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PSA > FLUID PRESCRIPTIONS > Flashcards

FLUID PRESCRIPTIONS Flashcards

1
Q

How is fluid distributed in the body of an average 70kg male?

A

total = 42L
intracellular = 28L
extracellular = 14L

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2
Q

How is fluid distributed in the extracellular component of an average 70kg male?

A

interstitial = 10.5L
intravascular = 3.5L

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3
Q

what are the sources of fluid gain?

A

oral intake
parenteral fluids

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4
Q

how much fluid does an average healthy adult require per day?

A

2-2.5L
20-30ml/kg/day of water

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5
Q

how much sodium, potassium and chloride is required each day?

A

1 mmol/kg/day of each

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6
Q

how much glucose is required each day?

A

50-100g

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7
Q

what are the sources of fluid loss?

A
  • urine
  • GI
  • insensible losses
  • surgical drains
  • bleeding
  • burns
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8
Q

how much do insensible losses account for each day?

A

500-800ml

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9
Q

give an example of an isotonic colloid fluid

A

sodium chloride 0.9%

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9
Q

what is the minimum urine output required on fluid replacement?

A

0.5ml/kg/hour

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10
Q

give an example of hypertonic colloid fluids

A

5% glucose
hartmanns solution

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11
Q

how does the fluid of an isotonic crystalloid distribute in the body?

A
  • 100% stays in extracellular fluid compartment
    25% of volume goes into intravascular compartment - 75% of volume goes into interstitial compartment
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12
Q

how does the fluid of a hypertonic crystalloid fluid distribute in the body?

A

2/3 (666ml) goes into intracellular space
1/3 (333ml) goes into extracellular space (of this 80ml goes into intravascular space and 254ml goes into interstitial space)

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13
Q

give some examples of colloid fluids

A

blood
dextrans
gelatin
human albumin solution
HES

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14
Q

how do colloid solutions distribute in the body?

A

100% of solution stays in intravascular compartment

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15
Q

how do you assess dehydration?

A

blood pressure
CRT
fluid balance charts
skin turgor
weight

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16
Q

what are the different types of shock?

A

distributive shock
hypovolaemic shock
cardiogenic shock
obstructive shock

17
Q

what are the causes of distributive shock?

A

sepsis
anaphylaxis
neurogenic shock

18
Q

what are the causes of hypovolaemic shock?

A
  • most common cause of shock
  • haemorrhage
  • burns
  • substantial fluid loss
19
Q

what are the causes of cardiogenic shock?

A

A relative or absolute reduction in cardiac output due to primary cardiac disorder
- ischaemia
- heart failure
- arrhythmias

20
Q

what are the causes of obstructive shock?

A
  • physical impedance of flow to blood
  • PE
  • cardiac tamponade
21
Q

how should you prescribe fluid in rescuscitation?

A

500ml crystalloid containing 130-154mmol/L NaCL (e.g. sodium chloride 0.9%) administered over less than 15 minutes

22
Q

what are the complications of fluid overload?

A

dilutional hyponatraemia
pulmonary oedema

23
Q

what is the management of fluid overload?

A

stop IV fluids
furosemide
sublingual nitrate
CPAP

24
Q

what are the 4 D’s of fluid therapy?

A

drug
dose
duration
de-escalation

25
Q

how can you manage the risk when prescribing fluids?

A

Clear prescription
Review patient regularly
Discontinue fluids ASAP
Daily weights
Measure U&Es
Minimum urine output of 0.5ml/kg/hour
Do not administer K+ at a rate over 40mmol/litre over 4 hours
Be aware that glucose 5% may deteriorate glyaemic control

26
Q

what type of fluid should be used for resuscitation fluids and how should they be delivered?

A

crystalloids delivered in boluses of 250-500ml over 10-15 mins

e.g.
hartmanns
sodium chloride 0.9%
plasmalyte 148

27
Q

when should resuscitation fluids be reviewed?

A

after every bolus
every 12 hours in patients requiring more than 3 litres per day
daily in stable patients

goal is to stop IVs ASAP

28
Q

what is the maximum amount of potassium that can be prescribed via IV in one day?

A

no more than 1 mmol per hour

e.g. 1 litre with 40 mmol potassium should be administered over a minimum of 4 hours

29
Q

In which groups of patients are normal fluid guidelines contraindicated?

A

Patients <16
Patients who are pregnant
Severe liver disease
Severe renal disease
Diabetes mellitus
Burns
Traumatic brain injury or requiring neurosurgery

30
Q

give examples of maintenance fluids

A
  • sodium chloride 0.18% / glucose 4%
  • sodium chloride 0.18% / glucose with 20 mmol/litre potassium chloride
  • maintelyte
31
Q

give examples of balanced crystalloid fluids (i.e. buffers used to lower sodium and chloride content closer to plasma levels)

A

Hartmanns
plasma-lyte 148

32
Q

give examples of unbalanced crystalloid fluids (i.e. no buffers used, therefore sodium and chloride content are significantly higher than plasma levels)

A

sodium chloride 0.9%
sodium chloride with potassium chloride

33
Q

what are the indications for using balanced crystalloids e.g. hartmanns

A
  • resuscitation of unwell and shocked patients
  • placement of pre-existing and ongoing losses in patients with normal potassium and sodium levels
34
Q

what are the indications for unbalanced crystalloidse.g. 0.9% sodium chloride?

A

fluid replacement e.g. D+V
- hypokalaemia
- hyperkalaemia
- hypovolaemic hyponatraemia

35
Q

other than fluids, what else can help in shock?

A

passive leg raise

36
Q

what are measurable fluid losses?

A

vomiting
diarrhoea
drains

37
Q

what are unmeasurable losses?

A

sepsis
SIRS
anaphylaxis
third space losses

38
Q

what monitoring should be done whilst a patient is on fluids?

A

renal function
electrolytes
every 12-24 hours

39
Q

what are the complications of fluid overload?

A

Peripheral oedema
Pulmonary oedema
Ascites
Delusional hyponatraemia
Prolonged hospital stay

40
Q

what is the management of fluid overload?

A
  • Stop IV fluids
  • Fluid restriction - up to 500ml less than maintenance requirement
  • Furosemide

Other treatments in pulmonary oedema:
- Sublingual nitrate
- IV nitrate
- CPAP

PSA (5 decks)

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