Fluid And Electrolyte

Question 1

Why prescribe IV

Answer 1

Maintainance - vomiting and diarrhoea

Replacement- people that are already dehydrated

Resuscitation- rapidly restore after haemorrhage or shock

Question 2

Total body water is what % of weight

Answer 2

60 man

50-55 woman

Question 3

icf

Ecf % of total water

Answer 3

ICF 60

EFC30

Question 4

How does fluid enter body

Answer 4

Food drink

Metabolism

Question 5

How fluid lost

Answer 5

Faeces
Sweat/skin
Lungs

Question 6

What% of NA in body not exchangeable

Exchangeable

Answer 6

25 non

75 exchangeable

Question 7

Normal range of NA in plasma

Answer 7

135-145 mmol/l

Question 8

Sodium excretion regulated by

Answer 8

Renin-Angiotensin-Aldosterone • Natriuretic Peptides • Intrinsic Renal mechanisms

Question 9

Osmoreceptor detect

Answer 9

Increased osmotic pressure

Question 10

Baroreceptors

Answer 10

Detect decrease blood pressure

Question 11

Aim of fluid replacement

Answer 11

Maintain normovolaemia
Main Tain electrolyte concs
Compensate extra fluid loss

Question 12

Features of colloids

E.g

Answer 12

Stay in compartment administered to
Mainly in plasma
E.g blood

Question 13

Normal prescription for someone who is otherwise well and has no extra losses

Answer 13

So… 1L Normal Saline 0.9% & 2L 5% dextrose with added K+
Or… 3l dextrose saline with k+

Question 14

How to maintain patient with physiological losses

Answer 14

AsAssess patient regularly. Keep a careful fluid balance chart • Stop iv fluids as soon as not required • > 3 days use oral/enteral feed or consider total parenteral
nutrition if necessary • Include fluid given in IV drugs, and pumps

Question 15

Entrap feed is

Answer 15

Straight through GI

Question 16

Parenteral feed is

Answer 16

Not through GI

Question 17

Fluid balance assessment

Answer 17

Limbs – temperature, pulse (volume and rate), BP sitting and standing
(postural), skin turgor, peripheral oedema • Head and neck - ? Sunken eyes, mucous membranes, JVP, carotid pulse • Chest – Capillary refill, lung auscultation for pulmonary oedema • Abdomen - ? ascites • Fluid balance chart • Weight chart

Question 18

Resuscitation therapy used when

Answer 18

Re suscitation therapy is used when a patient is hypotensive

Question 19

First thing todo in resuscitation therapy

Answer 19

Test the response to fluid with a
fast IV bolus of a crystalloid • Reassess the patient using ABCDE
approach and repeat the above if
necessary • Use blood as soon as available if
the patient is bleeding • Seek expert help early

Question 20

Hyponatremia is

Answer 20

NA less than 135 mmol/l

Question 21

Hyponatraemia results from

Answer 21

The intake and subsequent retention of water. Excess of water in relation to Na

Depletion of total body Na in excess of concurrent body water losses

Question 22

Hyponatraemia Good history and examination of the patient can lead to

Answer 22

Causes and rapidity of condition

Question 23

Hyponatraemia key feature

Answer 23

Volume status of patient

Question 24

Symptoms of mild hyponatraemia

Answer 24

• MILD hyponatraemia (130-135 mmol/L) – Asymptomatic

Question 25

Symptoms of moderate hyponatraemia

Answer 25

MODERATE hyponatraemia (121-129 mmol/L) – Cramps, Weakness, Nausea

Question 26

Symptoms of severe hyponatraemia

Answer 26

SEVERE hyponatraemia (<120 mmol/L) – Lethargy, Headache, Confusion

Question 27

Severe and rapidly evolving hyponatraemia symptoms

Answer 27

Severe and rapidly evolving hyponatraemia – Seizures, Coma, respiratory arrest

Question 28

Treatment of hyponatraemia

Answer 28

Hypovolaemia – Correct volume depletion e.g. IV 0.9% saline • Euvolaemia – Underlying cause, fluid restriction • Hypervolaemia – Underlying cause, fluid restriction, (vasopressin receptor antagonists)

Question 29

Aggressive therapy for hyponatraemia when

Answer 29

``` Severe symptoms Acute onset (less than 24 hours) ```

Question 30

Hypernatraemia is i

Answer 30

NA over 145 mmol/l

Question 31

Hypernatraemia results from

Answer 31

Net water loss | Hypertonic NA gain

Question 32

Symptoms of hypernatraemia

Answer 32

Similar to hyponatraemia

Question 33

Hypernatraemia treatment

Answer 33

Chronic hypernatraemia • Treat underlying cause • Use of hypotonic fluid e.g. 5% Dextrose givne slowly • Lower Na by maximum of 10 mmol/L per day • Always re-assess

Question 34

Hypokalaemia is

Answer 34

Less tthan 3.5 mol/l

Question 35

Hypokalaemia results from

Answer 35

Decreased K intake (rare) • Increased entry into cells • Increased losses - GI / urine

Question 36

Symptoms of hypokalaemia

Answer 36

Muscle weakness | ECG change and arythmias

Question 37

Hypokalaemia ECG

Answer 37

``` Flat T wave • U waves • ST depression • PR interval prolonged • Prolonged QT interva ```

Question 38

Hyperkalaemia is

Answer 38

K over 5.5 mol/l

Question 39

Symptoms of hyperkalaemia

Answer 39

Paraesthesiae • Muscle weakness – paralysis • Arrhythmias

Question 40

Hyperkalaemia ECG changes

Answer 40

``` Tall peaked T waves • Shortened QT interval • PR interval lengthening • QRS widening • P waves disappear – Sine wave ```

Question 41

Hyperkalaemia treatment

Answer 41

IV calcium gluconate – antagonise membrane action of high K • IV insulin with glucose – drive K into cells • Remove K from the body • Consider loop diuretics • Consider haemodialysis or haemofiltration • Other therapies to drive K into cells • Sodium bicarbonate • Beta agonists • Monitor • Treat underlying cause • Longer term – drug changes, diet changes