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Fluid Managment Flashcards

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1
Q

Intracellular ; Extracellular water volume ratio

A

2:1

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2
Q

Goal of perioperative fluid management

A

Maintain intravascular volume and cardiac preload
Maintain O2 carrying capacity
Maintain acid-base homeostasis and electrolyte balance

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3
Q

Acid-Base balance

A

Mechanism the body uses to keep its fluids close to neutral pH

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4
Q

Functions of fluids

A

Dissolve and transport substances
Account for blood volume
Maintain body temperature
Protect and lubricate body tissue

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5
Q

Functions of Electrolytes

A

Regulate fluid balance
Help nerves respond to stimuli
Signal muscles to contract

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6
Q

Daily water intake

A

2500ml

2200 - food
300 - byproduct of metabolism

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7
Q

Daily water loss

A

2500ml

1500 - urine
400 - respiratory tract evaporation
400 - skin evaporation
100 - sweat
100 - feces
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8
Q

Sensible water loss

A

Loss that can be perceived by the senses and can be measured

Urination, Defecation, Wound drainage

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9
Q

Insensible water loss

A

Loss through evaporation from skin or lung during exhalation

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10
Q

Percentage of (xxx) as percent of body weight

ICF
ECF
ISF
IVF

A

40%
20%
15%
5%

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11
Q

Percentage of (xxx) as percent of total body water

ICF
ECF
ISF
IVF

A

67%
33%
25%
8%

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12
Q

Percentage of water in

Lean tissue
Bone
Fat

A

60-80%
20-25%
10-15%

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13
Q

Most important determinant of intracellular osmotic pressure

A

K

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14
Q

Most important determinant of extracellular osmotic pressure

A

Na

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15
Q

Permeability of cell membrane to most protein

A

Impermeable

High Intracellular protein concentration

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16
Q

Composition of plasma vs interstitial fluid

A

Same composition except protein (higher in plasma)

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17
Q

Composition of interstitial fluid

A

Association with extracellular proteoglycans

Forms gel

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18
Q

Interstitial fluid pressure

A

-5 mmHg

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19
Q

ICF% and ECF% as percentage of body weight for

Neonate
Infant
Adult male
Adult female
Elderly female
A 
40 + 35
40 + 30
40 + 20
35 + 20
30 + 15
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20
Q

Diffusion

A

Random movement of molecules due to their KE

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21
Q

Factors that affect rate of diffusion

A

Permeability of substance through membrane
Concentration difference
Pressure difference
Electrical potential difference

