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Michaelmas 5th year > ECC fluids and blood products > Flashcards

ECC fluids and blood products Flashcards

1
Q

How is body water distributed

A

66% is ICF
33% is ECF; within this 75% is interstitial and 25% intravascular

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2
Q

Mechanisms of intravascular dehydration + potential causes

A

Haemorrhage
Vasculitis

e.g due to trauma, coagulopathies, sepsis/SIRS, allergic reactions, viral disease

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3
Q

Mechanisms of interstitial dehydration and potential causes

A

Third space loss, polyuria, hypernatraemia

e/g due to GDC, pyometra, burns, diabetes, chronic renal failure,

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4
Q

Mechanisms of intracellular dehydration and examples of potential causes

A

Hyperglycaemia/increased blood osmolarity
Loss of free water

e.g due to diabetes + ketoacidosis, ethylene glycl toxicity

Fever, heat stroke, diarrhoea, mannitol administration

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5
Q

What are the two particle size categories for fluids and how does this property affect our choice

A

Crystalloids contain small particles that cross biological membranes easily; so good to treat cellular and interstitial dehydration

Colloids contain larger particles that are retained in the intravascular space for longer so act to expand blood volume by increasing colloid osmotic pressure
- Good for intravascular dehydration

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6
Q

Difference in composition between crystalloids for replacement/resuscitation vs maintenance

A

Replacement/resus: = similar composition to ECF to allow large volumes to be administered quickly without causing any major changes in electrolyte concentrations

Maintenance: for longer term use e.g if not eating/drinking; contains more K+ (body consumes more of this) and less Na+ (body copes less well with lots of this)
- More K+ less Na+

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7
Q

What is the Hamburger shift and which fluid solution do we see it with

A

= when excess Cl- in NaCl solution enters RBCs; to maintain electroneutrality, bicarbonate leaves the cell causing plasma bicarbonate to rise
- Then this is eliminated by kidneys so net = elimination and get acidifying effect

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8
Q

What is NaCl 0.9% solution used for and when do we take care

A

For replacement
Care with use in renal and cardiac disease due to the high sodium

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9
Q

When might we use hypertonic saline (NaCl 7.2%) fluids

A

To treat severe hypovolaemia e.g after haemorrhage as it quickly drives large volumes of fluids from intertitium/cells into the vasculature
- 1ml increase circulating volume by 3ml for up to 1hr

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10
Q

How does hypertonic saline affect the heart

A

+ve inotropic effect because cells shrink so the intracellular Ca2+ concentration increases

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11
Q

What type of solution is HArtmann’s

A

Alkalinising solution due to lactate
= lacatated Ringer’s

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12
Q

How does Hartmann’s cause alkalinising effect

A

Gluconeogenesis of lactate consumes H+

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13
Q

dextrose 5% solution fluid properties

A

Provides energy
Causes transient osmotic diuresis since glucose is diuretic

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14
Q

What do we use to treat cellular dehydration

A

NaCl 0.18% and dextrose 5%

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15
Q

How can we alter NaCl 0.18% + Dextrose 5% to use it for maintenance

A

Add KCl
NB: must monitor blood glucose to avoid hyperglycaemia

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16
Q

What colloid solution is used most commonly

A

Succinylgelatins
each 1ml infused increases the plasma volume by 2ml
Lasts 2-4hrs

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17
Q

What are the possible side effects with succinylgelatins

A

Allergic reactions
Possible hypocalcaemia

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18
Q

What is the priority if there are signs of hypovolaemia

A

Improve perfusion first
Then in longer term can think about interstitial and cellular dehydration

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19
Q

Typical maintenance and intra-operative rate for crystalloid fluids

A

Maintenance = 2ml/kg/hr
Intra-operative = 4-5ml/kg/hr

20
Q

Calculating colloid fluid dosing

A

%dehydration x body weight = L of fluid
Give over 6-12hrs for acute loss or 12-48hrs for chronic loss

