Fluids

Question 1

How many L of fluid are there in a 70kg man?

Answer 1

42L

Question 2

what % of fluid is in the intracellular compartment?

Answer 2

65% - 28L in 70kg man

Question 3

what % fluid is in the extracellular compartment?

Answer 3

35% - 14L in 70kg man

Question 4

what % of extracellular fluids are interstitial?

Answer 4

75% - 10.5L

Question 5

what % of extracellular fluids are intravascular?

Answer 5

25% - 3.5L

Question 6

what ion determines the distribution of water between the intra and extracellular compartments?

Answer 6

sodium

Question 7

what are 3 characteristics of intracellular compartment?

Answer 7

high potassium conc
low sodium conc
intracellular solute conc is pretty constant

Question 8

what are 2 features of extracellular fluids?

Answer 8

high sodium conc
low potassium conc

Question 9

how many ml of water is released from metabolism a day approx?

Answer 9

400ml

Question 10

what is the average fluid maintenance requirements of an adult with no extra losses?

Answer 10

2-2.5L per day

Question 11

how many ml of water /kg should an adult have per day?

Answer 11

25-30 ml/kg/day

Question 12

how much sodium, potassium and chloride should an adult have maintenance per day?

Answer 12

1 mmol/kg/day

Question 13

what is the minimum glucose required for maintenance for an adult for one day?

Answer 13

50-100g/day of glucose to prevent starvation ketosis

Question 14

what is the minimum urine output to aim for in adults?

Answer 14

0.5 ml/kg/h

Question 15

what are approx GI losses per day?

Answer 15

100 ml/day

Question 16

what are average insensible losses per day?

Answer 16

500-800ml /day

Question 17

sweating leads to loss of which electrolyte?

Answer 17

sodium

Question 18

what electrolytes are lost in diarrhoea?

Answer 18

sodium
potassium
bicarb

Question 19

what electrolytes are lost in vomiting?

Answer 19

potassium
chloride
hydrogen

leads to hypercholraemic metabolic alkalosis

Question 20

How many mmol of sodium and chloride are there in normal saline?

Answer 20

Sodium - 154
Chloride - 154

Question 21

how much glucose is there in 5% glucose solution?

Answer 21

50g/litre

Question 22

what is the other name for hartmanns solution?

Answer 22

compound sodium lactate

Question 23

how much sodium, chloride and glucose is in NaCL 0.18% and glucose 4%?

Answer 23

sodium - 30
chloride - 30
glucose - 40g/litre

Question 24

what is in gelofusine?

Answer 24

154 mmol - sodium
124 - chloride

Question 25

what are 8 signs of hypovolaemia?

Answer 25

absent/low JVP decreased skin turgor dry mucous membranes low BP oligouria/anuria orthostatic hypertension peripheral shutdown/prolonged CRT shock tahcycardia

Question 26

what are 8 signs of hypervolaemia?

Answer 26

cough +/- frothy sputum Pleural/peritoneal fluid accumulation hypertension peripheral oedema pulmonary oedema dyspnoea raised JVP S3/4 heart sounds tachycardia

Question 27

wha are crystaloids?

Answer 27

solutions of mineral salts

Question 28

what are colloids?

Answer 28

solutions of larger water insoluble molecules like complex carbohydrates or gelatins

Question 29

How do isotonic solutions act?

Answer 29

stay almost entirely in extracellular compartment 0.9% sodium chloride

Question 30

How do hypertonic solutions act?

Answer 30

draw fluid out of cells by increasing plasma tonicity sodium chloride 3%, mannitol

Question 31

how do hypotonic solutions act?

Answer 31

lower serum osmolarity and are not commonly used NaCl 0.45%

Question 32

How does 1L of Normal saline distribute?

Answer 32

100% to extracellular compartment 25% to intravascular compartment 75% to interstitial compartment

Question 33

how does 1L of 5% glucose distribute?

Answer 33

distributes across all body compartments 2/3rds intracellular 1/3rd extracellular 80ml intravascular, 254ml interstitial

Question 34

How do colloids work?

Answer 34

increase osmotic force across capillary membrane drawing fluids from interstitial to intravascular compartment

Question 35

How is 1L of colloid distributed?

Answer 35

100% stays in intravascular compartment

Question 36

what is shock?

Answer 36

organ hypoperfusion to the extent that cellular metabolic demands are not met

Question 37

what is distributive shock?

Answer 37

systemic vasodilation leads to decreased organ perfussion

Question 38

what are 3 causes of distributive shock?

Answer 38

sepsis anaphylaxis neurogenic shock

Question 39

what is the most common type of shock?

Answer 39

hypovolaemic shock

Question 40

what is grade 1 hypovolaemic shock?

Answer 40

15% - 750ml mild tachycardia, slow cap refill (3s at 10% volume loss)

Question 41

what is grade 2 hypovolaemic shock?

Answer 41

15-30% loss, 750-1500ml cool peripheries, tachycardia, decreased pulse pressure, delayed cap refill (5s) may have catechloamine increased BP and anxiety

Question 42

what is grade 3 hypovolaemic shock?

Answer 42

30-40% volume loss, 1500-2000ml marked tachycardia and tachypnoea decresaed systolic BO, narrow pulse pressure, oliguria, low volume pulse, postural drop, confusion/agitation

Question 43

what is grade 4 hypovolaemic shock?

Answer 43

40-50% loss, 2000-2500ml low GCS, unconscious minimal/no urine thready pulse very tachy, very low BP, cold skin

Question 44

what are 6 indicators a patient may need urgent fluids?

Answer 44

systolic <100mmHg HR >90 CRT >2s or cold peripheries RR >20 NEWs >5 Passive leg raise suggests fluid responsive

Question 45

what is cardiogenic shock?

Answer 45

relative or absolute reduction in cardiac output due to a primary cardiac disorder

Question 46

what are 3 signs of cardiogenic shock?

Answer 46

circulatory collapse due to pump failure raised JVP Cardiac arrhythmias

Question 47

what are 4 causes of cardiogenic shock?

Answer 47

ischaemic heat failure arrhythmia cardiomyopathy

Question 48

what is obstructive shock?

Answer 48

when there is a physical impedance to blood flow

Question 49

what are 2 causes of obstructive shock?

Answer 49

PE cardiac tamponade

Question 50

what is the passive leg raise test?

Answer 50

lift patients legs check Obs - should improve in volume depleted patients and return to normal when they are positioned normally

Question 51

what are the 5 Rs of IV fluid prescribing?

Answer 51

Resuscitation Routine Maintenance Replacement Redistribution Reassessment

Question 52

what weight should be used to calculate maintenance fluids?

Answer 52

ideal body weight

Question 53

what is the IV fluid prescription according to body weight?

Answer 53

25-30 ml/kg/day

Question 54

what are 2 complications of fluid overload?

Answer 54

dilutional hyponatraemia pulmonary oedema

Question 55

how can nitrates improve fluid overload?

Answer 55

causes reduction in preload need BP monitoring if IV

Question 56

what are the 4 Ds of fluid therapy?

Answer 56

Drug - most appropriate fluid? Dose - is quantity calculated appropriately Duration - Start documented De-escalation - stop date documented

Question 57

what is the rate of maintenance fluids?

Answer 57

30 ml/kg/24 hours