FINAL- Fluid and electrolytes Flashcards
Isotonic solution into the intravascular space. What happens?
Most closely resemble ECF composition
HES’s associated with
Hydroxethyl starches
-A colloid
-Derived from starchy plant
-Synthetic macromolecule
-Some allergenic potential
-Several generations, controversial in use
-Kidney injury
-Dialysis requirements
-Coagulopathy
-Sepsis
-Increased mortality
Massive fluid resuscitation with normal saline. What might happen?
Hyperchloremic metabolic acidosis
Hypoventilation. Acid/base balance? Electrolytes?
Hypoventilation= increased CO2 = Acidosis
Hyperkalemia (K+ shifts from ICV to ECV)
Hypercalcemia (Acidosis decreased binding of Ca+ to albumin = increased ical)
Emergency C-Section on a preeclamptic patient. What anesthetic drug has an increased risk profile d/t an electrolyte abnormality?
Hypermagnesemia
Magnesium potentiates non-depolarizing muscle relaxants (succinylcholine) = can lead to prolonged paralysis/delayed recovery
Colloid infusions avoided except for when
Acute volume loss
Need to expand plasma volume in patient with a TRAUMATIC HEAD INJURY (not just neurosurgery). What do you pick?
Hypertonic (3%) NS or greater
Protection from intracranial hypertension
risk: osmotic demyelination syndrome
Fluid in capillary beds moves to interstitial side. What forces/changes in forces do you anticipate in a low CO state?
Increase Pc (capillary hydrostatic pressure)
Decrease capillary oncotic pressure
=filtration, edema
Capillary hydrostatic pressure and positive net filtration
How to calculate maintenance fluid rate
4:2:1 method
0-10 kg = 4mL/kg/hr
10-20 kg= 2mL/kg/hr
>20 kg = 1mL/kg/hr
Ex: 78 kg patient
10 kg x 4 = 40mL/hr
10 kg x 2 = 20mL/hr
58 kg x 1 = 58 mL/hr
= 118 mL/hr maintenance fluid rate
When treating hyperkalemia, onset and duration of sodium bicarbonate
Onset: 5-10 mins
Duration: 1-2 hours
Main determinant of net filtration in central nervous system
Interstitial Na+ concentration
