Fluid and Nutrition Management

Question 1

what are the three common reasons for fluids to be prescribed?

Answer 1

resuscitation
maintenance
replacement

Question 2

what is the distribution of fluid between extracellular and intracellular?

Answer 2

extracellular - 1/3

intracellular - 2/3

Question 3

what is the distribution of fluid between the extracellular vascular and interstitial compartments?

Answer 3

vascular - 1/4

interstitial - 3/4

Question 4

what is the absolute distribution of fluid in the vascular compartment?

Answer 4

1/12th or about 8%

Question 5

why is it important that fluid remain in the intravascular compartment?

Answer 5

in order to increase intravascular volume and increase tissue perfusion rate

Question 6

why is it important to give and monitor fluids in a NBM patient?

Answer 6

because majority of our fluid intake is oral and this needs to be replaced

Question 7

what are the signs and symptoms of a dehydrated patient?

Answer 7

• dry mucous membranes
• reduced skin turgor
• low urine output
• hypotension
• tachycardia
• increased capillary refill time

Question 8

what are the signs and symptoms of a fluid overloaded patient?

Answer 8

• raised JVP
• peripheral or sacral oedema
• pulmonary oedema

Question 9

what is the recommended daily water requirement?

Answer 9

25 ml/kg/day

Question 10

what is the recommended daily sodium requirement?

Answer 10

1.0 mmol/kg/day

Question 11

what is the recommended daily potassium requirement?

Answer 11

1.0 mmol/kg/day

Question 12

what is the recommended daily glucose requirement?

Answer 12

50 g/day

Question 13

what are the two kinds of intravenous fluids?

Answer 13

crystalloids and colloids

Question 14

how do colloid fluids work?

Answer 14

they have large proteins in the fluid, increasing the oncotic pressure keeping the fluid in the vascular compartment

Question 15

what are the three common crystalloid fluids?

Answer 15

• 0.9% saline (normal saline)
• 5% dextrose
• Hartmann’s solution

Question 16

what are the contents of normal saline?

Answer 16

water, sodium, and chloride

Question 17

true or false: normal saline is isotonic

Answer 17

true

Question 18

which compartments does normal saline distribute into?

Answer 18

it is isotonic so stays in the extracellular compartment

Question 19

what percentage of normal saline stays in the intravascular space?

Answer 19

25%

Question 20

true or false: normal saline can be used in resuscitation

Answer 20

true

it can be used in both maintenance and resuscitation

Question 21

what is hyperchloraemic acidosis?

Answer 21

when too much saline is given in fluid maintenance leading to an excess of chloride ions in the plasma

Question 22

what are the contents of 5% dextrose solution?

Answer 22

water and dextrose

Question 23

is 5% dextrose solution hypotonic or hypertonic?

Answer 23

hypotonic

Question 24

what happens to the dextrose in 5% dextrose solution?

Answer 24

it is immediately taken up by the cells, leaving the water behind

Question 25

how does the water distribute itself in 5% dextrose solution and how much remains in the vascular space?

Answer 25

it distributes itself evenly across all compartments, leaving only 8% in the vascular space

Question 26

when can 5% dextrose solution be used?

Answer 26

it can only be used in fluid maintenance as it maintains hydration without giving an excess of electrolytes

Question 27

why is it useful to give a NBM patient 5% dextrose solution?

Answer 27

as they have no other intake of glucose and need some form of energy

Question 28

what are the contents of Hartmann’s solution?

Answer 28

water, sodium, chloride, potassium, lactate, calcium

Question 29

true or false: Hartmann’s solution is isotonic

Answer 29

true

Question 30

what compartments does Hartmann’s solution distribute into?

Answer 30

it stays in the extravascular compartment, with 25% remaining intravascularly

Question 31

when is Hartmann’s solution given?

Answer 31

it can be used for maintenance and resuscitation

Question 32

why would someone use Hartmann’s over 0.9% saline?

Answer 32

because Hartmann’s is considered more physiologically accurate due to the other electrolytes present

Question 33

what measurement is considered a reduced urine output?

Answer 33

< 0.5ml/kg/hour

Question 34

how is a patient with reduced urine output managed?

Answer 34

• measure urine output
• check if they are in retention or if they have a blocked catheter
• be given a fluid challenge

Question 35

what is a fluid challenge?

Answer 35

250-500mls given over 15-30 minutes to prevent hypovolaemia

Question 36

true or false: malnourished patients make bad surgical candidates

Answer 36

true

they are at increased risk of surgical complications such as reduced wound healing and infection

Question 37

what does surgery do to the body’s metabolism?

Answer 37

the physiological stress results in a hyper metabolic state with a catabolic response

Question 38

what is the indication for giving oral nutritional supplements (ONS)?

Answer 38

if the patient is unable to eat sufficient calories

Question 39

what is the indication for giving a nasogastric tube (NGT)?

Answer 39

if the patient is unable to take sufficient calories orally or has a dysfunctional swallow

Question 40

what is the indication for gastrostomy feeding (PEG/RIG)?

Answer 40

if the patient’s oesophagus is blocked or dysfunctional

Question 41

what is the indication for jejunal feeding (jejunostomy)?

Answer 41

if the patient’s stomach is inaccessible or if there is an outflow obstruction

Question 42

what is the indication for parenteral nutrition?

Answer 42

if the patient’s jejunum is inaccessible or if they have intestinal failure

Question 43

when would treating malnutrition not be considered a reason to delay surgery?

Answer 43

if the underlying cause for malnutrition is being treated in the surgery (e.g. someone with active Crohn’s disease)

Question 44

true or false: patient should wait post-op before eating again

Answer 44

false

early post-operative feeding has been shown to reduce post-operative complications

Question 45

what is the recommended daily intake of sodium?

Answer 45

1-2mmol/kg/day

Question 46

what is the recommended daily intake of potassium?

Answer 46

1mmol/kg/day

Question 47

what is the recommended daily intake of glucose?

Answer 47

50g/day

Question 48

what is the recommended daily intake of water?

Answer 48

25-30ml/kg/day