4: IV fluid prescribing

Question 1

Why may patients be given fluids?

Answer 1

Resuscitation in emergencies

Replacement in deficiency (could also be an emergency)

Routine maintenance

Question 2

It is important that people being given IV fluids are ___.

Answer 2

reassessed

Question 3

passive leg raise for indication of fluid level

Question 4

If a patient is hypotensive, how much fluid can you give them in 500ml boluses before you should call for help?

Answer 4

2L

Question 5

If a patient is at risk of heart failure, you should give ___ml boluses of fluid.

Answer 5

250ml

Question 6

look at values for routine maintenance

Question 7

look at table for types of fluid therapy and what to use for each

Question 8

In routine maintenance, your daily fluid requirement depends on your ___.

Answer 8

weight

Question 9

All fluids apart from crystalloids (and colloids) rapidly ___ out of the vascular system.

Answer 9

redistribute

Question 10

Why isn’t 0.9% NaCl used for routine maintenance?

Answer 10

Twice the daily Na

Question 11

potassium chloride is almost a controlled drug

Question 12

use hartmann’s in dka (contains K) - hypokalaemia, monitor

Question 13

remember for routine maintenance:

need to make up to 2L

and need to be within daily requirements

you can half / double / mix things

Question 14

When are colloid solutions used?

Answer 14

Severe sepsis

revise that lecture

Question 15

large volume ascites paracentesis in liver failure:

evacuated space > loads of fluid drains in after paracentesis

so blood volume goes down, renals not perfused, nothing else perfused

give colloids (hyperoncotic, stays in the vascular system) to avoid this

Question 16

hepatorenal syndrome in liver failure:

kidneys don’t work

give colloid fluids

Question 17

blood products which can be given IV:

packed red cells

platelets

fresh frozen plasma (full of antibodies)

cryoprecipitate

Question 18

What can cause hyponatraemia?

Answer 18

Too much water (fluid overload e.g SIADH)

Too little salt

Question 19

How do you treat hyponatraemia due to

a) too much water
b) too little salt?

Answer 19

a) Fluid restrict

b) Give 0.9% NaCl

Question 20

Which endocrine disorder causes hyponatraemia in a euvolaemic patient?

Answer 20

SIADH

Question 21

What happens to plasma and urine osmolality in SIADH?

Answer 21

Plasma osmolality decreases - too much salt

Urine osmolality increases - MORE salty water excreted as RAAS turns off

Question 22

In SIADH, urine sodium levels are (high / low).

Answer 22

high

Question 23

How is SIADH treated?

Answer 23

Fluid restrict until cause (inflammation/infection/tumour) is resolved

Question 24

If sodium imbalance is corrected far too quickly, what occurs?

Answer 24

Brain damage

Question 25

Which patients are at risk of brain damage by rapid sodium correct?

Answer 25

Hyponatraemic

Malnutrition

Extremes of age

Question 26

By how much can you change a patient’s [Na] in a 24h period?

Answer 26

4-6

Question 27

Sodium excess / deficiency must be corrected very ___.

Answer 27

slowly

Question 28

In emergency correction of hyponatraemia, how much are you aiming to correct [Na] by?

Answer 28

4-6

just in less time