Prescribing IV Fluids/ Blood Products Flashcards
Clinical approach to fluids?
1A and 5Rs
Assessment
Resuscitation
Routine maintenance
Replacement
Redistribution
Reeassessment
If resuscitating then use?
Crystalloid (0.9% Na)- bolus of 500ml over less than 15 minutes
If older or HF or frail -250ml
Involve HDU/ITU if given 2L, no response
What to give for routine maintenance?
25-30 ml/kg/day of water + 1mmol/kg/day of potassium/sodium chloride + 50-100 g/day of glucose to limit starvation ketosis
20-25ml/kg/day- for older or frail, renal impairment or cardiac failure, malnourished, risk of reseeding syndrome
Redistribution for?
Gross oedema, severe sepsis, hypo/hyper Na, hypo/hyperK, renal liver and cardiac impairment, post op fluid retention, malnourished and refeeding issues
Hypokalaemia on ECG, severe?
U waves and inverted T waves
Which drugs can cause high K?
ACE i, spironolactone
What does high K cause?
Broad QRS complexes
Treatment of hyperkalaemia?
ECG changes- 30ml of 10% calcium gluconate over 15 mins
Insulin/glucose IV infusion
How does insulin lowers K?
Drives it into cells
Other methods of lowering K?
Salbutamol nebuliser
Calcium reasoning, sodium zirconium,
Haemodialysis
Treatment of hypercalcaemia?
Most common reasons: malignancy, hyperparathyroidism
IVI 0.9% sodium chloride/ furosemide (older patient)
IV bisphosphonates take up to 8 hours (zolendronic acid/ pamidronate)
Steroids, calcimemtics, denosumab, haemodialysis
Treatment of severe hypocalcaemia?
10ml of 10% calcium chloride IV over 15 minutes ( with ECG changes)
Alfacalcidol (if vit D low)
replace Mg ( if low)
Why is Mg needed?
For PTH production and secretion
Red cells should be infused over?
1-2 hours
Platelets should be infused over?
30-60 mintues