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22
Q

Carrier proteins

A

Carry substance from one side of a membrane to another

Glucose, Amino acids

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23
Q

Channel proteins

A

Water-filled pores that enable charged substances to diffuse through membrane

Ions

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24
Q

Capillary fluid exchange

Arterial End

A

CHP > 30
IHP > 5
IOP > 6
POC > -28

Net > 28

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25
Capillary fluid exchange | Venous End
CHP > 10 IHP > 5 IOP > 6 POC > -28 Net > -7
26
Normal osmolarity of body fluids
300 mosm/L
27
ADH
Hormone that prevents fluid loss and promote conservation of body water
28
Stimulus for ADH release + Reaction
Stimulus Increase in blood osmolarity Reaction Increase reabsorption in distal convoluted tubules and collecting ducts
29
Cause for Diabetes insipidus + Result
Cause Absence of ADH Result Decreased water reabsorption Large volumes (25L) of dilute urine excretion
30
Aldosterone
Hormone that regulates blood sodium level
31
Stimulus for Aldosterone release
Increase in K (primarily) Decrease in Na RAAS
32
Stimulus for renin release
Decrease in blood volume and/or pressure
33
Major actions of Angiotensin II
Stimulate release of Aldosterone | Vasoconstriction
34
ANP
Hormone that promotes both fluid and sodium loss by the kidney
35
Major effects of ANP
Decrease Aldosterone release Decrease ADH release Decrease thirst
36
Osmolarity Osmolality
Measurement of solute concentration per unit volume Measurement of solute concentration per unit mass
37
Determinants of serum (and intracellular) osmolarity
Na (K) Glucose Urea
38
Plasma osmolality calculation
[Na]x2 + BUN/2.8 + Glu/18
39
Tonicity
Measure of osmotic pressure gradient between two solutions
40
Filtration
Movement of water and solute molecules across membrane due to hydrostatic pressure
41
Tools used for estimation of Intravascular volume
Patient history Physical examination Laboratory analysis
42
Important factors to consider in patient history
``` Recent oral intake Vomiting or Diarrhea Significant blood loss Significant wound drainage Hemodialysis ```
43
Indication of hypovolemia in physical examination
``` Abnormal skin turgor Dehydration of membrane Thready peripheral pulse Increased HR and Decreased BP Orthostatic HR and BP Decreased urinary flow ```
44
Intraoperative physical diagnosis
Fullness of peripheral pulse Urinary flow rate Indirect signs (response of BP to positive ventilation or vasodilation)
45
Indication of hypervolemia in physical examination
``` Pitting edema Increased urinary flow Tachycardia Elevated Jugular pulse pressure Wheezing, cyanosis Pink, frothy pulmonary secretion ```
46
Indication of dehydration in Laboratory evaluations
``` Rising hematocrits Arterial pH increase (acidosis) Urinary specific gravity (>1.010) and osmolality (>450 mosm/L) Urinary Na (<10 mEq/L) concentration Serum Na BUN : Serum creatinine (>10:1) ```
47
Indications of volume overload in laboratory
Increased vascular and interstitial marking (Kerley B lines) | Diffuse alveolar infiltrates
48
Crystalloid solutions
Aqueous solutions of ions with or without glucose
49
Colloid solutions
Solutions which contain high molecular weight substance such as proteins or large glucose polymer
50
Location of crystalloid and colloid solutions
Crystalloid Rapidly equilibrate and distribute throughout the entire ECF Colloid Maintain plasma oncotic pressure and remain mostly intravascularly
51
Maintenance-type solutions
For losses primarily involving water | Hypotonic solutions
52
Replacement-type solutions
For losses involving both water and electrolytes | Isotonic solutions
53
Conditions where crystalloids are usually considered as initial resuscitation
Hemorrhagic and septic shock Burn patients Head injury (maintain CPP) Patients undergoing plasmapheresis and hepatic resection
54
Component and osmolarity of NS
Na - 154 Cl - 154 308 mosm/L Iso-osmolar to normal plasma
55
Indications and use
``` Intravascular resuscitation Replacement of salt loss (diarrhea, vomiting) Diluting drugs Hyperkalemia Hyponatremia Hypochloremic alkalosis ```
56
Large volume of NS
Hyperchloremic metabolic acidosis
57
Component of RL
``` Na - 130 Cl - 109 K - 4 Ca - 3 L - 28 (converted to bicarbonate in liver) ```
58
Large volume of RL
Hypochloremic alkalosis
59
Component, Indication and risk of Hypertonic salt solution
250-1200 mEq/L of Na Hyponatremia Hemolysis at point of injection
60
Component, osmolarity and use of D5W
50g/L of glucose No electrolyte 253 mOsm/L Maintain water balance in NPO Hypernatremia
61
Half life of crystalloid vs colloid
20-30 min 3-6 hrs
62
General indications for colloids
Severe intravascular fluid deficit | Severe hypoalbuminemia or large protein loss (burns)
63
All colloids...
Derived from either plasma protein or synthetic glucose polymer Supplied in isotonic electrolyte solution
64
Blood-derived colloid
``` Albumin (5% and 25%) Plasma protein (5%) ```
65
Synthetic colloid
Dextrose starch and Gelatin
66
Colloid associated with histamine mediated allergic reaction
Gelatin
67
Macrodex vs Rheomacrodex
Macrodex Dextran 70 (average molecular weight) Better volume expander Rheomacrodex Dextran 40 Improve blood flow through microcirculation (decrease blood viscosity)
68
Prolonged bleeding time caused by colloid
Dextran (20 mL/kg/day) + interfere with blood typing and kidney failure Hetastarch Older formulations more than 1.0 L
69
Why Hetastarch is better than Dextran
Highly effective as plasma expander Less expensive than albumin Non-antigenic
70
Pre-existing deficit
Water imbalance arising from an overnight fast or a periods without fluid intake proportional to its duration
71
What do serial hematocrits or hemoglobin concentration reflect?
Ratio of blood cells to plasma | Rapid fluid shifts
72
Third space loss
Losses due mainly to evaporation and internal redistribution of body fluids
73
Additional fluid requirement for Minimal (herniorrhaphy) Moderate (cholecystectomy) Severe (bowel resection)
0-2 2-4 4-8
74
When is blood transfused to a patient?
When the danger of anemia outweighs the risk of transfusion
75
Average blood volumes of ``` Premature Neonate Full-term Neonate Infant Adult Male Adult Female ```
``` 95 85 80 75 65 ```

Fluid Management (1 decks)

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