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Anaesthesiology > Fluid Therapy > Flashcards

Fluid Therapy Flashcards

1
Q

What fraction of body fluid is ICF?

A

2/3

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2
Q

Extracellular Fluid is 1/3rd body fluid and comprises what structures?

A

Interstitial and Intravascular

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3
Q

Intracellular fluid has low/high Na+ and low/high K+

A

low Na+, high K+

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4
Q

Intravascular fluid when compared with interstitial fluid has high/low protein

A

high

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5
Q

What is the normal range for urinary losses

A

1500ml-2000ml per day
0.5-1.0mls/kg/hr

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6
Q

What is the normal Potassium requirement per day

A

0.5-1.0 mEq/kg/day

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7
Q

What is the normal Sodium requirements per day

A

1-2 mEq/kg/day

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8
Q

In 1L of N/S how many mEq of Na+ is there

A

154mEq, and 77mEq in a 500ml (the more commonly used bag at UHWI)

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9
Q

How much N/S and Potassium should be added for every litre of NG aspirate

A

1L N/S
10-20mEq K+

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10
Q

Do you administer supplementary potassium in the first 48 hrs post op ?

A

No
1) Hypovolemia causes aldosterone secretion and slat retention by kidney
2) potassium is released by damaged tissues
3) Potassium levels can also increase post blood transfusion

(Do not give K+ until the patient is passing adequate urine)

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11
Q

What is the maximum amount of potassium that can be safely administered in 500ml of N/S

A

20mEq

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12
Q

Q1-
In a 70 kg patient with normal U/Es and a daily urine output of 1500ml who also has NG losses of 2L what should the fluid replacement regime be?

A

Total vol. replaced: 4.5L

3L N/S, 1.5L D5W

60mEq of KCl

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13
Q

How much crystalloids should be given as replacement for every ml of blood lost, and why

A

3ml

This is because at least 2ml will move into the interstitial tissue and 1ml will remain intravascular

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14
Q

What is the formula for total fluid requiremnt?

A

Maintenance fluid + deficit + ongoing losses

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15
Q

List 4 types of ongoing losses

A

GI, Tubes/Drains, Third Spacing, Blood loss

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16
Q

Define crystalloids

A

These are solutions of crystalline solids in water

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17
Q

Why do you need to administer 3-4x the deficit when N/S is used to resuscitate a patient?

A

Because only 30% of the N/S administered actually remains in the intravascular component

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18
Q

Large volumes of N/S can lead to what metabolic complication

A

Hyperchloremic acidosis, since N/S has a higher concentration of Cl- ions than plasma

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19
Q

How can you avoid hyperchloremic metabolic acidosis when large volumes are required ?

A

Use balanced fluids such as Ringer’s LActate

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20
Q

What is the value, in mmol/L, of Na+ in Hartmann’s?

A

131

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21
Q

What is the value, in mmol/L, of Na+ in N/S

A

154

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21
Q

What is the value, in mmol/L, of Cl- in Hartmann’s

A

112

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21
Q

What is the value, in mmol/L, of K+ in Hartmann’s

A

5

22
Q

What is the value, in mmol/L, of K+ in N/S

A

0

23
Q

What is the value, in mmol/L, of Cl- in N/S

A

154

24
Q

What is the fluid content of Lactated Ringer’s ?

A

Na+ = 131
K+ = 5
Cl- = 112
HCO3- =29
Ca2+= 4

25
Q

What is the fluid content of N/S?

A

Na+= 154
K+ = 0
cl- = 154
HCO3- = 0
ca2+= 0

26
Q

Why is N/S concidered an almost isotonic solution?

A

Because the conc. of Na+ and Cl- both exceed that of plasma

27
Q

How many grams of glucose is in 1L of D5W

A

50g

28
Q

How many calories is in 1 L of dextrose water?

A

200 calories= (50g x4)

29
Q

Is D5W hypotonic or hypertonic solution?

A

hypotonic

30
Q

Is N/S hypotonic or hypertonic solution?

A

isotonic (slightly hypertonic)

31
Q

What is an indication for 5% dextrose, 0.2% saline?

A

Hypernatremic children (since the 1/5th n/s will have a dilutional effect on the Na)

Renal Impairment

32
Q

What is the main indication for NaHCO3 8.5% sol. ?

A

Severe metabolic acidosis

33
Q

What is the formula used to determine the necessary amount of NaHCO3

A

1/3 x body weight x base excess

34
Q

What is the average dose of NaHCO3 when correcting acidosis

A

2-4 mls over 15 minutes

35
Q

What are the clinical indications for mannitol

A
  • raised ICP (due to cerebral edema)
    -renal impairment
36
Q

What are the indications for Hypertonic saline?

A

Dilutional Hyponatremia
- TURP syndrome
- SIADH secretion

37
Q

Dilutional Hyponatremia
- TURP syndrome
- SIADH secretion

Can be corrected with which crystalloid

A

Hypertonic solution

38
Q
  • raised ICP (due to cerebral edema)
    -renal impairment

can be corrected with which crystalloid

A

MAnnitol

39
Q

What are colloids

A

These are suspensions of high molecular weight molecules

40
Q

How are colloids classified

A

As synthetic or natural
and protein or non-protein

41
Q

List 2 protein colloids

A

Albumin
Gelatin sol.List

42
Q

2 non-protein colloids

A

hydroxyethol starch
Dextrans

43
Q

List 2 natural colloids

A

Plasma
Albumin3

44
Q

List 3 synthetic colloids

A

Gelofusine
Hydroxyethyl starch
Dextran

45
Q

List 1 advantage and 1 disadvantage of colloids

A

Adv: stays in the intravascular component for up to 24hrs

Disad: large volumes can cause coagulopathy (Factor VII)

46
Q

What is the infusion to blood loss ration for colloids
(Crystalloids 3mls:1ml blood lost)

A

1ml:1ml blood lost

47
Q

What are some disadvantages of using Plasma in fluid therapy (3)

A
  • may activate complement system
  • increased risk of transfer of infections
  • inc. risk of post traumatic multi-organ system failure
48
Q

What is one advantage of using albumin in fluid therapy?

A

It is a free radical scavenger

49
Q

What is one disadvantage of using albumin in fluid therapy?

A

It inhibits platelet aggregation and enhances the inhibition of factor xa by antithrombin II

50
Q

List 6 complications of fluid thearpy

A

1)Volume overload
2)Electrolyte imbalance
3)Haemodilution&coagulopathy
4)hyper/hypoglycemia
5)anaphylactic reaction
6)complications of blood transfusion

51
Q

What are the three grades for dehydration

A

Mild: 5-10%
Moderate: 10-15%
Severe: >20%

52
Q

What are the normal plasma potassium levels

A

3.5 -5.0mEq/L

53
Q

What method is used for calculating fluid requirements per hour

A

4, 2, 1 rule
4- first 10
2- 2nd 10
1- rest

Anaesthesiology (10 decks)

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