Fluids

Question 1

What is osmolarity?

Answer 1

Conc of osmotically active particles in solution

Question 2

Daily requirements of water

Answer 2

30-40 ml/kg

Question 3

Daily requirements of energy

Answer 3

30-40 kcal/kg

Question 4

Daily requirements of sodium

Answer 4

1-2mmol/kg

Question 5

Daily requirements of potassium

Answer 5

1mmol/kg

Question 6

Is Na+ + K+ intra or extracellular?

Answer 6

Na+ major extracellular

K+ major intracellular

Question 7

Stress response in homeostasis

Answer 7

ADH release 
Water retention 
Dilutional hyponatraemia 
Renin release 
Sodium retention 
Fluid overload

Question 8

What is the total obligatory loss for water in adults?

Answer 8

1500ml

Question 9

What is the definition of oliguria?

Answer 9

Urine output less than 0.5ml/kg/hr

Question 10

What are crystalloids + give examples?

Answer 10

Water soluble crystalline substance that diffuses across a semi-permeable membrane
NaCl
Dextrose
Dex/Sal
Hartmanns/ Ringers/ compound sodium lactate

Question 11

What are colloids?

Answer 11

Dispersion of finely divided particles in a medium 
Fluid stays in circulation 
Gelofusine 
Voluven 
Volulyte

Question 12

Describe composition of 0.9% NaCl

Answer 12

% means g/100ml
9g NaCl per L
154 mmol Na 154 mmol Cl

Question 13

How many litres of NaCl will give a 1L increase in plasma volume?

Answer 13

4.7L

Question 14

What are the consequences of NaCl infusion?

Answer 14

Hyperchloraemic acidosis
Metabolic acidosis
High Cl + low HCO3

Question 15

What does Hartmans contain?

Answer 15

Na
Cl
K
Ca++
Lactate

Question 16

What is the difference between Hartmans and Ringers?

Answer 16

Hartmans = has lactate

Question 17

Describe the composition of dextrose + how much is needed for a 1L increase in plasma volume?

Answer 17

50g dextrose per L of water

14L to increase PV by 1L

Question 18

How many calories in 5% dextrose?

Answer 18

170

Question 19

What is HAS?

Answer 19

Human albumin solution

- pooled human plasma

Question 20

What type of fluid is blood?

Answer 20

Colloid

Question 21

What is HES?

Answer 21

Starch

Question 22

How to assess fluid status?

Answer 22

Check mucous membranes 
Skin turgor 
Urine output 
BP 
HR 
JVP

Question 23

What is the criteria for mild fluid deficit?

Answer 23

Loss of 4% body weight
Loss of skin turgor
Dry mucous membranes

Question 24

What is the criteria for mod fluid deficit?

Answer 24

Loss of 5-8% body weight
Oliguria
Tachycardia
Hypotension

Question 25

What is the criteria for severe fluid deficit?

Answer 25

Loss of >8% body weight Profound oliguria CVS collapse

Question 26

What do you use for a fluid challenge + how do you do it?

Answer 26

Large bore IV cannula Colloid 500ml bolus Observe BP + HR

Question 27

What patients have abnormal fluid losses?

Answer 27

``` GI - suction/ vomiting, bowel prep Hyperventilation Fever (12% loss per 1 degree rise) Burns Hyperglycaemia Diuretics ```

Question 28

What are patients with DKA deficient in + what metabolic state are they in?

Answer 28

``` 3-5L fluid deficiency 300-500mmol Na deficiency 150-250mmol K deficiency Hyperglycaemia Hyperketonaemia Metabolic acidosis ```

Question 29

What fluids to give in DKA?

Answer 29

Initially 2-3L NaCl | Add K+