Fluids

Question 1

What is normal urine output?

Answer 1

> 0.5ml/kg/hour

Question 2

What are the signs of fluid depletion?

Answer 2

• Dry mucous membranes,
• Reduced skin turgor,
• Decreasing urine output,
• Orthostatic hypotension,
• Hypotension
• Tachycardia

Question 3

What are the signs of fluid overload?

Answer 3

• Raised JVP,
• Oedema,
• Lung crackles (pulmonary oedema)

Question 4

Explain a fluid challenge

Answer 4

Roughly 500mls of fluid over 15mins (Or 250mls over 15-30mins). Fife prefer PlasmaLyte as it is better handled than 0.9% saline

• If patient has comorbidities like heart failure, renal impairment or elderly then give 250mls
• Can go up to 2000ml but if reach this limit then seek senior help

Question 5

What rate do you give maintenance fluids

Answer 5

30mls/hour/24 hours

- Never give more than 100mls/hour for maintenance fluids

Question 6

What are the electrolyte requirements?

Answer 6

Sodium - 1mmol/kg/24 hours.
Potassium - 1mmol/kg/24hours
Calories - 50-100g of glucose in 24 hours.

Question 7

How do you give replacement fluids?

Answer 7

Estimate the losses over the past 24 hours then give this volume as PlasmaLyte or 0.9% NaCl in the case of upper GI loss or bile loss. This is on top of maintenance fluids.
Diarrhoea may result in loss of potassium

Question 8

What is the preferred fluid for maintenance in fife?

Answer 8

0.18% NaCl 4% glucose