Fluid Resuscitation

Question 1

Initial assessment of fluid requirements

-when would a patient need fluid resus?

Answer 1

A-E

• low BP, high HR, RR
• high CRT or cold peripheries
• 45 deg passive leg raise suggesting fluid responsiveness

Question 2

Management of fluid resuscitation

Answer 2

Identify cause of deficit
Give 500ml crystalloid over 15mins and reassess
-repeat until fluid resuscitation no longer needed
If 2000ml given OR shocked => senior advice

Question 3

If fluid resus no longer needed, how would you assess fluid and electrolyte needs

Answer 3

Hx - thirst, past intake, losses, comorbidities

Examination - HR, BP, CRT, JVP, edema, postural hypotension

Monitoring - NEWS, fluid balance chart, weight

Bloods - FBC, U&E

Question 4

When would you initial routine maintenance

-how would you manage fluid requirements

Answer 4

No existing or ongoing deficits/excesses?
Cannot meet fluid or electrolyte needs orally or enterally

Daily fluid and electrolyte requirements

• 25-30ml/kg/day water
• 1mmol/kg/day Na, K, Cl
• 50-100g/day glucose

0.9% saline, Hartmann, Saline 0.18% Glucose 4%, Dextrose 5%

If IV fluids needed for 3+ days => NG fluids and enteral feeding used

Question 5

When would you initiate fluid replacement

-how would you manage fluid requirements

Answer 5

Existing or ongoing deficits/excesses
Cannot meet fluid or electrolyte needs orally or enterally

Prescribe fluid by adding or subtracting from routine maintenance

• assess for fluid, electrolyte deficits or excesses
• frequent monitoring and adjust