Fluid & Electrolyte Therapy

Question 1

TBW: BW X _____ (_____ L) = ICF BW X _____(_____ L) + ECF BW X _____ (_____ L)

Answer 1

0.6; 42

0.4;28

0.2; 14

Question 2

ECF BW X ____ ( ____ L) = IVS BW X ____ (____ L) + ISS BW X ____ (____ L)

Answer 2

0.2;14

0.05;3

0.15;11

Question 3

At birth higher % of water is in ECF

• TBW = BW X _____
  -ECF= BWX _____

Answer 3

0.8

0.45

Question 4

-TBW is _________ in females (BW x _____) because of _____________

Answer 4

lesser

0.5

greater fat content

Question 5

Between ECF and ICF, water moves by _______ across ____________ cell membrane

• Depends on number of __________________ on either side of membrane

Answer 5

osmosis

semi-permeable

osmotically active particles

Question 6

Fluid movement between IVS and ISS

Between IVS and ISS, water movt. depends on ________ forces at ________ end and _______________________________ forces at ________ end, across semi- permeable cap. memb

Answer 6

hydrostatic; capillary

protein- albumin colloid osmotic (oncotic)

venous

Question 7

Distribution of common electrolytes

ICF : ECF

What are the MAIN ELECTROLYTES

Answer 7

Potassium; magnesium; phosphate

Sodium; chloride ; bicarbonate

Question 8

Fluid Balance, Requirements & Replacement

______________– __________ requirement
_________– ___________
_____________ losses

Answer 8

Maintenance; Basal fluid

Deficit; Pre-existing

On-going

Question 9

In children,
Water – ___mls/kg/hr for the 1st ___ kg,
- then ____mls/kg/hr for the next ____kg - then ____ml/kg/hr for ______ kg.

Answer 9

4;10
2;10
1; any extra

Question 10

Basal/Maintenance Fluid Requirement

• Adult (70kg)- ____L or ______mls/kg/day -

Answer 10

2.5 ; 30-35

Question 11

Basal/Maintenance Fluid Requirement

Infants req. up to _____mls/kg/day due to
- higher _____________,
- higher ____________ and
- less _____________ ability.

Answer 11

100

metabolic rate

insensible loss

renal concentrating

Question 12

Common Electrolytes Daily Requirements
Electrolytes

• Na+ – _____ mmol/kg/day . approx ____mmol/day
  K+ – _____mmol/kg/day. Approx ______mmol/day

Mg2+ - ______mmol/kg/day
- Ca2+ - ______mmol/kg/day

Answer 12

1-2; 50-80

1-2; 50-80

0.1-0.2
0.1-0.2

Question 13

1g of NaCl = ____mmol Na+
1g of KCl = _____mmol K+

Answer 13

17; 13

Question 14

Pre-existing Deficits
— — —
________ e.g paeds

Decreased intake – ______,________,_________
Increased loss – _________,_________,___________ losses
- polyuria
-_______ esp in paeds
-____________ into bowel

Answer 14

Fasting

nausea, vomiting, coma

vomiting, diarrhoea, NGT

fever; sequestration

Question 15

On-going Losses

GIT –fluid sequestrated into gut lumen, NGT

Intra-op losses
–__________ loss. Severity depends on extent of surgery
-_________ loss from exposure of viscera
-________ loss

Post-op losses
– Drains- _______,_______,___________
- Vomiting, blood loss, gut fistula, 3rd space loss

Answer 15

3rd space; Evaporative; Blood

NGT, peritoneal, chest

Question 16

3rd Space Loss
— —
— —
_____tonic transfer of fluid from _____ to a _____________,_______________ interstitial/tissue compartment.

Due to surgical trauma, infection, burns. Loss depend on degree of t/s trauma
Results in depletion of ———— volume. Should be replaced with ———-tonic fluid – _____,______

Reverts by ______ as fluid moves back into circulation.

Answer 16

Iso; ECF

non-fxnal ; non- communicating

plasma; N/S, R/L

72hrs

Question 17

3rd space loss

Caution in _____,_____when replacing the loss

Minimal trauma –______mls/kg/hr
Moderate trauma – _____mls/kg/hr
Severe trauma - _____mls/kg/hr

Answer 17

Cardiac failure; renal failure

0-2

2-4

4-8

Question 18

3rd Space and evaporative losses can approximate _______mls/kg/hr in highly invasive, manipulative and surgically exposing procedures
Actual replacement needs vary from pt to pt based on other confounding factors

Answer 18

10-15

Question 19

Preoperative management

HX- source of loss, duration and amount presence of _______
urine volume/output – aim at ____ml/kg/hr
Abd distension –[ gut secretes ____ of fluid which is all reabsorbed except for ____ mls in faeces –site for potential massive fluid loss]

Answer 19

fever; 1; 5L; 100

Question 20

Pre-operative management

EXAM- _____ lips, _______ tongue, dry mucous membrane, _____ eyes,
 loss of ________ , __________ extremities
 Altered _———, lethargy, confusion
 _____tension, _____cardia, vaso_________, oliguria

Answer 20

Dry; furred; sunken

skin tugor; cold clammy

LOC; hypo; tachy

constriction

Question 21

Treatment/Resuscitation
—
—
Resuscitate with _________ solutions

____,______ for loss of water and electrolyte
_______ for loss of water only
__________ if fluid loss is severe or blood loss

