Fluid and Body Therapy - Quiz 4 Flashcards by Donny Le

How much of Total Body Weight is Water?

Water is 60% of TBW

40% Intracellular

20% Extracellular

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What makes up the Extracellular Compartment?

75% Interstitial Volume

25% Plasma

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What is the Total Body Water for Man, Woman, Baby?

Man: 55%

Woman: 45%

Baby: 80%

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What is found in the Intracellular Fluid Compartment?

Potassium (K+), Phosphate (PO₄^3-), & Magnesium (Mg)

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What elements are found in the Extracellular Fluid Compartment?

Sodium (Na+) & Chloride (Cl)

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What affects Fluid movement accross Compartments?

Membrane & Osmotic Properties

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What is the main determinant of Osmotic Pressure?

Albumin

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What is the difference between Osmolarity and Osmolality?

Osmolarity = # of osmoles in a Liter of Solution

Osmolality = # osmoles in a Kg of Solvent

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Whats the difference between Hypovolemia and Dehydration?

Hypovolemia deals with actual fluid loss.

Dehydration deals with concentration in relation to water

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What is Hypervolemia?

Excess fluid in an isotonic concentration

EX: CHF, Renal Failure

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All gain/loss of sodium is accompanied by the gain/loss of what?

Water

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What is the amount of Sodium in the ECV vs ICV?

Extraceullar: 140 mEq

Intracellular: 25 mEq (NaKATPase)

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What are some causes of Hyponatremia?

Adrenal Insufficiancy

SIADH

CHF

Liver Failure

Renal Failure

Nephrotic Syndrome

Diuretics

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What are some symptoms of Hyponatremia?

Neuro problems

Anorexia

N/V

Cramps & Weakness

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How do you treat Hyponatremia

Restrict Fluids

Give 3% Hypertonic Fluid

Osmotic/Loop Diuretic

Correct Slowly or Brain Explodes (1-2 mEq/L per hour)

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What is the most common cause of Hypernatremia?

Water Deficiency: Excessive loss or Inadequate Intake

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What diseases can cause Hypernatremia?

Hyperaldosteronism

Diabetes Insipidus

Renal Dysfunction

Salt Intake

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What are some symptoms of Hypernatremia?

Neuro Problems

Thirst

Hypervolemia

Polyuria or Oliguria

Renal Insufficiency

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How do you treat Hypernatremia?

Replace Water Deficit

Correct Slowly (1-2 mEq/hr)

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What is largely reponsible for Resting Membrane Potential?

Potassium

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How is the amount of Potassium balanced by the body?

Potassium absorbed through GI and excreted by Kidneys

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What are some things that cause Hypokalemia?

GI Loss

DKA

Diuretics

Poor Diet

Systemic Alkalosis

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What are the CV effects of Hypokalemia?

ST Depression & U Wave

Flat T Waves

Ventricular Ectopy

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What are the Neuromuscular effects of Hypokalemia?

Weakness

Decreased Reflexes

Confusion

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How do you treat Hypokalemia in the OR?

Slow IV Potassium Avoid Hyperventilation & Glucose

What are some causes of Hyperkalemia?

Renal Failure Potassium-Sparing Diuretics Giving Too Much K+ & Salt Substitutes

What are factors that alter Potassium Distribution?

Acidosis Digoxin Toxicity Insulin Deficiency Tissue/Muscle Damage Succinylcholine Ace Inhbitors, ARBs, B-Blockers

How would Hyperkalemia look on an EKG?

Tall, Peaked T-Waves Wide QRS Prolonged PR Interval Flat/Absent P-Wave ST Depression Cardiac Arrest

How do you treat Hyperkalemia?

Give Insulin + Glucose to shift K+ into cells IV Calcium Upper Limit of K+ is 5.5 mEq/L

Where is Magnesium stored in the body?

Muscle and Bones: 40-60% Cells: 30% Serum: 1%

Which organs regulate Magnesium?

Intestines & Kidney

What role does Magnesium play in the body?

Enzyme Reactions Protein Synthesis Neuromuscles Na-K-ATPase

What causes Hypomagnesemia?

Poor Intake of Mag TPN w/o Mag Starvation GI Losses Chronic Alcoholism

What would Hypomagnesemia look like on an EKG?

Flat T-Waves U-Waves Prolonged QT Interval Wide QRS Atrial & Ventricular PVCs

How is Hypomagnesemia treated?

Give 1-2g Mag over 5 minutes then Continuous Infusion 1-2g/hr

What causes Hypermagnesemia?

(\>2.5 mEq/L) Giving too much Mag: Preeclampsia, Antacids, Laxatives Renal Failure Adrenal Insufficiency

Symptoms for Mag of 3-5 mEq/L

Flushing, N/V

Symptoms for Mag of 4-7 mEq/L

Drowsiness, ↓Deep Tendon Reflex, Weakness

Symptoms for Mag of 5-10 mEq/L

Hypotension & Bradycardia

Symptoms for Mag of 7-10 mEq/L

Loss of Patellar Reflex

Symptoms for Mag of 10 mEq/L

Respiratory Depression

Symptoms for Mag of 10-15 mEq/L

Respiratory Paralysis, Coma

A Magnesium level of \>15 mEq/L causes what?

