VIVA: Pharmacology - Fluids

Question 1

Give an example of a preparation of calcium that is taken orally

Answer 1

1 needed to pass:
- Calcium carbonate
- Calcium acetate
- Calcium citrate
- Calcium glubionate
- Calcium gluconate
- Calcium lactate
- Calcium phosphate

Question 2

What are the possible uses of oral calcium preparations?

Answer 2

Treatment of hypocalcaemia* (e.g. in patients with primary hypoparathyroidism, vitamin D deficiency, chronic renal disease or malabsorption)
As an antacid

• needed to pass

Question 3

What are the potential adverse effects of giving calcium intravenously?

Answer 3

Irritation of the veins (chemical phlebitis*)
Cardiac arrhythmias with rapid administration
Hypercalcaemia

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Question 4

How does Hartmann’s solution differ from normal saline?

Answer 4

Addition of sodium lactate*, potassium chloride *, and calcium chloride *
pH adjustment
Na 130 *, K 5.4 *, Cl 112, Ca 1.8 *, lactate/bicarb 28mmol *
Compared with normal saline which is Na 154 Cl 154 *

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Question 5

What are the potential advantages of Hartmann’s solution in resuscitation?

Answer 5

Closer to physiologic values for sodium, potassium, calcium
Less hyperchloraemia *
Effective bicarbonate - some (slow) good effect on acidosis * (proof of superiority lacking)

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Question 6

What are the potential complications of IV fluid therapy?

Answer 6

Overload or under resuscitation
Hypothermia
Extravasation
Acidosis
Electrolyte abnormalities
Osmolality changes
Air embolism
Infection
Cerebral oedema
Haemodilution

Question 7

What are the different classes of IV fluids? Give an example of each

Answer 7

3 examples and 2 classes needed to pass:
1. Colloid (substance evenly dispersed throughout another solution in which it is insoluble)
- Albumin (naturally occurring)
- Dextran (synthetic)
- Gelatin (synthetic)
2. Crystalloid
- Isotonic: 0.9% sodium chloride, Hartmann’s, Plasmalyte
- Hypertonic: 3% or 7.5% sodium chloride
- Hypotonic: 0.45% sodium chloride, dextrose (5% or 10%)
3. Blood and blood products

Question 8

What are the complications of crystalloid fluid therapy?

Answer 8

3 needed to pass:
- Acute pulmonary oedema
- Cerebral oedema (particularly with correction of hypernatraemia)
- Tissue oedema, limb and abdominal compartment syndromes
- Under-resuscitation
- Hypothermia
- Dilutional coagulopathy
- Acidosis
- Electrolyte abnormalities and osmolality changes
- Haemodilution
- Extravasation
- Air embolism
- Infection

Question 9

What are the indications for the use of magnesium in pregnancy?

Answer 9

Indicated in pre-eclampsia* and eclampsia* for the prevention and treatment of life-threatening seizures*

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Question 10

What are the other uses of magnesium in emergency medicine (besides for pre-eclampsia and eclampsia)?

Answer 10

Anti-convulsant effect*
Possible anti-arrhythmic effect*
Bronchodilator effect*
Influences Na+/K+ ATPase, Na+ channels, and certain K+ and Ca2+ channels

• 2/3 needed to pass

Question 11

What are the toxic effects of magnesium?

Answer 11

Signs and symptoms of hypermagnesaemia include (3 needed to pass):
- Nausea and vomiting
- Flushing
- Hypotension
- Muscle weakness and paralysis
- Loss of reflexes
- CNS depression
- Blurred or double vision
- Respiratory depression
- Renal failure
- Cardiac arrhythmia