Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

(75 cards)

Start Studying
1
Q

What questions do you ask before prescribing fluid

A

What is my patients volume status - ABCDE
Does my patient need IV fluid
How much fluid do they need
What type of fluid do they need
What is cause of deficit / surplus and Rx this! e.g AKI / sepsis

When examining for fluid status

  • Are they thirsty / check tongue
  • Pulse, BP, CRT, JVP
  • Oedema - look peripheral and listen to lungs for peripheral
  • Look at U+E
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs of hypovolaemia

A 
Nausea
Thirsty
Flat veins
Cool periphery
No sweat
Low or postural BP 
High HR
Conc oliguria
Responds to SLR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do people with hypovolaemia need

A

Resuscitation fluid if low BP
Rehydration fluid
Need to work out cause of fluid loss and stop the leak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs of euvolaemia

A 
Feel well, not thirsty
Filled veins
Warm extremities
Mild sweat
Normal BP and HR
Normal urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do euvolaemic people need

A

No fluids unless electrolyte deplete or low BP

Can be in this state as fluids are maintaining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of hypervolaemia

A 
SOB
Not thirsty
Warm and oedematous 
Distended vein 
Sweaty
High BP and HR
Dilute urine 
Oliguric or polyuric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do hypervolaemic people need

A

No more fluids
Diuretics possibly if respiratory compromise
Haemofiltration if anuric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you work out fluid deficit

A 
Catheter 
Chest drains 
Fluid balance chart
Weight 
Vomit bowl / sputum pot / stool chart + stoma 
U+E's
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the insensible that cannot be measured

A 
Transepidermal diffusion
Sepsis sweat
Ventilation 
Open wound
Burns
Blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How much water is lost through transepidermal diffusion

A

400-800ml per day

NO SOLUTE LOSS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are fluids given for

A 
IV vs oral vs NG 
Resuscitation
Routine maintenance
Replacement
Redistribution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of fluid are there

A

Dextrose
Crystalloids
Colloids - Plasma expanders
All go into different areas of body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When do you give resuscitation fluids

A

Hypovolaemic shock

Cannot perfuse organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What fluid do you give in hypovolaemic shock

A

Rapid bolus to increase intravascular space

500ml over 15 minutes CRYSTALLOID with 130 mmol of Na (saline)
- 0.9% saline = hypercholaraemic acidosis risk
- Hartman’s / PlasmaLyte but caution if hyperkalaemia
Can give further bolus up to 2000ml then senior

Colloid only if haemorrhagic or blood on BTS chart

250ml if HF/ renal / elderly as less strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you check that resuscitation fluids have worked

A

REASSESS
Check BP
Give another 250-500ml if respond
May require vasopressors if in shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do you give routine maintenance fluids

A

Fasted patients >8 hours or after surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of fluid is given as routine maintenance

A

Crystalloid
Look in guidelines to find out what is needed
If >3 days then enteral feeding is preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When do you give replacement fluids

A

To replace electrolytes that have been lost - Mg, K, Po4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you check that replacement fluids have worked

A

Take blood

Check electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is dextrose useful in

A

Chronic dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is dextrose not useful in

A

Resuscitation

Low albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is dextrose not useful as resuscitation

A

Isotonic so moves through all compartments and won’t expand blood to fill up BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are most fluids

A

Crystalloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are crystalloids useful in