Cardiac Arrest

How is Hypermagnesemia treated?

Stop giving Mag Use Calcium if Bradycardic, Heart Block or Respiratory Depression

Where is Calcium found in the body?

99% in Bones

What are the functions of Calcium?

Bone Strength Second Messenger of Cell Membrane Muiscle contraction, Cardiac Muscles

What causes Hypocalcemia?

Hypoparathyroidism Malignancy Chronic Renal Insufficiency

Symptoms of Hypocalcemia

Cramps & Weakness Chvostek Trousseau Seizure Numbness/Tingling

What are the CV effects of Hypocalcemia?

Dysrhythmias Hypotension Decreased Cardiac Contractility

What are the Pulmonary Effects of Hypocalcemia?

Laryngospasm Bronchospasm Hypoventilation

What causes Hypercalcemia?

Hyperparathyroidism Malignancy Immobility

What are the CV effects of Hypercalcemia?

HTN Heart Block Short QT Interval Dysrhthmias

How is Hypercalcemia treated?

Treat underlying cause Give Fluids Give Loop Diuretics

What kind of Fluid losses would you see Intra-Operatively?

Insensible Loss Third Space Loss Blood Loss

What is Insensible Loss?

Water Loss via Urine, Feces, Sweat, & Lungs Correct w/ 2mL/kg of Crystalloid

How much fluid replacement is needed for Third Space loss?

Surgery Dependent Minimal Trauma: 3-4mL/kg Moderate Trauma: 5-6mL/kg Severe Trauma: 7-8mL/kg

What happens after the 3rd Post-Op day with Third Space Loss?

Fluid moves back from space to intravascular Pts with Heart issues = P. Edema or Hypervolemia

What is PeriOperative Goal-Directed Fluid Therapy?

Protocols for fluid managememt to minimize O2 demand and optimize Cardiac Output & Perfusion

Crystalloids

Water + Electrolytes May Dilute Plasma Proteins Increases Intravascualr Volume Risk for P. Edma Can cause Hemodilution

Which fluids do you avoid for Cerebral Risk Patients?

Which fluids contain calcium and has sodium lactate as a buffering agent?

Which fluid is Gluconeogenic, can cause alkalosis, and should be avoided along with citrate transfusion products?

Which fluids are the Most Isotonic balanced Salt Solutions that have no lactate buffers or calcium?

Plasmalyte, Normosol, and Isolyte

What is the volume of Crystalloid used to replace IntraOperative Blood Loss?

3x the EBL

When do you use Glucose Containing Solutions Intraoperatively?

Rarely - Only to prevent Hypoglycemia

What are some Colloids that are used?

Albumin Plasmanate Hetastarch Dextran

Why are Colloids used?

Stays in Intravascular Space Replaces blood 1:1

What is the advantage of Colloids?

No Disease RIsk

What are the Diasdvantages to Colloid use?

No O2 Carrying Capacity No Coagulation Factors Expensive

Why isn't Hetastarch used anymore?

Coagulapathy & Increased Mortality

Why isn't Dextran used?

Coagulopathy Anaphylaxis Unable to Crossmatch pt. after given

What are some characteristics of Albumin?

Carries Proteins - Donnan Effect - Increases Osmolality Anaphylaxis Risk Pretreated to Kill Pathogens

When do you use 5% Albumin vs 25% Albumin?

5% - Rapid Volume Expansion 25% - Hypoalbuminemia

What are signs of IntraOp Blood Loss?

↑HR ↓BP ↓CVP ↓Mixed Venous O2 ↓Urine Output

What is the Primary reason for blood tranfusion?

Increase Oxygen Carrying Capacity Give when Hb \< 6g/dL

When do you give Whole Blood instead of PRBCs?

Hemorrhage - Whole blood expands blood volume & red cell volume

What Blood type do you give for Emergency Transfusions?

O-Negative then switch to patient's blood type

What Preservatives are added to Donated Blood?

Phosphate - Buffer Dextrose - Energy Adenine - ATP Citrate

How long can blood be stored?

21-35 Days

At what temperature is blood stored to prevent glycolysis?

1 - 6 C

How much Hb is correct by 1 unit of PRBCs?

1g/DL per 1 unit of PRBCs

Which fluids are avoided when transfusing blood?

Hypotonic solutions and fluids containing glucose or calcium

When is giving Platelets indicated?

Platelet \< 50,000

How much is the Platelet count corrected per Unit given?

5000 - 10,000 per Platelet unit

When is FFP indicated?

PT/PTT \> 1 - 1.5x normal Reverse Warfarin Factor Deficiency

When is Cryoprecipitate given?

Hemophilia A - Factor VIII deficiency Von Willebrand Factor Deficiency Fibrinogen Deficiency

What is the most common Transfusion Reaction?

Febrile Reaction - when antibodies react w/ donor antigens

What are some metabolic complications of blood therapy?

Hyperkalemia Hypocalcemia ↓2,3-DPG Alkalosis

What happens to the patient's pH after a blood transfusion?

Increase in pH

What is Autologous Blood?

Retransfusion of patient's own blood during significant surgical blood loss

Fluid and Body Therapy - Quiz 4 Flashcards

(90 cards)