Sepsis and IV fluids Flashcards
What is the NaCl content and pH of 0.9% NaCl?
154mmol/L
pH 4.5
What is the daily sodium intake requirement?
1mmol/kg
What is the primary determinant of water distribution?
Osmotic pressure
What is the primary determinant of extracellular volume?
Sodium
What are a persons daily electrolyte requirements?
Na: 50-100mmol
K: 40-80mmol
1.5-2.5L of water
What is true hypovolaemia?
When the rate of fluid loss of extra-cellular fluid exceeds net intake.
What is relative hypovolaemia?
Where there is a decrease in the effective circulating volume - eg sepsis
What would you see in hypovolaemia?
Cap refil - >2secs Skin turgor - increased Pulse - increased BP - low/postural drop JVP - not visible Urine output - reduced Weight - decreased Lung fields - clear
What would you see in hypervolaemia?
Cap refil - normal Skin turgor - normal Pulse - normal BP - low/normal/raised JVP - elevated Urine output - normal/reduced Weight - increased Lung fields - crackles Pitting oedema
What are crystalloids?
Water to which solutes have been added
Low sodium fluids disperse throughout intracellular and extracellular compartment
5% dextrose
Sodium containing fluids disseminate into extracellular compartment as cell membrane pumps remove sodium from the intracellular compartment.
eg saline & 5% dextrose or ‘balanced’: Hartmann’s & Ringer’s(lactate).
What are colloids?
Fluids that contain large proteins or other similarly sized molecules
These solutes are too big to cross capillary walls and therefore stay in the intravascular space for a longer period of time
Useful for increasing intravascular volume
Can be synthetic often using gelatin
Large volumes without free water can cause a hyperoncotic state
What is the sepsis mnemonic?
BUFALO - Blood cultures, Urine output, U&E, culture, Fluid resuscitation, antibiotics IV, Lactate and Oxygen
