Fluids, Electrolytes & Nutrition MCQs

This is characterized by shift in fluid and electrolyte shift in malnourished patients undergoing refeeding. It is more common with parenteral fluids . It results in hypophosphatemia, hypocalcemia and hypomagnesemia. Reference: Bailey & Love's short practice of surgery, chapter: 25, Edition: 28 th , Pg: 338

Explanation: Inotropic agents should never be started without ensuring adequate preload. In shock, the first step is to restore circulating volume with crystalloids. Starting inotropes before correcting hypovolemia can worsen ischemia, increase oxygen demand and cause arrhythmias. Principles of fluid therapy in shock: The first step is to gain rapid venous access with a short, wide-bore cannula and begin crystalloid infusion. (Option A) Ringer lactate is considered the most physiological crystalloid solution due to its electrolyte composition. ( Option C) Colloids (like albumin) are not recommended in the immediate resuscitation period because crystalloids are faster, safer and more accessible. (Option B) Inotropes are only considered after adequate fluid resuscitation if hypotension persists. (Option D)

100*3.4=340 kcal from dextrose 40*10=400 kcal from lipid 30*4=120 kcal from aminoacid Total 860 kcal Reference: https://jamieberray.weebly.com/uploads/5/3/0/9/53090885/parenteral nutrition calculations.pdf

Option A : Peripheral feeding is appropriate for short term feeding up to 2 weeks. Option B : Common disadvantage which is seen after peripheral feeding is Thrombophlebitis, which irreversibly damage vein. Option C : For central parenteral feeding Hickman lines are preferable as they Minimize possibility of line dislodgement and reduce the possibility of Sepsis. Option D : Common metabolic complications following central feeding includes fluid overload, hyperglycaemia, abnormalities of liver function and vitamin deficiencies. Fluid overload can be avoided by daily weighing of the patient. A weight change of >1 kg/day normally indicates fluid retention. Reference: Bailey & Love's short practice of surgery, chapter: 25, Edition: 28 th , Pg: 338-340

Please remember that 5%dextrose in water is isotonic when it is in pint form but when administered in body, Dextrose will rapidly utilize and then it will act as hypotonic fluid. So, if asked without mentioning in body go with 5% Dextrose as isotonic Fluid. Ringer solution is similar to Ringer lactate, but it has no lactate as content. Reference: Bailey and Love’s Short Practice of surgery 28 th edition Chapter 2 page no 18

Explanation: According to the provided guideline, adult maintenance fluid rate is calculated as: weight in kilograms + 40. For a 65-kg patient, maintenance fluid would be 65 + 40=105 ml/hour. This is the safest and most accurate maintenance rate for an adult of this weight after stabilization from shock.

Explanation: Nutritional support (enteral or parenteral) should be considered when a patient has inadequate intake for 5 days or more , as metabolic stress and protein-energy deficit begin to significantly affect clinical outcomes around this timeframe. Guidelines for initiating nutritional support: 5 days of inadequate intake - initiate support to prevent malnutrition Earlier initiation (within 1-3 days) is recommended in critically ill or high-risk patients Enteral nutrition is preferred over parenteral whenever feasible Goals: maintain lean body mass, support immune function, reduce complications

Any patient who has sustained 5 days of inadequate intake or who is Anticipated to have no or inadequate intake for this period. Reference : Bailey & Love's short practice of surgery; chapter: 25; Edition: 28 th ; Pg: 335