Fluids and transfusion in hypovolemia

Question 1

Osmolarity

Answer 1

Measures the solute concentration per unit of solvent

Question 2

Osmolality

Answer 2

Measure of solute concentration per unit MASS of solvent - the same in the ICF and ECF

Question 3

Tonicity

Answer 3

Measure of osmotic gradient between two solutions - influenced by solutes that can’t cross membrane

Question 4

Organ dysfunction and fluid regulation

Answer 4

• Heart failure - fluid overload, increased peripheral oedema
• Cirrhosis - ascites, RAAS
• Pituitary dysfunction - diabetes
• Syndrome of Inappropriate ADH secretion - water retention

Question 5

The 4 stages of hypovolemic shock

Answer 5

1) BP maintained, normal RR, pallor of skin
2) Increased RR, BP maintained, narrow pulse pressure, sweating
3) Tachycardia, tachypnoea, decreased BP
4) Extreme tachycardia, tachypnoea, diastolic BP <70

Question 6

How to administer fluid to a patient in hypovolemic shock

Answer 6

Resuscitation: 500mls of crystalloid solution

If still in shock, give up to 2000mls in 500ml bolus

Question 7

The three different crystalloid solutions that can be administered

Answer 7

0.9% saline - isotonic
5% dextrose - hypotonic
Balanced crystalloid Hartmann’s

Question 8

Colloids

Answer 8

Human albumin solution
Starch
Dextrans
Gelofusion

Question 9

Lethal triad

Answer 9

Acidosis, hypothermia and coagulopathy

Question 10

Risks with blood transfusions

Answer 10

• ABO incompatability
• Delayed haemolysis
• Lung injury
• Infection
• Iron overload
• Hypersensitivity
• Thrombocytopenia
• Allergic reactions