IV Fluids

Question 1

Discuss how fluid balance changes with age

Answer 1

water proportion decreases
salt retention increases

Question 2

how much of the water is intracellular and extracellular?

Answer 2

40/20 of total 60% water

Question 3

how much normal leakage of albumin occurs from capillaries into interstitial space?

Answer 3

5%

Question 4

what does albumin do in terms of fluid

Answer 4

contributes to oncotic pressure

Question 5

what is the main extracellular ion?

Answer 5

Na

Question 6

true or false, when sodium levels are measured it reflects the amount in the body?

Answer 6

true

Question 7

what is the main intracellular ion

Answer 7

K

Question 8

if a bolus is given of potassium, magnesium or calcium why will levels go up quickly and then drop back down again?

Answer 8

hasnt had time to get into cells

Question 9

why are levels of potassium that can be measured in the blood different to the true levels of potassium in the body?

Answer 9

locked in cells which isnt accounted for

Question 10

what other intracellular ions are present?

Answer 10

Mg, Ca

Question 11

which electrolyte generally has a range of 135-145 mmol/L?

Answer 11

Na

Question 12

which electrolyte usually has a range of 3.5-5 mmol/l?

Answer 12

K

Question 13

which electrolyte has a range of 98-105 mmol/l usually?

Answer 13

Cl

Question 14

what is the usual osmolarity of the blood in mOsm/L?

Answer 14

280-300

Question 15

what does injury lead to

Answer 15

water and Na retention, RAS activation, vasoconstriction, ADH release and thirst

Question 16

what is the reaction to injury

Answer 16

salt and water retained for first few days.
urine vol high
escape rate alb increases from 5% to 15%
in recovery water and salt excretion increases

Question 17

when prescribing IV fluids, remember the 5 Rs what are they?

Answer 17

resus
routine maintenance
replacement
redistribution
reassessment

Question 18

what consideration should be made with regards to resus?

Answer 18

on admission how much fluid was lost and how quick

Question 19

what consideration should be made in relation to routine maintenance?

Answer 19

is it needed

Question 20

what consideration should be made in relation to replacement?

Answer 20

has circulating volume been lost due to blood loss or diarrhoea

Question 21

what consideration should be made in relation to redistribution?

Answer 21

has the fluid gone into intra or extra vasc space or cells

Question 22

why is it important when examining electrolyte levels like sodium you take into account oral or enteral intake from different drugs like bicarbonates?

Answer 22

usually sodium bicarbonate hence will increase sodium levels

(Na in drugs)

Question 23

what fluid type is made from a simple crystal forming molecule such as salt and sugar?

Answer 23

crystalloid

Question 24

what do crystalloids act as?

Answer 24

make water isotonic with blood, act as a carrier for water

Question 25

name a salt and a sugar than can be used to produce a crystalloid?

Answer 25

dextrose and sodium chloride

Question 26

what is the purpose of adding a salt or sugar to fluid before giving it in the blood?

Answer 26

make the water as isotonic as possible with blood to act as a carrier for fluid intake

Question 27

what property of crystalloids mean that they do not cause a permanent rise in blood circulating volume?

Answer 27

able to pass freely through semi permeable membrane

Question 28

list some different properties/ benefits of crystalloids?

Answer 28

minimal oncotic pressure allows fluid to be lost from intra vasc space easily non physiological short action on plasma expansion cheap

Question 29

glucose acts a carrier for water mainly and sugar is taken into cells leaving water behind. Why is it not recommended in children?

Answer 29

drop in sodium levels

Question 30

NaCl can have drawbacks. when used you effectively give 2x Na and 4x Cl requirements a person needs. What effect can high Cl levels have in patients?

Answer 30

hyperchloraemic acidosis, breathing difficulty due to respiratory compensation

Question 31

what effect can using sodium chloride have on the renal system?

Answer 31

vasoconstriction reduced renal perfusion reduced glomerular filtration rate salt and water retention

Question 32

what effect can sodium chloride have on the GI system?

Answer 32

oedema reduced gastric blood flow impaired anastomotic healing

Question 33

true or false, balanced salt solution is the safest option for fluid replacement and least likely to cause issues with sodium and chloride?