A 
Dehydration
AKI
Sepsis
SHock
Resuscitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are cryalloids not useful for
Long term maintenance as puts strain on the heart Hypernatraemia as contains Na Hyperchloraemic metabolic acidosis
26
How do crystalloids work
Come in various combinations and remain in ECF
27
What is a common crystalloid
0.9% saline Contains a lot of sodium - risk of hyperchloraemic metabolic acidosis Plasma Lyte - preferred now post-op as more balanced
28
What are plasma expanders
Colloids
29
What are examples of colloid
Blood TPN IV albumin - used in Burns
30
What do colloids do
Stay exclusively in IVS so give if bleeding
31
When are colloids used
Liver patients as have low albumin - post paracentesis Selected intra-op NOT commonly prescribed
32
When do you get specialist help
``` Low oncotic pressure CCF Renal or live failure Obstetrics Head injury Children ```
33
Does a euvolemic patient with low urine output need fluids after surgery?
No Most likely physiological post-op stress response Possible AKI
34
When do you not give Hartmann's / Plasma Lyte
If hyperkalaemia
35
What do NICE recommend as maintenance
25-30ml/kg/24 hours water 1mmol/kg/day K,Cl, Na 50-100g glucose to limit starvation ketosis e. g. 25-30ml/kg NaCl 0.18% in 4% dextrose with 27mmol of K of maintenance - Never give mixed back >100ml / hr due to risk of hyponatraemia and central pontine demyelination If Na <132 the us PlasmaLyt To work out find how much needed in 24 hours then / 24 to see the rate you should give / hour
36
What to think
If post op major loss = more needed HF = less needed as pulmonary oedema If elderly / malnourished or renal may need less If obese - Adjust to idea body weight - A patient will rarely need >3L - Expert help if BMI >40
37
What are most commonly used fluid
PlasmaLyte (NaCL + HCO3 + K) 0.9% saline - NaCl (more than 0.18%) 5% glucose 0.18% saline + 4% glucose
38
What are risks of fluid
``` Acute LVF Hyponatraemia Hyponatraemic encephalopathy Electrolyte imbalance - hyperkalaemia Cerebral oedema ```
39
Paediatric fluid
HARD 0.45% NaCl + 5% dextrose Risk of hyponatraemia and cerebral oedema if use 0.18% saline
40
What is ABCDE when assessing fluid balance
A B = any HF? C = JVP, BP, HR, CRT, FBC / U+E D = dry membrane / turgor / oedema
41
What does plasma have in regards to Na, K, Cl, bicarb, lactate -
Na - 137 K - 4 Cl - 95 Bicarb - 22
42
What does 0.9% saline have
H20 = 1L Na - 154 Cl - 154 No K or glucose
43
What is risk if give too much 0.9% saline
Hypercholarmic acidosis More Na and CL in one bag than is required in 24 hours so monitor Cl levels daily
44
What does 5% Dextrose have
``` 1l - H20 Glucose - 50g Essentially water as no Na / K / Cl Na - 30.6 Cl - 30.6 ```
45
What does PlasmaLyte have have
Na - 130 K - 4 - risk of hyperkalameia so CI Cl - 110 Lactate- 0
46
What is given as bolus to see if low BP due to hypovolaemia
0.9% saline 500 ml over 15 minutes
47
How does hyponatraemic encephalopathy present
Gait Headache Confusion Low BP
48
What causes
Hypotonic solution - 0.45% NaCL Paeds at risk Also SIADH after surgery. / stress
49
If on maintenance fluid what should happen
Monitor U+E | Even if good fluids can still get hypontraemia e.g. if on diuretic increasing Na
50
Why do you avoid 0.45% NaCl as resus
Hypotonic so won't expand plasma | Also risk of cerebral oedema
51
Paeds fluid bolus
20ml / kg 0.9% saline Repeat 10ml/kg up to 40 If circulation not restored = senior
52
Paeds maintenance
``` 0.9% saline + 5% dextrose +-KCL 4,2,1 rule or First 10kg = 100ml / kg Next 10kg = 50ml / kg Next 10kg = 20ml / kg ```
53
What should you do if risk of cerebral oedema
Go slower | Use 10ml/kg 0.9% saline if DM
54
When is Hartmann's CI
Hyperkalaemia as contains potassium
55
What is max speed K can be infused peripherally
10mmol / h | If >20 needs cardiac monitor as risk of arrhythmia
56
How do you assess fluid status
ABCDE approach
57
What suggests patient needs fluid resus
``` BP <100 HR >90 CRT >2s Cold periphery to touch RR >20 NEWS >5 ```
58
What do you give as resus
500ml crystalloid over <15 minutes (Na 130-150)
59
What else
Identify cause of deficit
60
What do you do after
Reassess using ABCDE to see if needs resus Senior help if unsure If better = see algorithm for non-resus fluid If <2000ml given can give another bolus of 250-500ml If still signs of shock = senior help
61
How do you assess fluid and electrolyte needs in patient who does not require resus
Examination - Pulse - BP - CRT - RR - JVP - Oedema - Postural hypo Monitoring - NEWS - Fluid balance - Weight Lab - FBC - U+E
62
If patient can meet needs oral
OK
63
If patient cannot meet needs through oral but no complex issues
Routine
64
If complex
Replacement and redistribution algorithm
65
What is routine maintenance
25-30ml/kg/day water 1mmol / kg / day Na, K, Cl 50-100g glucose
66
When do you stop
When no longer needed
67
If >3 days
NG or enteral feeding preferred
68
Redistribution and replacement
Add or subtract according to deficit
69
What is average needs in 70kg adult
``` 1.75-2.1l water 70-140 Na 35-70K 70Cl 50-100g glucose ```
70
How can you meet this
Mixed bag of NaCll 0.18% + 4% glucose with 27mmol KCl on day 1 Prescribe 2 1L bags + 1 500ml
71
What increases risk of hyponatraemia
>2.5l
72
If don't have mixed bag what can you do
Use a mix of single bads 2 bags of 5% dextrose with KCl 1 bag of 0.9% saline 500ml with potassium Makes up 2.5L
73
If prescribed 3x 8 hourly bag of Hartmann what is risk
Giving 3l of H20 Giving way to much Na and Cl Not enough K Not enough glucose
74
Wha is Hartmann's good for
Resus but not maintenance
75
If patient is hyper-volaemic what do you do
Restrict Consider diresis Consult senior

Pharmacology (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions