Fluid Administration Flashcards

Question

What is the pH of plasmolyte

Answer 1

276 (effective osmolality is 248)

Answer 2

294mosm calc. 244 reality

Answer 3

20-40 minutes in health euvolaemic longer in shock up to 8hrs (RAAS)

Answer 4

50% of infused volume out of IV space in 30mins, finishes in another 30min

Answer 5

100% bioavailability, well absorbed

Answer 6

0.2L/kg, in ECF  25% intravascular – 250mls – redistribution delay means during infusion ~400-450mls 75% interstitial – 750mls

Answer 7

Below circulatory reflex activation 5%, volume expansion maximal prior to redistribution(during infusion) . See action at other organ system for electrolyte and osmolality effects

Answer 8

900ml extraC, 100ml intraC, 25:75 ratio leaves 225ml IV. Below Baroreceptor. No lactic acidosis (no H+ ion) – incorporated in ciritc acid cycle consuming H+ion (decreased total body acidity) making CO2 1L = 9 calories. Osmolality change 1mmol/L change <1%.

Answer 9

900ml extraC, 100ml intraC, 25:75 ratio leaves 225ml IV. Below Baroreceptor. No lactic acidosis (no H+ ion) – incorporated in ciritc acid cycle consuming H+ion (decreased total body acidity) making CO2 1L = 9 calories. Osmolality change 1mmol/L change <1%.

Answer 10

Same as Hartmans but 227mls IV. Osmo ~3% Acetate enter citric acid cycle  CO2 and water (consume H+ ion) 1L 15calories. K+ inside cells, Mg mostly extracell. Gluconate excreted in urine unchanged.

Answer 11

Same as Hartmans but 227mls IV. Osmo ~3% Acetate enter citric acid cycle  CO2 and water (consume H+ ion) 1L 15calories. K+ inside cells, Mg mostly extracell. Gluconate excreted in urine unchanged.

Answer 12

Same as Hartmans but 227mls IV. Osmo ~3% Acetate enter citric acid cycle  CO2 and water (consume H+ ion) 1L 15calories. K+ inside cells, Mg mostly extracell. Gluconate excreted in urine unchanged.

Answer 13

Crystalloid fluid – isotonic monosaccharie solution 50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents pKa 12.9 i.e. non ionised, water solubility pH 3.5 – 6.5 (regardless of conc of glucose)

Answer 14

Crystalloid fluid – isotonic monosaccharie solution 50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents pKa 12.9 i.e. non ionised, water solubility pH 3.5 – 6.5 (regardless of conc of glucose)

Answer 15

Crystalloid fluid – isotonic monosaccharie solution 50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents pKa 12.9 i.e. non ionised, water solubility pH 3.5 – 6.5 (regardless of conc of glucose)

Answer 16

Crystalloid fluid – isotonic monosaccharie solution 50g dextrose, IV. From hydrolysis of corn starch, Sterile, no buffers or bacteriostatic agents pKa 12.9 i.e. non ionised, water solubility pH 3.5 – 6.5 (regardless of conc of glucose)

Answer 17

Expands extracellular fluid volume and ICF – 8% of infused volume after 15-20 minutes remains intravascular. 2.5% change in osmolality sensed by OVLT osmosesnor leading to decreased vasopressin release and diuresis.

Answer 18

Expands extracellular fluid volume and ICF – 8% of infused volume after 15-20 minutes remains intravascular. 2.5% change in osmolality sensed by OVLT osmosesnor leading to decreased vasopressin release and diuresis.

Answer 19

Hyperglycaemia + Hyponatraemia Higher concentration dextrose  RBC lysis (hyperosmolar  fluid out of RBC)  thrombosis and phlebitis

Answer 20

250 (calculated 278mmol/L  278mosm/L) – (556 for 10%, 2780 for 50%)

Answer 21

15-20 minutes

Answer 22

Vd 0.6L/kg – distributed widely after 20 minutes - 66% intracellular  660mls - 26% intersitital  260mls - 8% intravascular  80mls

Answer 23

Each glucose metabolised by all tissues with aerobic metabolism to 6H20 and 6CO2 but especially the liver – thus from 1L makes extra 30ml of fluid Eliminated by kidney and lungs

Answer 24

Below circulatory threshold (80ml^ = 1.5%) 2.5% change in osmolality (6.5mmol) OVLT stimulated and decreased vasopressin (diuresis). Na drop 4mmol/L  angiotensin 2 + aldosterone ction Decrease bicarbonate and base excess 3mmol/L 198 calories

Answer 25

Organum vaculosum laminae terminalis Circumventricular organs

Answer 26

Concentrated human plasma albumin/ Colloid - From multiple whole blood donor/ plasma apheresis collection.

