dehydration.
Urine output under ?ml/kg/hour suggests dehydration.
Blood results will show raised ?, with disproportionately raised ?

Answer 7

fluid balance chart
hourly
1
E-
urea

Question 8

It is important to be able to assess dehydration in the surgical patient as the stress response to surgery includes release of ?, ? and ? activation, so the patient may be ? but actually be ?.

Answer 8

adh
catecholamines
RAAS
oliguric
euvolaemic