1. Fluid Management Alistair Ward 16/11/12

2. Hypotonic solutions Hypertonic Solutions Crystalloids Colloids Isotonic Solutions

3. Scenario 1 10 Yr old male. 4wk Hx of polyuria, polydipsia, nocturia.BM is normal. He has a hypernatraemia. What is the correct fluid management? • Glucose 5% in water • 0.9% Saline • 0.45% Saline • Glucose 5% in half normal saline solution • Hartmann’s

4. Scenario 1 • Diagnosis: Diabetes insipidus • Answer: Glucose 5% in water

5. Crystalloids: Isotonic Solutions Glucose 5% in Water Uses • Hypernatraemia • Cautions • Becomes hypotonic when glucose metabolised • Not for rescuss: may cause hyperglycaemia • Not enough calories for daily use

6. Crystalloids: Isotonic Solutions 0.9% Saline Uses • Shock • Hyponatraemia • Initial fluid in DKA Cautions • Can cause fluid overload • Replaces EC fluid • Not for HF

7. Scenario 2 • 23 Yr old male. Returns from India three wks ago. Severe diarrhoea. Malaise, headache, fever and rose spots on trunk. Signs of dehydration • What is the correct fluid management? • Glucose 5% in water • 0.9% Saline • 0.45% Saline • Glucose 5% in half normal saline solution • Hartmann’s

8. Scenario 2 • Diagnosis: Enteric Fever • Answer: 0.9% Saline or 0.45% Saline

9. Crystalloids: Hypotonic Solutions 0.45% Saline Uses • Gastric fluid loss • Cautions • Trauma • Burns • Liver Disease • Can cause • Raised intracranial pressure and cerebral oedema

10. Scenario 3 24 Yr old male, PMH of Addison’s disease. Collapsed following 2/7 Hx of N+V. What is the correct fluid management? • Glucose 5% in water • 0.9% Saline • 0.45% Saline • Glucose 5% in normal saline solution • Hartmann’s

11. Scenario 3 • Diagnosis: Addison’s Crisis • Answer: 5% glucose in normal saline solution

12. Crystalloids: Hypertonic Solutions 5% glucose in normal saline solution Uses • SIADH • Addison’s Crisis Cautions • Heart Failure

13. Colloids Types • Albumin • Plasma protein fraction Use is controversial due to higher risk of IV complications. • Phlebitis • Infection • Extravasation

15. DKA Presentation • Polydipsia,Polyuria • Malaise, Generalized weakness, fatigability • Nausea and Vomiting • Abdo pain, decreased appetite, anorexia • Weight loss • Confusion • Coma • Infection symptoms

16. DKA Diagnosis • Tests to confirm the diagnosis and monitor the patient • Blood ketones, • plasma glucose, • urea and electrolytes, • blood gases, • Results • Ketones, High BM, Hyperkalaemia, Acidosis

17. DKA • Tests to rule out other pathologies • full blood count (FBC), • blood cultures, • ECG, • chest X-ray, • urinalysis and culture, • continuous cardiac monitoring, • continuous pulse oximetry

18. DKA Management • Fluid loss- 0.9% NaCl 500mls over 15 mins • Hyperglycaemia- Fixed rate insulin infusion with NaCl • Electrolyte imbalance- K+ may fall dramatically after treatment with insulin • Acid-base balance Order? • Fluid and Electrolyte loss • Hyperglycaemia and acid base balance

20. Questions?

21. Resource Survey GnRH CORPUS LUTEUM BREAK DOWN = FALL IN PROGESTERONE = MENSES