Urinary > Fluid Replacement Therapy > Flashcards

Fluid Replacement Therapy Flashcards

(42 cards)

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1
Q

What % of the total body weight is fluid in a newborn baby?

A

75%

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2
Q

What % of the total body weight is fluid in the eldery?

A

45%
Decreasing muscle mass

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3
Q

What % of the total body weight is fluid in a man?

A

60%

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4
Q

What % of the total body weight is fluid in a female?

A

55%

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5
Q

Why does fluid take up more of the total body weight in men than women?

A

Men have more muscle mass
Water is stored in the muscle

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6
Q

outline the fluid compartments of the body

A
  • intracellular space 2/3
  • extracellular space 1/3 > intravascular space 25% + interstitium 75% + third space
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7
Q

What is the ‘third space’?
examples

A
  • areas of the body that do not normally contain fluid
  • peritoneal cavity > ascites
  • joints > joint effusions
  • pericardial cavity > pericardial effusions
  • pleural cavity > pleural effusions
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8
Q

what is third spacing?

A

fluid shiifting into non functional third space > oedema, hypotension + reduced perfusion

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9
Q

Why do patients need fluids?

A

Nil by mouth
Malfunction in GI tract
Dehydration
Fluid loss
Abnormal electrolyte levels

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10
Q

What is insensible fluid loss?

A

fluid output that is difficult to measure e.g. respiration, sweat, stools, burns

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11
Q

What are the 5Rs of fluid prescription

A

Resuscitation
Routine Maintenance
Replacement + Redistribution
Reassessment

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12
Q

How can you add K+ to fluids?

A

As KCl
As 20 or 40mmol

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13
Q

What happens if you administer 5% dextrose in 1L bag?

A
  • glucose taken up by cells rapidly
  • H2O is left and distributed through all compartments
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14
Q

What happens if you administer 0.9% saline?

A
  • osmolarity is similar to ICF so liquid says in ECF
  • distributes proportionally between interstitium 75% and plasma 25%
  • contains Na+ and Cl-
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15
Q

What happens when you administer Hartmann’s?

A
  • osmolarity is similar to ICF so liquid says in ECF
  • distributes proportionally between interstitium 75% and plasma 25%
  • contains Na+, Cl-, K+, Ca+ and lactate (HCO3-)
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16
Q

What fluids are the first choice for resuscitation?

A

Hartmann’s
Saline

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17
Q

What happens when you administer 4% dextrose/0.18% saline in a 1000ml bag?
(200ml 0.9% saline + 800ml 5% dextrose)

Study These Flashcards
A
  • 800ml H2O reduces osmolarity across ALL compartments from 5% dextrose (+glucose taken up by cells)
  • 200ml 0.9% saline remains in ECF + distributes proportionally across interstitium 75% + intravascular space 25%
18
Q

When are maintenance fluids needed?

Study These Flashcards
A

Patient is haemodynamically stable but unable to meet their daily fluid requirements via oral or enteral routes
e.g. Nil by mouth before surgery

19
Q

When are resuscitation fluids needed?

Study These Flashcards
A

Patients in hypovolaemic state

20
Q

When are replacement fluids needed?
How do you decide what is needed?

Study These Flashcards
A
  • required to replace the loss of bodily fluids
  • choice of fluid depends on what’s being lost
  • context dependent: volume needed, is it ongoing?
21
Q

What time should you administer maintenance fluids?
Why?

Study These Flashcards
A

During the daytime
To prevent sleep disturbance

22
Q

What are indicators that a patient may need urgent fluid resuscitation?

Study These Flashcards
A
  • Systolic BP <100mmHg
  • > 90bpm
  • Cap refil time >2 seconds
  • Cold peripheries
  • > 20 resp rate
  • NEWS >5
  • Passive leg raising suggests fluid responsiveness
23
Q

How much water do you need a day?

Study These Flashcards
A

25-30ml/kg/day

24
Q

How much glucose is needed per day?

Study These Flashcards
A

50-100g
Regardless of weight

25
How much K+ Na+ Cl+ is needed per day?
1mmol/kg/day
26
What is the composition of extracellular fluid?
75% interstitial fluid 25% plasma
27
Examples of crystalloid fluids
Saline Dextrose Hartmann’s
28
Why is saline used for bolus fluids but not maintenance? What risk does it have?
Risk of hypercholermic metabolic acidosis
29
What are the types of fluids you can give? Composition Examples
- **crystalloids**: small molecules that can diffuse through capillary wall *e.g. saline, hartmann’s dextrose* - **colloid**: large molecules that do not diffuse out of capillaries *e.g.blood*
30
When would you give 3% hypertonic saline?
In patients with raised intracranial pressure
31
When would you give 7% hypertonic saline?
Nebulised to help with respiratory secretions
32
What acid base status can be improved by giving fluids?
Metabolic acidosis
33
Outline resuscitation fluids
- **Saline 0.9% or Hartmann’s 500ml over 15 mins** - if risk of fluid overload: 250ml over 15 mins - seek senior helps if needing >2L . - if due to haemorrhage, replace with blood
34
What needs to be replaced in diarrhoea patients?
HCO3-
35
Outline resuscitation fluids in paediatrics
- **Hartman’s or 0.9% saline 10ml/kg in 15 mins** - normally intraosseous - seek senior helps at 40-60ml/kg
36
Outline maintenance fluids in paediatrics
- Holliday Segar method - **4,2,1 method** - first 10kg: 4ml/kg - second 10kg: 2ml/kg - every kg after: 1ml/kg - **0.45% saline 20mmol/L KCl + 5% dextrose**
37
Prescribe maintenance fluids in a 36kg child
- 4,2,1 - first 10kg: 4x10 = 40ml/kg - second 10kg: 2x10 = 20ml/kg - every kg after: 1x16 = 16ml/kg - total: 40+20+16 = 76ml/hr - of 0.45% saline 20mmol/L KCl + 5% dextrose
38
Outline replacement fluids in paediatrics
- **%dehydration x weight (kg) x 10 = fluid deficit (ml) over 12-24 hours** - moderate dehydration: 5% - severe: 10% - critical: 15%
39
Calculate the replacement fluids in a 7 year old 22kg child with moderate dehydration
**%dehydration x weight (kg) x 10 = fluid deficit (ml) over 12-24 hours** - 5% x 22 x 10 = 1100ml over 12-24 hours of 0.45% saline 20mmol/L KCl + 5% dextrose
40
What fluids do you give for maintenance + replacement in paediatrics?
0.45% saline 20mmol/L KCl + 5% dextrose
41
signs of hypovolaemia
- hypotension - tachycardia - cap refill >2 seconds - cold peripheries - tachypnoea - dry mucous membranes - reduced skin turgor - reduced urine output - sunken eyes
42
signs of fluid overload
- peripheral oedema - pulmonary oedema > SOB, reduced O2 stats, bibasal crackles - raised JVP - increased boyd weight from baseline
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