Monitor B.P, HR, U/O, CVP
– fluid challenge, capillary refill, level of consciousness

Answer 21

crystalloid; N/S, R/L

D/W; Colloid

Question 22

Treatment /Resuscitation

Volume Deficit

= Plasma _____ - _____ X _______
——————————-
______
—

Answer 22

Na; 140; TBW

140

Question 23

K+ Deficit (Hypokalaemia)

Must be corrected. May result in __________ (prolonged PR & QT intervals, low/inverted T waves), difficulty in reversing NMB, labile BP, renal dysfunction, paralytic ileus

Normal – _________ mEq/L

______ X______ X_____ (0.4 is ICF fraction)

Answer 23

arrhythmias

3.5 - 5.5

Deficit; Weight; 0.4

Question 24

K+ Deficit ( hypokalemia)

Max rate of infusion is _____mmol/hr which must be done under_____________ (Max._____ mmol/day), via a ________ line.

With __________ line, do not exceed ____ mmol/L to prevent ——————

NOTE: Add __________ requirement, when correcting deficit.

Answer 24

20; ECG monitoring

500; central

peripheral; 40; thrombophlebitis

maintenance

Question 25

Hyperkalaemia ____________(tall tented T waves, wide QRS & dep. ST segment) , __________ and __________ weakness, Nausea, vomiting, diarrhoea, abd colic

Answer 25

Arrhythmias skeletal muscle and cardiac muscle

Question 26

HyperKalemia ______________ 5-10mls of 10% to antagonise cardiac effect __________–45meq (1-2 mEq/Kg) causing Alkalosis ________ (30-50g) + ________ (10 units) infusion Dialysis – Peritoneal- or Haemo-

Answer 26

Ca 2+ gluconate Na HCO3 Glucose; Insulin

Question 27

HCO3- deficit (Acidosis)- Base deficit x _____ x____ Give ______ then recheck ABG. — —

Answer 27

Wt; 0.3 1⁄2 t

Question 28

Intraoperative — — — — —Consider ________, _________ losses, __________ loss Blood loss >____% of EBV (Paed > ____%) ___________________ point, consider transfusion. Postoperative Losses from _________,________,________, ______________ loss, continuing ______ loss

Answer 28

maintenance, on-going 3rd space ; 15; 10 Transfusion trigger drains, fistulae, catheter, 3rd space blood

Question 29

Determining Transfusion Trigger Point — In practice, intra-operatively – Initial fluid replacement for Estimated blood loss (EBL) is with _____________ soln/ _________. _______ times d vol. of EBL OR with _________ ___:___until TTP is reached. Thereafter, blood loss is replaced unit for unit with ___________

Answer 29

lactated Ringers’ ; 0.9% Saline; 3-4 Colloids; 1:1 whole blood

Question 30

TTP is often calculated preoperatively Using the ___________, _____________ Generally, TTP is after EBL is >______% of _____.

Answer 30

PCV/[Hb] Estimated Blood Vol. (EBV) 10-20; EBV

Question 31

Guidelines for TTP — Estimated Blood Volume (EBV) calculation – Neonate - preterm = ____ml/kg - Full term = ____ ml/kg

Answer 31

95 ;85

Question 32

EBV Calculations Infants = ______ml/kg Adults - male =____ ml/kg - female = ____ ml/kg

Answer 32

80 75;65

Question 33

Calculating max allowable Blood loss for TTP Gross’s formula Using preop PCV, EBV MABL =__________ - ____________ X _______ ————————————————— ___________

Answer 33

Preop PCV – lowest allowable PCV EBV Average PCV

Question 34

The EBL necessary for PCV to fall from 35% to 30% in a man weighing 70 kg =??

Answer 34

= (35 – 30) x (75x70) = 807.7mls ——————————- 32.5

Question 35

1 unit of blood will ↑ PCV/Hb by _____%/__g/dL resp. in adults A 10 ml/kg blood transfusion, in children will ↑ the PCV/Hb by ____%/__g% resp.

Answer 35

2-3 ;1 10; 3

Question 36

Crystalloids vs Colloids — — — — Initial expansion of vascular compartment, extent depends on ability to _______________

Answer 36

cross vascular endothelium

Question 37

(Crystalloids or Colloids?) do not freely cross – may draw water into vascular space by osmosis

Answer 37

Colloids

Question 38

(Crystalloids or Colloids?) are Plasma expanders. Fluids move from IVS to ISS at ratio of ______ in plasma :____ in ISS

Answer 38

Colloids 1⁄4; 3⁄4

Question 39

Colloids- volume infused expands vascular compartment –ideal for ______________

Answer 39

plasma/ blood loss

Question 40

___________,__________________ – expand ECF (____ in plasma : _____ in ISS) and are ideal for ______ losses ____________ expands TBW (___/3 ECF & ___/3 ICF). Replaces _____ deficit. Only ___/12 of infused vol. remains in vascular compartment.

Answer 40

Saline 0.9% , Hartmann's solution (Lactated Ringers’ solution) 1⁄4 ; 3/4; ECF 5% dextrose; 1; 2; water 1