Fluids

Question 1

What situations would you use an alternative to 0.9% saline?

Answer 1

• Hypernatraemic or hypoglycaemia - give 5% dextrose
• Has ascites - give HAS, maintains oncotic pressure
• Is shocked from bleeding - give blood transfusion, crystalloid first if no blood available

Question 2

What do you give to an oliguric patient?

Answer 2

If not due to urinary obstruction e.g. enlarged prostate then give 1L over 2-4 hrs then reassess, especially HR, BP, urine output to assess response.

Question 3

What is the general rule of reduced urine output and fluid depletion?

Answer 3

• Oliguric <30ml/hr, anuric 0ml/hr - indicates 500ml fluid depletion
• Decreased UO and tachycardia - 1L fluid depletion
• Decreased UO and tachycardia and shock - 2L fluid depletion

Question 4

How much K an hour?

Answer 4

No more than 10mmol/hr

Question 5

What is the maintenance fluids?

Answer 5

• 3L/24hrs (8hrly bags) or 2L/24hrs in elderly (12hrly bags)
• Adequate electrolytes by 1L 0.9% saline and 2L 5% dextrose

Question 6

How would you add K to maintenance fluids?

Answer 6

• 5% dextrose and 0.9% saline contain potassium chloride
• Normal K level - 40mmol KCl/day so 20mmol KCl in 2 bags

Question 7

What does 1% mean in drug calculations?

Answer 7

• 1g in 100ml (or 10mg in 1ml)
• 1g in 100g

Question 8

What preparations of adrenaline are available?

Answer 8

• 1 in 1000 (1g in 1000ml) preparation is available for treatment in anaphylaxis
• 1 in 10,000 (1g in 10,000ml) for cardiopulmonary resus