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Anaesthetics > Use of IV Fluids > Flashcards

Use of IV Fluids Flashcards

1
Q

Total body water is what percentage of body mass?

A

60%

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2
Q

What are the 2 compartments TBW is split into?

A
  • ICF
    • 2/3 of total water
  • ECF
    • 1/3 of total water
    • Composed of interstitial fluid (ISF, 80%) and plasma (20%)
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3
Q

What is ECF composed of?

A
  • Composed of interstitial fluid (ISF, 80%) and plasma (20%)
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4
Q

What is osmosis?

A

Osmosis = water diffuses from diluted solution to concentrated solution through a semi-permeable membrane

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5
Q

How is osmosis prevented?

A

Can prevent osmosis by applying pressure to concentrated solution – osmotic pressure:

  • The more particles in solution the higher the rate of osmosis and therefore the osmotic pressure
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6
Q

Through a permeable barrier, high concentration solution on one side and diluted on the other, where does water move?

A

From diluted solution to concentrated solution

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7
Q

Describe the difference between osmolality and osmolarity?

A
  • Osmolality = number of osmoles of solute/kg
  • Osmolarity = number of osmoles solute/litre
  • 1 osmole = 6.02 x 1023 particles
  • Body fluids measured in mOsm/kg
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8
Q

Body fluid osmolarity is measured in what?

A

mOsm/kg

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9
Q

How many particles are in 1 osmole?

A
  • 1 osmole = 6.02 x 1023 particles
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10
Q

What is normal plasma osmolarity?

A

298mOsml/L

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11
Q

What are the dailty requirements of:

  • water
  • sodium
  • potassium
  • magnesium
  • calcium
  • phosphorus
  • glucose
  • energy
  • protein
A
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12
Q

What is tonicity?

A

Tonicity = effective osmolarity

  • Only particles restricted to one of the compartments will determine water distribution
  • Particles that move freely will not influence water distribution
  • Hypertonic solution – causes water to leave cell and cell to shrink
  • Hypotonic solution – causes water to enter cell and cell to swell
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13
Q

Who do hypertonic and hypotonic solutions cause RBC to do?

A
  • Hypertonic solution – causes water to leave cell and cell to shrink
  • Hypotonic solution – causes water to enter cell and cell to swell
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14
Q

Na and K are greater in ECF or ICF?

A
  • Na is greater in ECF than ICF
  • K is greater in ICF than ECF
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15
Q

What are some symptoms of tonicity change?

A
  • Largely neurological
  • Swelling
    • Raised ICP, compromised CBF, herniation
  • Shrinkage
    • ICH venous sinuous thrombosis
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16
Q

What are different fluid types?

A
  • 0.9% NaCl – 100/250/500/1000ml
  • 0.9% NaCl/0.15% KCl
  • 0.9% NaCl/0.3% KCl
  • 0.9% NaCl/5% glucose
  • Hartmann’s solution
  • 5% glucose
  • 5% glucose/0.15% KCl
  • 5% glucose/0.3% KCl
  • 0.18%NaCl/4% glucose
  • 0.18%NaCl/4% glucose/0.15%KCl
  • 0.45%NaCl/5% glucose/0.15%KCl
  • Geloplasma
  • Isoplex
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17
Q

What should never be given for resuscitation?

A

Different fluids distribute in the body in different ways due to composition:

  • DO NOT give 5% glucose to resuscitate
    • Need fluid in intervascular space which this will not do
18
Q

What are the different categories of IV fluid types?

A
  • Crystalloids
    • Aqueous solutions that are soluble in water
  • Colloids
    • Insoluble in water, larger molecules
19
Q

What are crystalloids and colloids?

A
  • Crystalloids
    • Aqueous solutions that are soluble in water
  • Colloids
    • Insoluble in water, larger molecules
20
Q

What are examples of crystalloids and colloids?

A
21
Q

What are possible side effects of colloids?

A
  • Anaphylaxis
  • Coagulopathy
  • Renal failure
  • Rheology
22
Q

What are possible side effects of crystalloids?

A
  • ECF expansion
  • Oedema/increased vascular pressure
23
Q

What are sensible and insensible losses?

A
24
Q

What are examples of sensible losses and the typical values per day?

A
25
Q

What are examples of insensible losses and the typical values per day?

A
26
Q

What are some methods of measuring body fluid?

A
  • Clinical assessment (used most often)
    • ABCD assessment, history (thirst, abnormal losses), examination (pulse, BP, capillary refill, JVP, oedema, postural hypotension), clinical monitoring (NEWS, fluid balance charts, weight) and lab assessments (FBC, urea, creatinine and electrolytes)
  • Oesophageal Doppler
  • Pulmonary artery catheter
  • IVC collapsibility
  • Minimally invasive CO monitors
27
Q

Describe a fluid chart?

A
  • 24 hour chart
  • Patient weight
  • Guidance
    • Structured framework to support prescribing
    • 4 questions
      • Assess patient – hypovolaemic, auvolaemic or hypervolaemic
      • Why give fluid – maintanence, replacement or resuscitation
      • How much
      • Which fluid
28
Q

What aspects of the history are important for assessing body fluid?

A
  • Thirst
  • Abnormal losses
29
Q

What aspects of examination are important for assessing body fluid?

A
  • Pulse
  • BP
  • Capillary refill
  • JVP
  • Oedema
  • Postural hypotension
30
Q

What lab assessments are useful for assessing body fluid?

A
  • FBC
  • Urea
  • Creatinine
  • Electrolytes
31
Q

What clinical monitoring is useful for assessing body fluid?

A
  • NEWS chart
  • Fluid balance charts
  • Weight
32
Q

How much fluid should be given for maintanence?

A
  • 30ml/kg/24 hours (20-25 in frail and elderly)
33
Q

For maintanence, should never give more than x ml/hour?

A

100ml/hour due to risk of hyponatraemia

34
Q

How is all IV maintanence administered?

A
  • All IV maintenance given in ml/hour via volumetric pump
35
Q

What fluid is best to use for maintenance?

A
  • 0.18% NaCl/4% glucose/0.3% KCl (40mmol/l KCl)
    • Contraindications – K>=5 then use 0.18% NaCl/4% glucose
36
Q

How much fluid should be given for replacement?

A
  • Add up losses in last 24 hours and give volume back
    • Such as bleeding, D and V, drain output, fistulae
37
Q

What fluid should be given for replacement?

A
  • Plamalyte 148
    • Administration – gravity giving set or volumetric pump
    • Contraindications – upper GI loses use 0.9% NaCl with KCl
38
Q

For plamalyte 148:

  • administration
  • contraindications
A
  • Administration – gravity giving set or volumetric pump
  • Contraindications – upper GI loses use 0.9% NaCl with KCl
39
Q

How much fluid should be given for resuscitation?

A
  • For severe dehydration, sepsis or haemorrhage leading to hypovolaemia and hypotension
    • Fluid challenge 250-500ml over 5-15 mins and reassess
  • Use fluid challenge algorithm
40
Q

What fluid should be used for resuscitation?

A
  • PlasmaLyte 148/colloid/blood

Anaesthetics (6 decks)

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