Answer 27

Ethanol fractionation or chromatographic separation methods. Pasteurised by heat at 60 degrees for 10 hours. Octanoate preservative weakly antimicrobial and antifingual, stops denaturing in pasteurisation

Answer 28

Ethanol fractionation or chromatographic separation methods. Pasteurised by heat at 60 degrees for 10 hours. Octanoate preservative weakly antimicrobial and antifingual, stops denaturing in pasteurisation

Answer 29

MW 67000 daltons. Shelf life 36 months. Hypotonic saline carrier fluid, weak acid pKa 6.75 good water solibility

Answer 30

MW 67000 daltons. Shelf life 36 months. Hypotonic saline carrier fluid, weak acid pKa 6.75 good water solibility

Answer 31

MW 67000 daltons. Shelf life 36 months. Hypotonic saline carrier fluid, weak acid pKa 6.75 good water solibility

Answer 32

MW 67000 daltons. Shelf life 36 months. Hypotonic saline carrier fluid, weak acid pKa 6.75 good water solibility

Answer 33

Oncotic mediated expansion of extracellular fluid volume– increasing circulating volume, albumin exerts 75% of the total 20-30mmHg oncotic pressure

Answer 34

100ml of 20% albumin draws interstitial fluid and intracellular fluid over 15 minutes, and negative charge attracts sodium adding another 50% to intrinsic osmotic activity Combined effect - Interstitial fluid -32mls - Intracellular fluids -88mls - IV +220mls (inclusive of the 100mls given)

Answer 35

Neutralises vasodilating effects of nitric oxide Buffer in intersitital space (only one) Immunomodulatory – antioxidant by binding copper and iron which cause production of reactive oxygen species; addit binding bilirubin and homocysteine; and neutralising oxygen radicals/nitrites. Transport – endogenous + exogenous binding – calcium, fatty acids, bile acids, zinc

Answer 36

May worsen TBI mortality, ?efficacy (see notability) Allergic and anaphylactic reactions possible Hyperoncotic – risk of fluid overload More expensive than crystalloid

Answer 37

Na 140 Cl 128 (or in normal saline) Albumin 40g/L – makes it isooncotic with blood (no extra water attracted interstitial) Electrolyte effect similar to salineW

Answer 38

Na 48-100 Octanoate 32mmolLL Albumin 200g/L (0.03mmol/L)  20g

Answer 39

Hypotonic saline carrier (130mosm/kg electrolytes, total 210-262 mosm/Kg, 20%)

Answer 40

6-12 hours

Answer 41

Vd 0.07L/kg – confined to circulating volume. 4% per hour redistribution of albumin to interstitial fluid – septic can be 10% per hour. 50% lost from vascular compartment per day (interstitial). 100ml of 20% albumin draws an addition 120ml of interstitial fluid over 15 minutes (11ml per g), keeping the 100ml originally given intravascular.

Answer 42

Vd 0.07L/kg – confined to circulating volume. 4% per hour redistribution of albumin to interstitial fluid – septic can be 10% per hour. 50% lost from vascular compartment per day (interstitial). 100ml of 20% albumin draws an addition 120ml of interstitial fluid over 15 minutes (11ml per g), keeping the 100ml originally given intravascular.

Answer 43

11ml per g

Answer 44

By fibroblasts and macrophages (reticuloendothelial system) - 50% muscle and skin, 15% liver, 10% kidneys to free amino acids; 10% lost in gut. Minimal renal excretion, most degraded by macrophages and 10% eliminated through the gut

Answer 45

The attraction of free water intravascularly by 20% albumin would seem to risk decreasing osmolality, and triggering osmoreceptors however the Gibbs Doonan effect drags positively chanrged ions preventing significant changes. 4% albumin 500mls may trigger barocreceptor reflex, does not trigger osmoreceptors,

Answer 46

50% intravascu;alr compared to 25% of NaCl Baroreflex activiated

Answer 47

Isoosmolar Isooncotic

Answer 48

a fluid with heterogeneity, multiphasic constituents and insoluble particles in solution. A fluid containing particles unable to pass through physiological semipermeable membranes

Answer 49

* Scatter light * Susended in solvent without precipitating and separating * Subject to Brownian movement * All have the same charge keeping them separated by electrostatic propulsion

