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Stage 2: Supporting Life > Treatment of Fluid and Electrolyte Imbalance > Flashcards

Treatment of Fluid and Electrolyte Imbalance Flashcards

1
Q

When may a patient with fluid overload still be prescribed IV fluids?

A

e.g. if someone with LV failure has pulmonary oedema → doesn’t mean their TBW is high so may be situations here they need IV fluids

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2
Q

When do you give IV fluids/fluid replacement?

A

1) Maintenance
2) Replacement
3) Resuscitation

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3
Q

When do you give maintenance fluids?

A

To maintain euvolaemia when oral intake is reduced e.g. NBM< nausea, vomiting, diarrhoea (not absorbing)

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4
Q

When do you give replacement fluids?

A
  • Previous ongoing or predictable future losses

- e.g. D&V, urine, drains, skin losses, sweat, third spacing, burns, surgery, polyuria

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5
Q

When do you give resuscitation fluids?

A
  • To rapidly restore the intravascular compartment

- e.g. following haemorrhage, marked dehydration, vasodilation, shock

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6
Q

How do you diagnose dehydration>

A

1) High Hb → blood is haemoconcentrated → less fluid in blood
2) Low body weight → if 3kg less than 3 days ago, loss of water not fat, look at daily weight
3) Urine output → retrospective
4) Hypotension (depends on physiological state of patient) → BP tends to be one of the last things to fall bc of vasoconstriction in young people but in older people might go down quicker

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7
Q

What are the aims of fluid replacement?

A

1) Maintain normovolaemia
2) Maintain normal electrolyte concentrations
3) Compensate for any extra fluid losses with like for like → esp. with blood

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8
Q

How do you try and replace losses exactly?

A

1) Previous loss → volume, type of fluid
2) Maintenance requirement → volume (what have they lost and what extra do they need)
3) Expected future loss → volume, type of fluid

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9
Q

What are 5 types of IV fluids?

A

1) Glucose 5%
2) Sodium chloride 0.18% and glucose 4% (dextrose saline)
3) Saline 0.9%
4) Balanced crystalloids
5) Colloid

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10
Q

What is a feature of all IV fluids?

A

They are isotonic → same osmolality as plasma

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11
Q

Why is glucose 5% given?

A

It is used just for water replacement → it makes fluid isotonic but without electrolytes and glucose is broken down rapidly

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12
Q

Describe how glucose 5% acts in the body

A

1) Fluid stays in circulation for a few minutes and then is distributed into cells (so intracellular)
2) Doesn’t increase blood glucose (maybe just temp)
3) Not nutritional → doesn’t cover calorie intake

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13
Q

What is dextrose saline used for?

A

Maintenance → it covers sodium and water requriement

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14
Q

What is normal saline used for?

A

One bag (1L) meets daily sodium need in one dose

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15
Q

What is an example of a balanced crystalloid fluid?

A

Hartmann’s

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16
Q

What fluid does balanced crystalloid reflect?

A

ECF (physiological) → basically dextrose saline and potassium + buffer

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17
Q

What can balanced crystalloid not be used for?

A

Replacing potassium → only has 5mmol so not enough to replace intracellular potassium

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18
Q

When should you not give balanced crystalloids and why?

A

Hyperkalaemia → might push them over the edge into cardiac arrhythmia

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19
Q

What do colloids contain and therefore where does it stay?

A

Molecules that don’t cross semi-permeable membranes e.g. proteins → therefore the fluid mainly stays in the plasma volume

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20
Q

What is the ultimate colloid?

A

Blood

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21
Q

Why can colloids be better to use than balanced crystalloid?

A

Bc BP stays up longer

22
Q

What are other colloids?

A

Albumin, gelatine

23
Q

What is the difference between treating a healthy euvolaemic patient who is NBM and someone who is susceptible to fluid overload but is also euvolaemic and NBM?

A

Healthy → better to go slightly over bc otherwise they often lie there thirsty

Susceptible to fluid overload (heart/liver/kidney failure) → don’t do this

24
Q

What are the principles when giving IV fluids?

A

1) Assess patients regularly, keeping a careful fluid balance chart
2) Stop IV fluids as soon as not required → much better to drink
3) If on IV fluids for > 3 days use oral/enteral feed or TPN (can be on IV TPN for a long time) if necessary
4) Include fluid given in IV drugs and pumps

25
Q

How much volume do you give for maintenance?

