Prescribing Flashcards
How much Na, K and Cl do we lose daily normal?
1mmol/kg/day
How much glucose do we normally lose a day?
100g/day
What fluid contains both NaCl and glucose?
Dextrose salin - 0.18% NaCl, 4% glucose
What fluid does NICE recommend for maintenance?
Dextro-saline
30mmol Na, Cl and 4g/100ml dextrose
What does Hartmans include?
Na, K, Ca, Cl, HCO3, lactate
Osmotically closer to blood than NaCl, why sometimes preferred in resus situation
What to assess when redistributing fluids?
Fluid status and U+Es
What is fluid balance?
Fluid balance is the measuring of a patient’s fluid input and output and calculating the net difference or balance
What happens when give too much ‘normal’ saline
Hypernatremia
Cl excess → metabolic acidosis, ileus, impaired eGFR
What level is a patient hypokalemic?
K < 3.5
Symptoms of hypokalemai
Letahrgy weakness, leg cramps
Rhabdomyolysis, respiratory difficuklties
What is the maximum safe IV replacement for hypokalemia? What other levels need chcking?
20mmol/hr + cardiac monitoring
Mosyt wards not comfortable@ more than 10 per hour
Check magnesium
How to prevent hypernatremia when giving fluids?
Give with potassium and glucose
Hypokalemia on ECG
U waves mostly due to severe hypokalaemia or profound bradycardia; U waves amplitude increases as bradycardia worsens
TWI with U wave
Not everyone with hypokalemia will have ECG changes
Which specific treatment is given for varcieal bleeds?
Telepressin 2mg IV
What is telepressin given for and why?
Varcieal bleeds
Its a splanchic vasoconstrictor - reduces portal pressure but increases systemic BP