Answer 33

true

Question 34

why is sodium chloride a good option to use in the case of TBI? traumatic brain injury

Answer 34

want to reduce brain swelling if sodium levels high in blood keeps fluid out of brain

Question 35

what is normal saline

Answer 35

a solution containing 1g equivalent per litre

Question 36

is 0.9% NaCl isotonic to blood?

Answer 36

yes

Question 37

what are the downsides of NaCl?

Answer 37

giving more Na and Cl than needed, vasoconstriction in kidneys and gut (cramps and increase creatinine)

Question 38

what is the role of chloride in the body

Answer 38

acid-base, body becomes more acidic and body compensates by breathing if too much Cl

Question 39

colloids are larger molecules that are non crystal forming, name some different examples?

Answer 39

blood gelatine dextrose

Question 40

true or false, colloids do not escape from capillaries and stay in the intra vasc space to exert oncotic pressure?

Answer 40

true

Question 41

can colloids pass through semi permeable membranes?

Answer 41

no

Question 42

what are the downsides to colloids

Answer 42

allergic reactions and expense, can escape which leads to later problems

Question 43

are capillaries more or less permeable in critical illness?

Answer 43

more

Question 44

true or false, crystalloids are associated with oedema?

Answer 44

true

Question 45

what is the routine maintenance of water in ml/kg/day?

Answer 45

25-30

Question 46

when is albumin good?

Answer 46

for treating sepsis

Question 47

list some patients groups in which the routine maintenance of water is reduced to 20-25 ml/kg/day

Answer 47

frail, renal or cardiac impairment, malnourished

Question 48

what is the routine maintenance of sodium and potassium daily?

Answer 48

1mmol/kg

Question 49

what is the lowest number of calories that must be consumed each day to prevent starvation ketosis?

Answer 49

400

Question 50

what is an example of redistributed fluid?

Answer 50

ascites

Question 51

eg of fluid losses

Answer 51

stoma output urine loss

Question 52

what are the 4ds of fluid stewardship?

Answer 52

drug dosing duration de escalation

Question 53

What electrolyte change can cause concussion and loss of consciousness

Answer 53

low Na

Question 54

4 stages of fluid therapy ROSE

Answer 54

resus optimisation stabilisation evacuation

Question 55

symptoms of hyponatremia

Answer 55

weakness, solenmness and seizures

Question 56

different classes of medication that can cause hyponatremia?

Answer 56

thiazides loop diuretics SSRIs typical and atypical antipsychotics

Question 57

Causes of hyponatremia include

Answer 57

loss of body fluid, inappropriate ADH secretion, fluid overload

Question 58

treatment of hyponatremia should raise sodium levels by 0.5mmol in increments of?

Answer 58

1h

Question 59

problems with giving sodium too quickly in hyponatremic patients?

Answer 59

if increase sodium levels outside brain pulls water out brain shrinks demyelination permanent brain injury

Question 60

in order to equilibrate sodium levels between brain and surrounding blood vessels should it be given quickly or slowly?

Answer 60

slow

Question 61

hypernatremia symptoms

Answer 61

irritable, lethargy, confusion, coma

Question 62

causes of high Na

Answer 62

withholding water and inadvertent Na admin

Question 63

what happens when you correct high Na too quickly

Answer 63

brain swelling

Question 64

what should be considered in terms of formulations and sodium?

Answer 64

effervescent contains high Na amounts and shown to increase CV mortality

Question 65

what happens if K given peripherally in high concs

Answer 65

extravasates and local tissue necrosis

Question 66

what happens if K given too fast

Answer 66

lethal - cardiac arrest

Question 67

if someone has low K even after intervention and they have low Mg, what should you do?

Answer 67

correct Mg and kidney more likely to retain Mg than K= more likely to retain K

Question 68

what is it about K admin that can kill?

Answer 68

the rate it is being given (independent of route)

Question 69

when is conc important for K?

Answer 69

when given peripherally (central = dilutes K very quickly)

Question 70

max peripheral conc K

Answer 70

40mmol/L

Question 71

max central K conc

Answer 71

no max as high blood flow around, cant tip dilute blood flow quick

Question 72

safe K rates a. w cardiac monitor b. w/out

Answer 72

10mmol/hr 20-30mmol/hr