week 7-fluid Flashcards
what are the fluid intakes in the body ?
• Intake ▫ Fluids 1500mL ▫ Food 800mL ▫ Metabolism 300mL
what is the fluid outputs i the body?
• Output ▫ Urine 1500mL ▫ Stools 200mL ▫ Insensible losses (e.g. Skin, lungs) 900mL
what is the normal daily requirment?
25-30mL/kg/day
what can/t pass through cell memranes?
large colloid substances and proteins, water and small molecues can move through
-needs to be an osmotic graident
what is the hormne that is involved in volume homestatsis?
- Renin Angiotensin System
- Anti Diuretic Hormone
what does Anti Diuretic Hormone do?
▫ Increase thirst
▫ Reduce renal excretion of water
what does Renin Angiotensin System do?
▫ Activated by falling renal perfusion
▫ Increase aldosterone → increase sodium and
water retention
when do you need to decreased fluid requirements?
- Renal impairment
- Hepatic impairment
- Cardiac failure (increase pressure in the brain)
- Head injury
when do you need increased fluid requirements?
- Vomiting/Diarrhoea
- High output stoma
- Fistulas
- Burns
when would a paiten need fluid?
• Correct acute losses or maintain homeostasis ▫ Blood volume ▫ Fluid levels ▫ Organ perfusion and function • Prolonged failure of oral intake • Excessive losses • NBM • Special case patients – burns, brain injury, children
what can occur if fluid intake goes wrong?
➢Electrolyte imbalance ➢Peripheral oedema ➢Pulmonary oedema ➢Renal impairment ➢Acid/base disturbance
what are some clnical observations for the need of clinical observation?
Observation Fluid depletion Fluid Overload Weight Loss Gain Blood Pressure Lowered BP Normal or raised Respiratory Rapid, shallow Rapid, moist cough Pulse Rapid, weak Rapid Urine Output Reduced, concentrated Increased or decreased Skin Dry, less elastic Oedematous Thirst Present No disturbance Temperature May be raised No disturbance
what are some signs that can be identified for patients needing fluids?
▫ Thirst ▫ Reduced skin turgor (elasticity) ▫ Dry mucous membranes ▫ Increased capillary refill time ▫ Altered level of consciousness ▫ Tachycardia ▫ Concentrated urine
what are the different types of fluid?
- Crystalloids
- Colloids
- Blood
what are the advanatges of Crystalloids?
• Maintain osmotic gradient • Widely available • Low risk of ADR’s • Inexpensive
what are the advatages of colloids?
• Smaller volumes (1L considered equivalent to 3L of crystalloid) • Faster to give • Longer half life • Starches can reduce capillary leaks into interstitial space
what are the disadvantages of crystalloids?
• Poor in maintaining
oncotic pressure
• Short half life
why cant you just give water to patient who needs fluid
not hypotonic
-will hurt
what are the disadvantages of collids?
• Maximum volume per
day
• ADRs
• Expensive
what are some examples of crystalloids?
Solutions of small molecules in water e.g. ions (Na+ and Cl- ) and/or glucose ▫ 0.9% Sodium chloride ▫ 5% Glucose ▫ Dextrose-saline ▫ Hartmann’s
what are some examples of colliods?
• Dispersions of large organic molecules in a carrier solution ▫ Albumin ▫ Dextran ▫ Gelatin
what are some complications
- Heart failure (excess preload)
- Acute respiratory distress syndrome
- Biochemical abnormalities
- Allergic reactions
- Haemodilution
- Dilutional coagulopathy
- Renal impairment
what does NICE divide intravenous fluid therapy for people ?
- Resuscitation
- Routine maintenance
- Replacement
- Redistribution
- Reassessment
what is the routine maintencance for fluids?
• 25-30ml/kg/day fluid (max 2.5L – use IBW if
obese)
• Up to 1mmol/kg/day K+/Na+
/Cl-
• 50-100g/day glucose
• E.g. 4% Glucose/0.18% Sodium Chloride +
20mmol potassium chloride 500ml over 8hrs x 2
how are Peripheral Venous Access administered?
• Fore arm • Back of hand • Small vein • Short to mid-term length of use
how are centeral venousaccess administered?
• IV therapy > 10 days
•
• Poor peripheral access
