Required Reading-Fluids/Intraop Complications Flashcards
(58 cards)
Total body water is _____ of body weight. Intracellular is ___ and extracellular (interstitial fluid and plasma) is ____.
60%; 40%; 20%
Extracellular to intracellular shift of fluids cause dramatic illnesses, such as ____ of cells, swelling of ______ and ____.
lysis; brain/SC; renal failure
If 70kg man, TBW is ____, intracellular water is ____ and extracellular water is ____.
42L; 28L; 14L
Extracellular fluid consists of ____ (16% TBWt) and ____ (4% TBWt)
interstitial fluid (~11.2L); plasma (~2.8L)
RBCV + plasma volume is ___ liters, or the total blood volume
2L + ~3L = 5L
CO is about ____ per minute
5L
Transfusing blood products adds volume to BOTH ____ and ___ space.
extracellular; intracellular (RBCV)
Fluids are to support ___ of heart, avoid excessive expansion of ____ space, allow some ____ fluid to be transported back into intravascular space, and avoid changing ____ space (specifically in neurons)
preload; interstitial; interstitial; intracellular
Clinical var to assess intravascular volume status include:
skin turgor, neck veins, SBP, var of BP w/ respiration, CVP, HR, UO, hypoTN w/ anesthesia, orthostasis, base excess or HCO3
An increase in variability of BP w/ respiration indicates ___ intravascular volume status.
hypovolemic
A CVP between ____ indicates normal intravascular volume status.
8-12mmHg
Base excess less than -2 or HCO3 mEq/L less than 22 indicates ___ intravascular volume status.
hypovolemic
Pts kept deliberately hypovolemic are those with elevated ____ pressures, ____ pts, or after ____ surgeries.
pulmonary artery; COPD; thoracic
Crystalloids, like NS, LR (contains Ca+, K+, lactate), normosol-R mostly diffuse into ____ space and is for mostly minor procedures.
intracellular
Colloids are derived from human serum protein macromolecules like ____, or carb macromol like ___.
albumin/Plasmanate; Hetastarch
B/c oncotic pressure, macromol in colloids allows them to remain in ____ longer (hrs-days) than crystalloids (min-hrs)
intravascular space [minimize wt gain/edema]
Albumin 5% used for ____ replacement. If not diluted with NS (as opposed to 1/2NS), can cause fatal ____.
volume; hemolysis
Plasmanate contains 88% albumin and also alpha/beta/gamma ____; considered to be ______ therefore not given to Jehovah’s Witnesses. Diluted w/ NS.
globulins; blood product
Hetastarch derived from ____ and not a blood product; also less expensive than protein-derivatives
vegetable matter [complex carbs]
Calculating periop fluids: (1) Maintenance fluids (2) NPO (3) EBL (4) “third-space” loss
(1) 4 + 2 + 1 rule = 100ml/hr for first 60kg + 1ml/hr*remaining kg
(2) 8h x (maint. fluids) [give in first 2hrs] (3) 3 x EBL (4) minor 1-3ml/kg/h, laparoscopy 3-6ml/kg/h, exlap 6-10ml/kg/h
Estimate periop fluids for 100kg man who hasn’t eaten for 8 hrs, EBL about 100ml for 2h lap chole.
(1) Maintenance fluids = 140ml/h (2) NPO = 1220ml (3) EBL = 300ml (4) “third-space” loss = 500ml/h; Total = 2700 ml/h LR over 2h periop period
MC use for D5W
withdrawing alcoholic pts from becoming hypoglycemic
MC use D51/2NS + 30mEq KCL/l
classic maintenance fluid for medicine on ward (insensible losses)
MC use NS; MC problem
replacement for initial resuscitation for dehydration and blood loss; may cause metabolic acidosis
