Fluids

Question 1

How are maintenance fluids prescribed in adults?

Answer 1

Learn:
25-30ml/kg/day of water
1mmol/kg/day of Na+ and K+ (cannot give potassium faster than 10mmol/hr)
50-100g of glucose (5g/100ml)

Question 2

Suggest maintenance fluids for an 80kg man.

Answer 2

25 x 80 = 2000ml (2 litres)
1mmol x 80 = 80mmol (40mmol per bag)
50grams = 1000ml

2 1000ml 5% glucose bags
1 1000ml NaCl bags

Question 3

What should you considered when prescribing maintenance fluids?

Answer 3

Salty then sweet

Question 4

What is the fastest rate you can give potassium?

Answer 4

10mmol/hr

Question 5

Why can you not give potassium fast?

Answer 5

Administration of 80 mEq/h, for example, has been associated with electrocardiogram changes and complete heart block

Question 6

T or F, Always check the magnesium as hypokalaemia will not correct unless magnesium is corrected first

Answer 6

True, Always check the magnesium as hypokalaemia will not correct unless magnesium is corrected first

Question 7

T or F, Patients rarely need more than 3L of fluid per day.

Answer 7

True

Question 8

T or F, Consider reducing fluids in elderly/frail, renal impairment or cardiac failure

Answer 8

True

Question 9

What is the algorithm / Holliday Seger formula for maintenance fluids in young children?

Answer 9

First 10kg = 100ml/kg/24 hrs
Second 10kg = 50ml/kg/24hrs
>20kg = 20ml/kg/24hrs

Question 10

Suggest maintenance fluids for a child of 40kg?

Answer 10

1000
500
400

= 1900ml

Question 11

Suggest how it differs for neonates <28 days.

Answer 11

Birth-day1: 50-60ml/kg/day
day 2: 70-80
day 3: 80-100
day 4: 100-120
day 5: 120-150

Question 12

What is the equation for total fluid replacement?

Answer 12

Fluid deficit + maintenance fluids = total replacement

Question 13

What is the equation for fluid deficit?

Answer 13

%dehydration x weight x 10

Question 14

What is the equation for percentage dehydration?

Answer 14

(well weight-current weight/ well weight) x 100

Question 15

T or F, Fluid resuscitation is required where the child is shocked or haemodynamically compromised. Glucose-free crystalloids (e.g. 0.9% sodium chloride) are used for resuscitation; usually as a stat bolus of 10 mL/kg.

Answer 15

True - glucose free for resuscitation

Question 16

T or F, In infants and children, the oral or nasogastric route for fluids is preferred where possible.

Answer 16

True - oral or NG preferred

Question 17

T or F, replacement fluids = fluid deficit + maintenance fluids?

Answer 17

True

Question 18

T or F, In certain conditions, a smaller resuscitation bolus is used. For example, in neonates, children with cardiac failure, septic shock, diabetic ketoacidosis and major trauma.

Answer 18

True

Question 19

How should 40mmol of potassium be prescribed?

Answer 19

The maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour, whereas rates above 20 mmol/hour require cardiac monitoring