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RB Y2 Renal > Fluid Prescribing > Flashcards

Fluid Prescribing Flashcards

1
Q

5 Rs of fluid prescribing

A
  • resuscitation
  • replacement
  • routine maintenance
  • redsitribution
  • reassessment
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2
Q

name 2 crystalloids

A

sodium chloride 0.9% and Hartmanns solution

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3
Q

what are the benefits of crystalloids

A

cheap and widely available

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4
Q

what does Hartmanns contain

A

crystalloid with added electrolytes eg Potassium

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5
Q

define routine maintenance

A

provide daily maintenance requirements

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6
Q

define replacement

A
  • Provides daily maintenance requirements and replacement of any ongoing abnormal losses
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7
Q

define resuscitation

A
  • Re-establishes haemodynamic stability through restoring intravascular volume
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8
Q

name a colloid

A

Gelofusin

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9
Q

colloids

A

should theoretically maintain onctoic pressure, however in practice they are not very good

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10
Q

what are the negative sides of colloids

A

risk of anaphylaxis

expensive

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11
Q

what solution is recommended for resuscitation

A
  • crystalloid solution
  • balanced crystalloid is good as excessive sodium chloride 0.9% can cause hypercholermic metabolic acidosis
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12
Q

what is hypercholermic metabolic acidosis

A

an acidosis with a normal anion gap, caused by increased chloride and decreased bicarbonate

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13
Q

when is Hartmanns solution avoided

A

in cases of eg rhabdomyolysis and AKI/CKD, when sodium chloride 0.9% is preferred due to the risk of hyperkalaemia (cells die and release phosphate and potassium ions)

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14
Q

what is recommended for replacement therapy

A

balanced/crystalloid

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15
Q

what is the normal daily requirement for water

A

25-30ml/kg/day

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16
Q

what is the normal daily requirement for sodium, potasiuma and chloride

A

1mmol/kg/day

17
Q

what is the normal daily requirement for glucose

A

50-100g/day

18
Q

what fluids are recommended for routine maintenance

A
  • 0.18% Sodium chloride/4% dextrose
  • 0.45% Sodium chloride
  • 5% dextrose
19
Q

what is the max fluid volume given in a day roughly

A

2.4l

20
Q

which fluids redistribute most into the PV

A

balanced/crystalloids

21
Q

when should albumin be used

A
  • severe sepsis
  • hepatorenal syndrome
  • large volume paracentesis
  • therapeutic plasma exchange
22
Q

blood as a colloid

A

it is the most physiological colloid, it increases oxygen carrying capacity

there is a risk of a type II hypersensitivity ABO reaction - overwhelming systemic inflammatory response that can occur with 1ml of blood

23
Q

PRC

A

packed RBCs - indicated when paient has lost a lot of blood or has anaemia

24
Q

FFP and cryoprecipitate

A
  • FFP used when there are low clotting factors or other blood proteins
  • cryoprecipitate is a concentrated subset of FFP components
25
Q

management of hyponatraemia if the patient is dry

A

0.9% saline

26
Q

management of hyponatraemia if the patient is euvolaemic

A
  • consider SIADH - do a paired urine and serum osmolality and urinary electrolytes
  • the RAAS system is still intact, maintaining volumes
27
Q

treatment of SIADH

A

water restriction to ≤1l a day and treat underlying cause

28
Q

management of hyponatraemia if the patient is overloaded

A

water restriction

consider diuretics if there is significant or symptomatic volume overload (eg ascites or pitting oedema)

29
Q

what is the goal of initial therapy in correction of hyponatraemia

A
  • raise the serum sodium concentation by 4-6mg in a 24 hour period
  • in emergency, in a 6 hours period or less
  • maintain sodium constant thereafter
30
Q

what must sodium rise be restricted to in 24 hours

A
  • 9mg/L
  • rapid correction risks osmotic demyelination - widespread demyelination of pontine area
31
Q

which patients are at risk of osmotic demyelination

A
  • those with Sodium serum concentrations ≤105mg/L, and those with hypokalemia, alcoholism, malnutrition and liver disease
32
Q

what is severe hyponatraemia defined as

A

Na <120 mmol/L

33
Q

what is emergency treatment

A

100ml 3% saline over 10-15 minutes

34
Q

which patients are indicated for aggressive therapy to raise sodium ASAP

A
  • severe symptoms due to hyponatraemia eg seizures, obtundation
  • acute hyponatraemia with symptoms
  • hyperacute hypnatramie due to self induced water intoxication, even if there are no symptoms. serum Na may worsen spontaeously due to delayed ingestion of water
  • symptomatic patients with acute post op hyponatraemia or hyponatraemia associated with intracranial pathology
35
Q

what is there a risk of with acute onset hyponatraemia

A
  • cerebral oedema due to osmotically driven water flow across BBB
  • manifest as impaired consciousness, seizures, raised ICP
  • potentially death due to brain herniation
36
Q
A

RB Y2 Renal (26 decks)

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