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Module 3 : Prescribing

 

 

Massive Fluid Losses

 

There are some situations in which patients may have lost huge amounts of fluids and electrolytes, which will need replacing. In these cases it is often important to consider the electrolytes as often the repletion takes some hours or days, and these patients may have severely deranged electrolytes on admission. For example, it is not unusual for patients with diabetic ketoacidosis to require 10 or more litres of fluid over 24 hours, with careful monitoring and supplementation of electrolytes.

 

Patients who have had major blood loss may require significant transfusion with packed red cells (and possibly other blood products). These may serve to help maintain blood pressure, as well as replacing lost haemoglobin or other components.

 

 

  Test Yourself !  
   
  Which one of the following would be a priority in treating DKA?

That's correct, well done!
 

They are likely to require potassium supplementation over the first 24 hours of admission – Correct! Potassium supplementation is commonly required. Acidosis causes cells to release potassium in exchange for hydrogen ions. Due to the high blood glucose, there is a heavy diuresis in which the potassium is lost. As the patient is treated and the acidosis corrects, the remaining potassium in the blood is reclaimed by the cells, often leading to hypokalaemia which requires treatment.

 

They are likely to require potassium restriction over the first 24 hours of admission – Wrong answer. This is unlikely due to potassium loss by diuresis. However patients may present with a normal or high potassium due to the high level of blood acidosis.

 

They are likely to require sodium supplementation over the first 24 hours of admission – although they will have lost some sodium during the diuresis phase which may require some correction, potassium is more of a problem. Patients with DKA require large volumes of intravenous fluid resuscitation and it is important not to prescribe excess saline. It is common to prescribe normal saline in the early phase of fluid replacement in order to replace lost sodium, and avoid administering further glucose to an already very hyperglycaemic patient. As this corrects it is best to switch to glucose solutions.

 

They are likely to require sodium restriction over the first 24 hours of admission – wrong answer.

 

Sorry, that's incorrect!
 

They are likely to require potassium supplementation over the first 24 hours of admission – Correct! Potassium supplementation is commonly required. Acidosis causes cells to release potassium in exchange for hydrogen ions. Due to the high blood glucose, there is a heavy diuresis in which the potassium is lost. As the patient is treated and the acidosis corrects, the remaining potassium in the blood is reclaimed by the cells, often leading to hypokalaemia which requires treatment.

 

 

They are likely to require potassium restriction over the first 24 hours of admission – Wrong answer. This is unlikely due to potassium loss by diuresis. However patients may present with a normal or high potassium due to the high level of blood acidosis.

 

They are likely to require sodium supplementation over the first 24 hours of admission – although they will have lost some sodium during the diuresis phase which may require some correction, potassium is more of a problem. Patients with DKA require large volumes of intravenous fluid resuscitation and it is important not to prescribe excess saline. It is common to prescribe normal saline in the early phase of fluid replacement in order to replace lost sodium, and avoid administering further glucose to an already very hyperglycaemic patient. As this corrects it is best to switch to glucose solutions.

 

They are likely to require sodium restriction over the first 24 hours of admission – wrong answer.

 

 

 

 

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