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21 Cards in this Set

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Total body water in 70kg male

42l


- 60% of body weight

Volume of ICF in 70kg male


- fraction

28l
- 2/3

Volume of ECF in 70kg male


- fractions

14l


- 1/3

Components of ECF


- fractions

- plasma: 5l (1/9)


- interstitial fluid: 9l (2/9)

2

Daily water requirements for a 70kg male


- per hour

2.5-3l


- 1.5ml/kg/hr

Daily sodium requirements for a 70kg male
- per hour

70-140mmol


- 1-2mmol/kg/hr



Daily potassium requirements for a 70kg male


- per hour

35-70 (60) mmol


- 0.5mmol/hr/kg

Minimal obligatory volume of urine per day


- per hour

1l


- 0.5ml/kg/hr (35ml)

Types of IV fluids

Colloids




Crystalloids


- Hartmann's solution, aka Ringer's lactate


- normal saline


- 5% dextrose

4

Normal saline (NaCl 0.9%) components

Distributed throughout all ECF (isotonic), so only 1/3 enters plasma


- sodium: 154mmol


- chloride: 154mmol


Causes hyperchloraemic acidosis in excess and places a load on the kidneys

2

Hartman's solution components

Most physiological fluid and used for replacing plasma loss (not maintenance). It is hypotonic, so distributes throughout ICF & ECF, meaning only 1/9 enters plasma


- sodium: 131mmol


- chloride: 111mmol


- potassium: 5mmol


- bicarbonate: 29mmol

4

5% dextrose components

Maintains osmolality


- glucose: 50g

1

Assessing fluid loss

- Hx


- vitals


- examination: hydration status


- fluid balance chart: input/output


- U&Es

5

Replacing fluid loss

Give maintenance fluids and replace fluid that has been lost
- 1 salty, 2 sweet (each over 8hrs with 20mmol of K in each bag)

1

Replacing ECF loss (V&D, NG aspirate, stomas, burns, pacreatitis)

Hartman's solution

1

Replacing blood loss

- blood products


- FFP/platelets: if continued blood loss

2

Signs of shock: class 1

0.75l of fluid lost
- mild tachycardia

1

Signs of shock: class 2

0.75-1.5l of fluid lost


- tachycardia


- hypotension

2

Signs of shock: class 3

1.5-2l of fluid lost


- tachycardia


- hypotension


- confusion

3

Signs of shock: class 4

>2l of fluid lost


- critical tachycardia


- hypotension


- confusion

3

Fluid challenge

If patient is hypotensive


- 500ml of crystalloid over 15mins


- monitor response: BP, urine output, JVP


- give maintenance fluids if there is a response


- if there is no response, the patient is overloaded (don't give fluids) or depleted (give lots of fluids)

4