Practical Fluid Prescribing

Question 1

What are the 3 indications for fluids?

Answer 1

Maintenance
Replacement
- Pre-existing (dehydration, AKI)
- Ongoing (Obstruction, surgical drains, D+V)
Resuscitation

Question 2

What are the general requirements for fluid products

Answer 2

1mmol/kg/day potassium, sodium and chloride
25-30ml/kg/day water
50-100g/day glucose

Question 3

What do you do if both maintenance and replacement are needed?

Answer 3

Combine the two requirements (eg maintenance + losses)

Question 4

What are the cautions for potassium administration

Answer 4

NO MORE THAN 10MMOL/HR (eg 40mmol/1l bag over 4 or more hours)
Reduce in <30 eGFR

https://www.nice.org.uk/guidance/cg174

Question 5

Reference: Common Fluid types

Answer 5

Question 6

What are the indications for resuscitation fluids

Answer 6

Question 7

What is the maximum alteration of sodium in 24 hours

Answer 7

10mmol reduction (risks cererbal oedema)

Question 8

How is fluid overload managed?

Answer 8

Stop and restrict fluids by 500ml
Furosemide oral/IV
+Nitrates, CPAP