A.1 Flashcards
what determines distribution of water between IC and EC?
And what distributes the water between IC and EC?
Osmotic equilibrium and onconit pressure desides
Na+ K+ Cl- distributes
hormone increasing water reabsorption in kidneys?
ADH
normal plasma osmolarity?
280mOsm/L
daily requirements of Na
1,5-2,5 mmol/kg
max Na C kidney can handle
> 1500 mOSm/kg in healthy
600-800 mOsm/kg in ICU patients
what happens to renal perfusion pressure in ICU patiens?
In healthy individuals without systemic hypertension, intrarenal blood flow is auto-regulated at renal perfusion pressures between 60 and 100 mmHg. During critical illness, these processes may be compromised.
How does pressure affect filtration rate in the kidneys?
The glomerular filtration rate is directly proportional to the pressure gradient in the glomerulus, so changes in pressure will change GFR. GFR is also an indicator of urine production, increased GFR will increase urine production, and vice versa
mechanical ventilation effect on kidneys?
increase renal perfusion pressure by increasing preload on the heart
what effect does hyperthermia have on fluid loss`
increases insensible (skin, lung) fluid loss with 2,5 L/day
what effect does hyperventilation have on fluid loss`
increase insensible fluid loss by 0,5-2 L/day
what effect does tracheostomy have on fluid loss`
increase insensible fluid loss by 0,7 L/day
hypovolemia can cause
*Decreased tissue perfusion
*Tissue hypoxia
*Anaerob metabolism
*Inflammatory cascade↑
*Neutrophil oxidative killing↓
*Wound healing disorder
*Organ dysfunction
hypervolemia can cause
*Oedema
*Anastomosis insufficiency
*Bowel dysfunction, PONV
*Coagulation disorder
*Renal insufficiency
*Cardiopulm. complications
*Organ dysfunction
fluid compartments in the body
─ Intracellular fluid (ICF): 40% of body weight
─ Extracellular fluid (ECF): 20% of body weight
─ Interstitial fluid: 15% of body weight
─ Intravascular fluid: 5% of body weight
how can you increase Preload?
Colloid and Crystaloid solutions
how can you decrease Preload?
diuretics
How to measure CVP?
in SVC and tells us what the preload is
3 methods of measuring SV
PICCO
Swan-Gaz catheter
Echochardiography
best way to measure fluid responsivness?
measuring SV and change in the stroke volume
Normal value of IVC diameter?
1,5-2,5 cm
what can IVC tell us about volume status?
IVC < 1,5cm => volume depletion
IVC > 2,5cm => volume overload
what is the problem with using the gold standars SV do assess fluid response?
What is another option to increase fluids with 300ml withoud actullay giving fluids?
If the patient is already in a good fluid state giving 300ml crystalloid can cause edema
The led raise test because lower extremity containe about 300-400ml fluids
does the acute management of hyperkalemia solve the problem?
No, we need to do hemodialysis to actually remove the K+ from the body
what is the dose of IV K?
what can you do if you want to give a higher dose?
MAX 2g/h!!!! -
PVL- max 2g/500ml IV infusion in a PVK
if you want to give a higher dose use CVK
CVL- max 2g/hr IV KCl (Except in DKA)