21
Q

What can we consider an end point of fluids

A

Normalisation of ABP
Improved mentation
Increased urine output

22
Q

Restrictive vs liberal decision on transfusing based on PCV

A
  • Restrictive: transfuse at 21%
  • Liberal: transfuse at 25-27% e.g for acute perioperative bleeding
23
Q

When to transfuse in relation to [Hb]

A

AT <5g/dL

24
Q

Out of anaemia and hypovolaemia which do we correct first

A

Correct blood volume at expense of PCV first
- While doing this can make transfusion arragngements

25
Q

Properties of whole blood as a blood product

A

Contains platelets and labile coagulation factors
- If platelets/coagulation factors needed and if stored products not available
- In cases of whole blood loss

26
Q

Properties of packed RBCs as a blood product

A

Just RBCs; good shelf life of 42 days
- Use if only RBCs are needed; IMHA, CKD, haemolysis

27
Q

What electrolyte abnormality can packed RBCs case due to citrate preservative

A

Hypocalcaemia

28
Q

Properties of frozen plasma as a transfusion product

A

Provide albumin and vitK-depedent coagulation factors BUT NOT labile ones
- So good for rodenticide intoxication
- Can use for hypoalbuminaemia if albumins not available

29
Q

Properties of fresh frozen plasma and what makes it different to frozen plasma

A

= frozen within 8hrs of collection to -20*C
- Contains albumin and all coagulation factors
- Can be used for vWD and haemophilia A

30
Q

What are human albumins used for and what are the negatives

A

Hypoalbuminaemia that has decreased by >50%
Some reports of allergic reaction; expensive

31
Q

What are some potential side effects of transfusion

A
  • Nausea/vomiting
  • Fever = sign of a reaction or contamination of bad and infection
  • Sepsis due to contaminated blood
  • Allergic reactions; usually minor
  • Hypocalcaemia and thrombocytopaenia
32
Q

What is the most antigenic part of the blood

A

RBCs; so reactions more common with RBC infusion vs plasma

33
Q

What is the major crossmatch

A

detection of antibodies in recipient’s serum to donor RBCs; for red cell infusions

34
Q

What is the minor cross match and when is it especially important

A

looking for antibodies in DONOR serum against recipient RBCs which could cause haemolysis in recipient

Important in cats and for plasma infusion

35
Q

Once blood products are open when should they be used within

A

4 hrs

36
Q

What is PaCO2

A

Arterial CO2 partial pressure
- If elevated indicates hypoventilation

37
Q

What does it mean acid-base imbalance is characterised by primary increase in PaCO2

A

Respiratory acidosis

38
Q

What is PaO2

A

Arterial partial pressure; indicates the partial pressure of O2 DISSOLVED in blood; doesnt tell us about haemoglobin bound portion

39
Q

What is the main buffer substance in the blood

A

HCO3- bicarbonate

40
Q

What is base excess

A

Difference between actual buffer base content and expected base content
- If +ve suggests alkalosis
- If -ve suggests acidosis

41
Q

What does a high anion gap mean

A

Either decreased HCO3- (metabolic acidosis)
Or high Na+ (dehyration, tissue metabolic acidosis)

42
Q

What might cause a decreased anion gap

A
  • Severe hypoalbuminaemia so less bound to Na+ (= Gibbs-Donnan effect)
  • Haemodilution in fluid therapy
  • Specific diseases e.g multiple myeloma in humans
43
Q

What is the gibbs-donnan effect

A

When severe hypoalbuminaemia means less Na+ bound to protein so can get decreased anion gap

44
Q

What are common causes of hyperchloraemia

A

Diabetes, renal failure

45
Q

How do we tell what the primary acid/base disturbance is and what is compensation

A

The compensation doesnt usually override the primary issue i.e pH still acidotic in compensated metabolic acidosis

46
Q
A

Michaelmas 5th year (41 decks)

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