Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Anesthesiology > 6. Fluid balance and nutrition > Flashcards

6. Fluid balance and nutrition Flashcards

1
Q

Crystalloids

A
  • Small enough to pass through vessel wall

- 0,9% NaCl, Ringer, hypertonic saline (3, 5, and 7.5 %)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Colloids

A
  • Too large (>35kDa) to penetrate vessel wall - stays in vessel
  • Albumin, starch, plasma, dextran
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Extracellular fluid compartment components

A

1/3 intravascular, 2/3 interstitial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Total body water components

A

Intracellular fluid (40%) + extracellular fluid (20 %) (Blood+interst)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal osmolality

A

280 Osm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Fluid tonicity (isotonic, hypotonic etc)

A

Fluid osmolality compared to plasma

  • Isotonic - same as plasma
  • Hypotonic - less than plasma (fluid is absorbed faster)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Preload = ? (and how to increase/decrease)

A

Fluid volume

  • Increase: packed RBCs, colloids, crystalloids
  • Decrease: diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Contractility - how to increase

A
  • Dobutamine

- Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Afterload = ? (How to increase/decrease)

A

SVR: Systemic vascular resistance

  • Increase/vasopress: Epinephrine, norepinephrine
  • Decrease/vasodilate: Nitroprusside, nitrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Starling forces in infusional therapy

A
  • Hydrostatic and osmotic forces / semipermeable membranes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Osmotic vs oncotic pressure

A

Osmotic: independent of molecular size
Oncotic: osmotic pressure generated by macromolecules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Daily fluid loss in fever

A

1500-2000 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Daily fluid loss by tracheotomy

A

700 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Daily fluid loss in suction of bronchial secretion

A

500-1000 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Daily fluid loss in hyperventilation

A

500 - 2000 ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Assessment of intravascular volume

A

Macrocirculation: preload, contractility, afterload

Monitor: Skin turgor, tongue, urine output

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Swan-Ganz catheter

A

Pulmonary artery catheter - to detect HF or sepsis, monitor therapy and effect of drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PICCO plus

A

Arterial line with thermistor in end (detect temperature differences used to calculate CO) - used for hemodynamic monitoring (CO, pulse, preload etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Static hemodynamic parameters

A
  • Central venous pressure (CVP)
  • Pulmonary artery occlusion pressure (PAOP)
  • Right ventricular EDV (end-diastolic volume)
  • Left ventricular EDA (end-diastolic area)
  • Global end-diastolic volume (GEDV)
  • Intrathoracic blood volume (ITBV)
  • Not suitable for assessing fluid responsiveness*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Dynamic hemodynamic parameters

A
  • Systolic pressure variation (SPV)
  • Stroke volume variation (SVV)
  • Pulse pressure variation (PPV) - during pos. pressure ventilation (“PPV”)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SPV normal value

A

< 10 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PPV normal value

A

< 13 %

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SVV normal value

A

< 10 %

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Testing dynamic hemodynamic parameters