A

Normal amount

26
Q

How do you decide the composition of IV fluids?

A

Current and previous losses

27
Q

What are examples of fluid loss?

A
  • Nasogastric aspirate, vomit → loss of sodium, chloride, some potassium
  • Drains
  • Urine
  • Diarrhoea/stoma
  • Skin
  • Blood
28
Q

What are the rules of replacement therapy?

A

1) Prescribe for routine maintenance requirement + additional fluid and electrolyte supplements to replace the measured abnormal ongoing losses
2) Monitor and reassess fluid and biochemical status by clinical and laboratory monitoring
3) Seek expert help promptly bc getting it wrong can be fatal

29
Q

What is resuscitation therapy used?

A

If a patient is hypotensive (shock) if the cause is hypovolaemia

30
Q

How do you give resuscitation therapy in shock?

A

1) Test the response to fluid with a fast IV bolus of a crystalloid → 250ml over 30 mins
2) Reassess the patient using ABCDE approach and repeat the above if necessary
3) Use blood as soon as available in patient is bleeding
4) Seek expert help early

31
Q

What do you use normal saline for?

A

Resuscitation

32
Q

What do you use balanced crystalloid for?

A

Resuscitiation

33
Q

What do you you 5% glucose for?

A

Maintenance

34
Q

What do you use dextrose saline for?

A

Maintenance

35
Q

What do you use colloids for?

A

Resuscitation

36
Q

How do you treat hyponatraemia with hypovolaemia?

A

Correct volume depletion e.g. IV 0.9% saline

37
Q

How do you treat hyponatraemia with euvolaemia?

A

1) Treat underlying cause

2) Fluid restriction

38
Q

How do you treat hyponatraemia with hypervolaemia?

A

1) Underlying cause
2) Restriction
(vasopressin receptor antagonists)

39
Q

When is aggressive therapy for hyponatraemia indicated?

A
  • Severe symptoms

- Acute hyponatraemia (<24h)

40
Q

What do you do in aggressive hyponatraemia therapy?

A

1) Careful monitoring → raise serum sodium by 4-6 mmol/L over a few hours and no more than 8 mmol/L/day
2) Hypertonic 3% saline may be indicated but seek expert help

41
Q

What is the risk of rapid correction of low sodium (hyponatraemia)?

A

Risk of central pontine myelinolysis

42
Q

How do you treat chronic hypernatraemia?

A

1) Treat underlying cause
2) Use of hypotonic fluid e.g. 5% dextrose given slowly
3) Lower sodium by a maximum of 10 mmol/L per day
4) Always re-assess

43
Q

How do you treat hypernatraemia in an acute emergency?

A

1) Hypotonic fluid
2) Lower sodium by 1-2 mmol/L per hour to restore normal sodium levels within 24h
3) Bc the acute increase in plasma sodium can lead to irreversible neurology seek expert help

44
Q

How do you treat hypokalaemia?

A

1) Correct Mg levels
2) K replacement (oral or IV) → if IV, maximum 10-20 mmol/hr and cardiac monitoring
3) Address the cause
4) Give oranges or bananas

45
Q

What fruit should you give to someone in renal failure with hyperkalaemia?

A

Apples (not bananas or oranges)

46
Q

How do you calculate HR on an ECG?

A

300/number of big squares

47
Q

How do thiazides work?

A

1) Block reabsorption of sodium and chloride in DCT
2) Increase sodium to distal nephron
3) Make you pee out more

48
Q

Why does caffeine make you pee more?

A

Bc it suppresses ADH

49
Q

How do you treat hyperkalaemia?

A

1) IV calcium gluconate → antagonise membrane action of high K
2) IV insulin with glucose, sodium bicarbonate or beta agonists → drive K into cells
3) Remove K from the body → loop diuretics, haemofiltration or haemodialysis
4) Treat underlying cause
5) Monitor
6) Longer term → drug and diet changes

50
Q

Where are IV fluids administered and how do they re-distribute?

A

They are administered into the intravascular space but re-distribute differently according to their composition

51
Q

What should rate of correction of electrolyte disturbances be related to?

A

The rate of onset of electrolyte disturbance

Stage 2: Supporting Life (30 decks)

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