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Flashcards in Fluid And Electrolyte Deck (41)
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1
Q

Why prescribe IV

A

Maintainance - vomiting and diarrhoea

Replacement- people that are already dehydrated

Resuscitation- rapidly restore after haemorrhage or shock

2
Q

Total body water is what % of weight

A

60 man

50-55 woman

3
Q

icf

Ecf % of total water

A

ICF 60

EFC30

4
Q

How does fluid enter body

A

Food drink

Metabolism

5
Q

How fluid lost

A

Faeces
Sweat/skin
Lungs

6
Q

What% of NA in body not exchangeable

Exchangeable

A

25 non

75 exchangeable

7
Q

Normal range of NA in plasma

A

135-145 mmol/l

8
Q

Sodium excretion regulated by

A

Renin-Angiotensin-Aldosterone • Natriuretic Peptides • Intrinsic Renal mechanisms

9
Q

Osmoreceptor detect

A

Increased osmotic pressure

10
Q

Baroreceptors

A

Detect decrease blood pressure

11
Q

Aim of fluid replacement

A

Maintain normovolaemia
Main Tain electrolyte concs
Compensate extra fluid loss

12
Q

Features of colloids

E.g

A

Stay in compartment administered to
Mainly in plasma
E.g blood

13
Q

Normal prescription for someone who is otherwise well and has no extra losses

A

So… 1L Normal Saline 0.9% & 2L 5% dextrose with added K+
Or… 3l dextrose saline with k+

14
Q

How to maintain patient with physiological losses

A

AsAssess patient regularly. Keep a careful fluid balance chart • Stop iv fluids as soon as not required • > 3 days use oral/enteral feed or consider total parenteral
nutrition if necessary • Include fluid given in IV drugs, and pumps

15
Q

Entrap feed is

A

Straight through GI

16
Q

Parenteral feed is

A

Not through GI

17
Q

Fluid balance assessment

A

Limbs – temperature, pulse (volume and rate), BP sitting and standing
(postural), skin turgor, peripheral oedema • Head and neck - ? Sunken eyes, mucous membranes, JVP, carotid pulse • Chest – Capillary refill, lung auscultation for pulmonary oedema • Abdomen - ? ascites • Fluid balance chart • Weight chart

18
Q

Resuscitation therapy used when

A

Re suscitation therapy is used when a patient is hypotensive

19
Q

First thing todo in resuscitation therapy

A

Test the response to fluid with a
fast IV bolus of a crystalloid • Reassess the patient using ABCDE
approach and repeat the above if
necessary • Use blood as soon as available if
the patient is bleeding • Seek expert help early

20
Q

Hyponatremia is

A

NA less than 135 mmol/l

21
Q

Hyponatraemia results from

A

The intake and subsequent retention of water. Excess of water in relation to Na

Depletion of total body Na in excess of concurrent body water losses

22
Q

Hyponatraemia Good history and examination of the patient can lead to

A

Causes and rapidity of condition

23
Q

Hyponatraemia key feature

A

Volume status of patient

24
Q

Symptoms of mild hyponatraemia

A

• MILD hyponatraemia (130-135 mmol/L) – Asymptomatic

25
Q

Symptoms of moderate hyponatraemia

A

MODERATE hyponatraemia (121-129 mmol/L) – Cramps, Weakness, Nausea

26
Q

Symptoms of severe hyponatraemia

A

SEVERE hyponatraemia (<120 mmol/L) – Lethargy, Headache, Confusion

27
Q

Severe and rapidly evolving hyponatraemia symptoms

A

Severe and rapidly evolving hyponatraemia – Seizures, Coma, respiratory arrest

28
Q

Treatment of hyponatraemia

A

Hypovolaemia – Correct volume depletion e.g. IV 0.9% saline

• Euvolaemia – Underlying cause, fluid restriction

• Hypervolaemia – Underlying cause, fluid restriction, (vasopressin receptor
antagonists)

29
Q

Aggressive therapy for hyponatraemia when

A
Severe symptoms 
Acute onset (less than 24 hours)
30
Q

Hypernatraemia is i

A

NA over 145 mmol/l

31
Q

Hypernatraemia results from

A

Net water loss

Hypertonic NA gain

32
Q

Symptoms of hypernatraemia

A

Similar to hyponatraemia

33
Q

Hypernatraemia treatment

A

Chronic hypernatraemia
• Treat underlying cause • Use of hypotonic fluid e.g. 5% Dextrose givne slowly •
Lower Na by maximum of 10 mmol/L per day • Always re-assess

34
Q

Hypokalaemia is

A

Less tthan 3.5 mol/l

35
Q

Hypokalaemia results from

A

Decreased K intake (rare) • Increased entry into cells • Increased losses - GI / urine

36
Q

Symptoms of hypokalaemia

A

Muscle weakness

ECG change and arythmias

37
Q

Hypokalaemia ECG

A
Flat	T	wave
• U	waves
• ST	depression
• PR	interval	prolonged
• Prolonged	QT	interva
38
Q

Hyperkalaemia is

A

K over 5.5 mol/l

39
Q

Symptoms of hyperkalaemia

A

Paraesthesiae
• Muscle weakness – paralysis
• Arrhythmias

40
Q

Hyperkalaemia ECG changes

A
Tall	peaked	T	waves
• Shortened	QT	interval
• PR	interval	lengthening
• QRS	widening
• P	waves	disappear	– Sine	wave
41
Q

Hyperkalaemia treatment

A

IV calcium gluconate – antagonise membrane action of high K
• IV insulin with glucose – drive K into cells
• Remove K from the body
• Consider loop diuretics • Consider haemodialysis or haemofiltration
• Other therapies to drive K into cells
• Sodium bicarbonate • Beta agonists
• Monitor
• Treat underlying cause
• Longer term – drug changes, diet changes