A
  • S-G, PICCO, Echocardiography
  • CO = SV * HR
  • Inferior vena cava
  • Passive leg raising test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
György formula
For electrolyte disturbances | Na+ x K+ x OH-) / (Ca++ x Mg++ x H-
26
Treatment of hyperkalemia
- Calcium - Glucose-insulin - Beta-mimetics - NaHCO3 - Hemodialysis - Sodium polystyrene sulfonate resin (GI necrosis) - FSD - Treat underlying disorder
27
Treatment of hypokalemia
- Decrease potassium loss, find cause (e.g vomiting, diarrhea, diuretics, polyuria, laxatives) - Increase K+ stores (KCl - except in DKA) - Look for toxicity (ECG, ileus)
28
Ionized Ca++ levels
> 1,29 mmol/l
29
Corrected Ca2+ levels to serum albumin
> 2,6 mmol/l
30
MAH
Malignancy associated hypercalcemia - most frequent paraneoplastic SY, serious emergency
31
Hypercalcemia/MAH therapy
- Forced rehydration (NaCl 0,9% - 300-500 ml/hr) - After! FSD (furosemide?) 20-40 mg iv (not thiazide!) - Iv bisphosphonate (pamidronat, zoledronic acid) - Calcitonin - Hemodialysis - Steroid: lymphomas - RANKL AB (denosumab)
32
Hyponatremia
- E.g SIADH - Higher urine osmolality (> 100 mOsm/l) - Lower serum osmolality (< 280 mOsm/l) - Serum Na+ < 135 mmol/l - I.c edema
33
Jenny-spm: cramping/tremors are usually caused by hypo- or hyper-electrolytes?
Hypo (Ca, Na, Mg, K)
34
SIADH therapy
SeNa < 125 mmol/l - Restriction of free water intake (500-100 ml/d) - Demeclocyclin SeNa < 115 mmol/l - 3 % NaCl, then 0,9 % NaCl - Furosemide Vaptans: V2 antagonists
35
Limitations of increasing SeNa
Increase in SeNa must not exceed 0,5 mmol/l/h If too fast correction - central pontine myelinolysis
36
Phases after operation
I. Catabolic phase (5-10 days) II. Early anabolic phase (2-6 weeks) III. Late anabolic phase (2-6 months)
37
OFNoSH
Organisation of Food and Nutritional Support in Hospitals
38
Mild malnutrition weight loss
< 10 % weight loss in last 6 months (important!)
39
Moderate malnutrition weight loss
10 - 19 % weight loss in last 6 months (important!)
40
Severe malnutrition weight loss
> 20 % weight loss in last 6 months (important!)
41
Lab parameters to look at in malnutrition
- Serum albumin - Serum transferrin - Serum prealbumin
42
REE: Resting energy expenditure
REE = BEE x stress factor
43
TEE: Total energy expenditure (kcal/day)
TEE = REE x activity factor
44
Stress factors influencing REE
- Major surgery - Polytrauma - Burns (Highest influence - 2,20!!) - Sepsis - COPD
45
Activity factors influencing TEE
- Sedated-ventilated patient (lower activity - 1-1,2) - Ventilated (lower activity - 1,2) - Ward patient (1,3-1,7)
46
Risk of overfeeding
- Fatty liver - Hyperglycemia - Leukocyte dysfunction - Hyperosmolarity - CO2 production increase - Respiratory insufficiency
47
Carbohydrates
60-80 % of nutrition
48
Rate-limiting point in nutrition in sepsis
Pyruvate dehydrogenase - has decreased activity in sepsis, and extra pyruvate is the substrate of lactic acid production in hypoxia
49
Max glucose intake dose in ICU pts
5 g/kg/d
50
Daily minimum of carbohydrates
150 g
51
Lipids
20-40 % of nutrition
52
Max dose of lipid intake per day
1 - 1,5 g/kg/d
53
Overdose of lipids
- Hypertriglyceridemia - Fatty liver - Leukocyte R sensitivity lowered - AA (prostaglandin, TXA, leukotriene precursor)
54
For which pts are lipids not recommended
- Hypertriglyceridemia - Severe metabolic acidosis, hypoxia - DKA - Acute necrotizing pancreatitis - Serious lung disease - Trauma (infection rate, resp. insuff)
55
Protein daily intake
1 - 1,4 g/kg/d (50% should be branched chain)
56
Contraindication of protein intake
Congenital metabolic disorder
57
General nutrition guide
- Prefer enteral nutrition - Enteral nutrition (NG tube) should be started within 24 hrs - If EN is impossible: prokinetics, small bowel nutrition or parenteral nutrition
58
Problems with enteral nutrition
- Gastric residual volume - Gastric bacterial colonization - Aspiration pneumonia - Enteral ischemia
59
Problems with parenteral nutrition
- Bowel mucosal atrophy - Overfeeding - Hyperglycemia - Infection risk - Permanent line needed - More expensive (?)
60
General enteral nutrition guide
- Polymer formula - Upper body elevated 45° - Start within 24-48 hrs if no contraind - Begin with 25 ml/h and increase by 25 ml/h every 4 hrs
61
Enteral nutrition consideerations
- Lack of bowel sounds: does not (!) mean you have to reduce EN - GRV: gastric residual volume must be considered - try metoclopramide if too high (> 250 ml) - Single vomiting and diarrhea - not (!) contraindications
62
Indications for parenteral nutrition
- EN impossible for > 3 days - Malnutrition: early initialization required - EN is not possible/recommended: perioperative, pancreatitis, GI obstruction, malabsorption, short bowel syndrome - Patient doesn´t want to have EN (vomiting , lack of appatite) * *If no justified indications - PN should not be used!!*
63
Pharmanutrition
Some nutrient that also has biological effects (antioxidants, PG, NO, vitamins)
64
When is micronutrient substitution required?
- When patient have less than 1000 ml enteral nutrient intake - When using parenteral nutrition as it only contains macronutrients (sånn som jeg forsto sliden)
65
Malabsorption - vitamins affected
A, D, E, K
66
Which vitamin often lacks from vitamin products and why?
Vitamin K - anticoagulation potential
67
Most important trace elements
Zinc and Selenium | - Most products do not contain iron due to risk of anaphylaxis
68
Zinc deficiency
- Dermatitis - Alopecia - Decreased healing - Gonadal atrophy - Immune system decrease
69
Selenium
- Cardiomyopathy - Myositis - Arthritis - Hair and nail disorders
70
ATP and nutrition
Tissue oxygenation will not give ATP on its own unless supported by adequate nutrition
71
Clinical nutrition consists of
- Screening - Assessment - Plan - Documentation - Reassessment

Anesthesiology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions