230. Fluid Therapy and Blood Replacement

Question 1

What are the two fluid compartments of the body?

Answer 1

Intracellular fluid (ICF) and extracellular fluid (ECF)

The ICF comprises two-thirds of total body water, while the ECF accounts for the remaining third.

Question 2

What percentage of total body water (TBW) do infants, children, and adults comprise?

Answer 2

Infants: 70%, Children: 65%, Adults: 60%

These percentages indicate the higher body water content in younger populations.

Question 3

What is the 4–2–1 rule used for?

Answer 3

Calculating hourly fluid maintenance requirements

For patients less than 10 kg, it is 4 mL/kg; from 11 to 20 kg, it is 2 mL/kg; and for more than 20 kg, it is 1 mL/kg.

Question 4

How is preoperative fluid deficit calculated?

Answer 4

Multiplication of the hours the patient received nothing by mouth by the hourly fluid maintenance requirement

This helps in determining the amount of fluid needed before surgery.

Question 5

What is the 3:1 ratio used for in fluid therapy?

Answer 5

To replace whole blood loss with crystalloid or colloid solutions

This means for every 1 mL of blood lost, 3 mL of crystalloid or colloid is administered.

Question 6

What are the signs of significant hypovolemia?

Answer 6

Tachycardia, hypotension, decreased urine output, central venous pressure variations

These signs help in assessing the need for fluid replacement.

Question 7

What are crystalloids?

Answer 7

Fluid solutions that contain ion salts and other low-molecular-weight substances

They are commonly used in fluid therapy.

Question 8

What type of maintenance fluid is preferred preoperatively for pediatric patients?

Answer 8

0.2% normal saline with added dextrose and potassium

This is essential for maintaining hydration before surgery.

Question 9

When is glucose not recommended for maintenance intraoperatively?

Answer 9

In patients older than 1 year

Stress from surgery typically prevents hypoglycemia in older children.

Question 10

What is the maximum allowable blood loss (MABL) calculation?

Answer 10

MABL = (Patient hematocrit - Minimum acceptable hematocrit) / Patient hematocrit × Estimated blood volume (EBV)

This helps in managing blood loss during surgery.

Question 11

What is the recommended red blood cell transfusion volume to increase hemoglobin concentration?

Answer 11

10–15 mL/kg

This can increase hemoglobin concentration by 2–3 g/dL.

Question 12

True or False: Fresh frozen plasma (FFP) is given to correct coagulopathy.

Answer 12

True

FFP is administered to address insufficient coagulation factors.

Question 13

Fill in the blank: The body water content in infants is approximately ______ of their body weight.

Answer 13

70%

This percentage indicates their higher fluid needs compared to older children and adults.

Question 14

What should be done to avoid hypothermia during transfusion of blood products?

Answer 14

Transfuse blood and blood products through a fluid warmer

Hypothermia can cause platelet dysfunction even with a normal count.

Question 15

What are the three main targets of fluid therapy in pediatric patients?

Answer 15

• Replacement of preoperative deficit
• Maintenance fluids
• Ongoing intraoperative losses

These targets guide fluid management during surgery.

Question 16

What is the role of sodium-containing fluids in pediatrics during surgery?

Answer 16

Necessary due to obligatory sodium loss in urine

This is particularly important in patients with immature renal function.

Question 17

What is the formula for calculating hourly fluid maintenance requirements for a child weighing 27 kg?

Answer 17

40 + 20 + 7 mL = 67 mL/h

This follows the 4–2–1 rule for fluid requirements.