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Module 6 : Summary

 

 

Module 3 Summary : Prescribing

 

  • Prescribed fluids can be classified into two categories; colloid and crystalloids.
  • Colloids may be used to replace blood components and to expand the intravascular volume by increasing intravascular colloid oncotic pressure. Commonly prescribed colloids include synthetic colloids and human protein solutions.
  • Crystalloid fluids are commonly used for fluid maintenance and distribute freely from the intravascular compartment to the other compartments. Commonly prescribed crystalloids include glucose, saline and physiological solutions.
  • When calculating a fluid regimen, it is necessary to see the patient yourself and assess their current hydration status. In addition it is necessary to assess a patient’s fluid balance from the previous day, the current day and predicted future fluid losses and gains. Consider also in this calculation if there are likely to be radical losses or gains in electrolytes e.g. potassium rich GI losses.
  • In situations of fluid resuscitation in the hypovolaemically shocked patient, there is less concern for the composition of infused fluid but rather the aim is to infuse large volumes fast to maintain blood pressure. However in some cases of massive fluid loss such as DKA, a large derangement in electrolytes can result and so it is necessary to pay careful attention to correcting this.
  • Certain patient groups are at particular risk of fluid overload and thus exceptional care must be taken when prescribing fluids for them. Starting with a small fluid challenge is recommended.  This includes patients with heart failure, liver failure and chronic kidney disease.
  • When IV fluids are being given it is important to review the patient regularly and never prescribe fluids for more than a 24hr period as fluid requirements are likely to change!

 

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