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Anaesthetics & Genetics > 6 - Use of IV Fluids > Flashcards

6 - Use of IV Fluids Flashcards

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1
Q

what % of body weight is TBW (total body water)?

A

60%

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2
Q

where is TBW contained?

A

2 compartments -

ICF (intracellular fluid)

ECF (extracellular fluid)

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3
Q

how much TBW does an individual of 70kg have?

A

42 L

70kg x 60%

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4
Q

how to calculate TBW?

A

patient’s weight x 60%

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5
Q

how to calculate ICF?

A

patient’s weight x 40%

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6
Q

how to calculate ECF?

A

patient’s weight x 20%

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7
Q

ECF can be subdivided into 2 further categories?

A

interstitial fluid

plasma

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8
Q

Describe equation related to osmotic pressure and the movement of water?

A

n x c (c/M) RT

n = no of dissociated particles 
c = conc (g/l)
M = molecular weight 
R = universal gas constant 
T = absolute Temp (K)
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9
Q

Define osmolality?

A

No of osmoles of solute /KG

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10
Q

Define osmolarity?

A

No of osmoles of solute/Litre

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11
Q

How many particles are contained within an osmole?

A

6.02 x10 power of 23 particles

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12
Q

What are bodily fluids measured in?

A

Millimolar concentrations - mosm/KG

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13
Q

Describe the equation related to Na and K etc.

A

2([Na] + [K]) + urea + GLC

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14
Q

What is the normal plasma osmolarity?

A

2([Na] + [K]) + urea + GLC
2 ([140]+[4]) + 5 + 5
298 mosm/L

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15
Q

What are the values for Water, Na and K in terms of the daily requirement for routine maintenance of IV Fluids?

A 
Water = 30ml/KG
Na = 1-2 mmol/KG
K = 0.7-1 mmol/KG
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16
Q

What is tonicity?

A

Effective osmolality

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17
Q

What does tonicity mean in terms of particles which move freely?

A

Only particles which are restricted to one of the compartments will determine water distribution - particles which move freely will not influence water distribution

18
Q

What does tonicity mean for ECF?

A

ECF - Na and accompanying anions

19
Q

What does tonicity mean for ICF?

A

ICF = K and macromolecules

20
Q

Describe hypotonicity?

A

Cell swelling

21
Q

Describe hypertonicity?

A

Cellular dehydration

22
Q

Describe neurological changes due to swelling/ shrinkage? (ie tonicity changes)

A

Swelling - raised ICP, compromised CBF, herniation

Shrinkage - ICH venous sinuous thrombosis

23
Q

Name 3 Crystalloids?

A

5% dextrose
0.9% saline
Hartmann’s solution

24
Q

Name 3 Colloids?

A

Gelatins
Starches
Dextrans

25
Q

2 benefits to crystalloids instead of colloids?

A

Cheap

Non-allergenic

26
Q

How do we assess and manage patients fluids?

A

24 hour chart - Daily adult IV/SC Fluid prescription Chart

27
Q

Name 3 things which are on the 24hour chart for patients?

A

Guidance
4 questions
Patients weight

28
Q

Provide 3 pieces of guidance given in the 24 hr chart?

A

Structured framework for prescribers
Traffic light for fluids
Rationalise fluid available

29
Q

What 4 questions are asked in the 24 hr chart?

A

Is patient hypovolaemic/ euvolaemic/ hypervolaemic?

Why give fluid?

How much?

Which fluid?

30
Q

Give 4 examples of when you should consult senior member of staff when using the 24hr chart?

A

Cardiac dysfunction
Renal failure
Liver failure
Head injury

31
Q

Why should you never give over 100ml/hr regardless of weight?

A

Risk of hyponatraemia

32
Q

How should all IV maintenance be Accessed?

A

Via a volumetric pump

33
Q

How much should be given for maintenance fluid in frail & elderly?

A

20-25ml/kg/24hours

34
Q

How much should be given for maintenance fluid in most people?

A

30 ml/ kg/ 24hrs

35
Q

Taking 30 ml/ kg/ 24hrs into account, how much fluid is required for -

a) 35-44 kg
b) 45-54 kg
c) 55-64 kg
d) 65-74 kg
e) >75 kg

A

a) 35-44 kg = 1200 ml
b) 45-54 kg = 1500 ml
c) 55-64 kg = 1800 ml
d) 65-74 kg = 2100 ml
e) >75 kg = 2400 ml

36
Q

Which fluid should be used for maintenance fluid?

A

0.18% NaCl / 4% GLC / 0.3% KCl

40mmol/ l KCl

37
Q

What is the golden rule of replacement fluids?

A

If it hasn’t been lost then don’t give it

38
Q

Which fluid is used for replacement?

A

Plasmalyte 148

39
Q

Name 3 things contributing to daily intake source?

A

Drinks
Food
Cellular metabolism

40
Q

Name 5 things contributing to daily output source?

A 
Urine 
Sweat
Skin 
Lungs 
Faeces
41
Q

What are the average values for daily intake and output at temperate climates?

A

Intake - 2600

Output - 2600

42
Q

Although difficult, name 4 ways to clinically measure body fluid?

A

Oesophageal Doppler
Pulmonary artery catheter
IVC collapsibility
Minimally invasive co monitors

Anaesthetics & Genetics (9 decks)

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