Fluids & ECG

Question 1

When would:
Resus
Replacement
Maintenance
Fluids need to be prescribed?

Answer 1

Resus: Inadequate replacement of fluid +/- new losses (haemorrhage)
Replacement: Adequate resus but ongoing losses
Maintenance: Adequate resus/replacement no ongoing losses

Question 2

What are the indications for resus fluids?

Answer 2

Blood loss: Injury, surgery
Plasma loss: Burns, acute pancreatitis
GI/renal loss of water & salts

Question 3

What fluid is given for resuscitation? Are there any contraindications?

Answer 3

500mls (250mls in cardiac failure)
Hartmann’s
CI: Hyperkalaemia, oliguric AKI, rhabdomyolysis give 0.9% saline

Question 4

What should be given in major blood loss?

Answer 4

500mls (250mls in cardiac failure)
Response:
Y- Continue fluids
N- Repeat bolus and review
Cross-match & give packed cells, FFP, platelets (major haemorrhage pack)
Intravascular fluid loss: Combination of colloid & crystalloid
Avoid: Large doses of 0.9% saline

Question 5

What is the aim of maintenance fluids?

Answer 5

Restore insensible losses
Provide sufficient water & electrolytes to maintain normal status of body fluid compartments
Enable kidneys to excrete waste products

Question 6

How much water does the average person require?

Answer 6

1.5ml/kg/hour (approx 2L/24hours)

Question 7

How much K+ and Na+ does the average person require?

Answer 7

K+ 0.5-1mmol/kg/24hrs (approx 35-70)

Na+ 1-2mmol/kg/24hrs (approx 70-140)

Question 8

Describe Hartmann’s solution

Answer 8

Most physiological/similar to plasma
Good for replacing plasma loss
Not great for normal maintenance therapy as: too much Na+ and not enough K+

Question 9

What are the draw backs when prescribing normal saline?

Answer 9

Too much chloride can give hyperchloraemic acidosis
Cause renal vasoconstriction
Too much sodium puts an increased load on the kidneys

Question 10

Why is dextrose added to solutions instead of pure water?

Answer 10

Maintain osmolarity
Used for maintenance when water but no electrolytes needs to be given
NOT physiological so cannot replace blood/plasma loss
SE: hyponatraemia

Question 11

When are colloids prescribed?

Answer 11

Need to keep fluid in intravascular space
Molecules create osmotic gradient
SE: Anaphylaxis, renal failure

Question 12

How are overall fluid requirements calculated?

Answer 12

Overall = Maintenance fluids + Replacement of fluid loss

Question 13

How much maintenance fluid should an adult NBM be prescribed?

Answer 13

1L/8hours

approx 3L/day

Question 14

How is rhythm assessed?

Answer 14

Rate
Rhythm
QRS: Broad, narrow
Regular, irregular
Atrial activity