Answer 50

◦ No special storage requirements ◦ No need for crossmatching, or interference with crossmatching ◦ Long shelf life ◦ Not susceptible to biological contamination (eg. by acting as a substrate for microbial growth, or by allowing donor-recipient viral transmission) ◦ Cheap and readily available ◦ Acceptable to all patients (i.e. no cultural objections)

Answer 51

◦ No special limitations on volume that can be infused ◦ Low viscosity ◦ Distributed to intravascular compartment only ◦ Cleared completely and without reliance on organ function ◦ No toxic metabolites or accumulation

Answer 52

◦ High oncotic effect ◦ No interference with organ function (including red cell function) ◦ Non-pyrogenic, non-allergenic & non-antigenic ◦ No interference with haemostasis, coagulation, or acid-base balance

Answer 53

* The mechanisms which drive this distribution include: ◦ Oncotic pressure of the colloidal particles ◦ Gibbs-Donnan effects of the charge of the colloidal particles (for example, the negatively charged albumin attracts additional osmotically active sodium into the intravascular space) * A minor volume expanding effect is also attributable to the volume of the dispersed molecules themselves, which is non-trivial for large molecules. For example, the volume of normal plasma consists of 7-8% colloid. * Ergo, if the goal is to increase the circulating volume, fluid solutions containing substances with a large molecular weight should be more efficient, in terms of intravascular volume increase per volume of infused fluid

Answer 54

* Synthetic colloids ◦ Polyvinylpyrrolidone * Semi-synthetic colloids ◦ Gelatins (eg. gelofusine, polygeline, ) ◦ Dextrans (they are all called "dextran X", where X is the molecular mass in kDa) ◦ Starches (eg. hydroxyethyl starch) * Plasma derivatives ◦ Purified plasma proteins (eg. albumin) ◦ Whole plasma products (eg. fresh frozen plasma)

Answer 55

Succynylated bovin gelatin

Answer 56

0.9% saline

Answer 57

Minimal CJD not ruled outAntigenic r

Answer 58

Anaphylactogen Decrease clot integrity

Answer 59

PVC flexible bags with logn shelf life in years

Answer 60

PVC flexible bags with logn shelf life in years

Answer 61

Maize or corn

Answer 62

0.9% saline

Answer 63

Minimal to zero

Answer 64

Anaphylaxis Renal failure Pruritis

Answer 65

* Arterial hypotension causes baroreflex activation + low pressure volume receptors of the right atrium and great veins + if severe (with reduced cardiac output/fall in pH) may also induce chemoreceptor activation peripherally accentuating the response * Both reflexes result in autonomic phenomena: ◦ Decreased vagal stimulus; thus increased heart rate ◦ Sympathetic activation both directly and indirectly through systemic catecholamine release from adrenal glands, which has multiple effects: ‣ Increased peripheral vascular resistance - increased blood pressure ‣ Redistribution of blood flow away from the cutaneous, skin and splanchnic circulation - reduced renal and gut blood flow ‣ Precapillary constriction and reduced blood flow —> reduced hydrostatic pressure in downstream capillaries as net reabsorption leading to autotransfusion ‣ Venoconstriction mobilising venous reservoir - increased venous return ‣ Stimulation of vasopressin release via the projections from the nucleus of the solitary tract to the hypothalamus ‣ Stimulation of renin release by sympathetic stimulation of the juxtaglomerular cells, and due to lower renal perfusion * Net effect ◦ Reduced SBP and DBP ◦ Reduced pulse pressure ◦ Tachycardia - Increased inotropy - Increased PVR with vasoconstriction ◦ Cardiac output will be intitially reduced but with compensation will improve towards normal Maximal response within 30 seconds

Answer 66

* Renin secretion causes: ◦ Vasoconstriction (by angiotensin) ◦ Increased sodium retention (by aldosterone) leading to increased reabsorption of water ◦ Increased thirst * Vasopressin release causes: ◦ Vasoconstriction (by V1 receptors), augments noradrenaline mediated arteriolar vasoconstriction ◦ Increased water retention (by V2 receptors) * Venous hypotension decreases atrial natriuretic peptide secretion, which causes: ◦ Decreased renal blood flow ◦ Decreased urinary water and sodium excretion * Catecholamines - see above * The net effect is decreased urine output and increased retention of sodium and water

Answer 67

Compensatory mechanisms overwhelmed resulting in reduced BP and tissue perfusion with anaerobic metabolism and lactic acidosis. Decreased catecholamine sensitivity

Answer 68

* Erythropoerisis is stimulated by EPO release from the kidney stimulated by decreased oxygen delivery leading to increased RBC production - happens within the first 24 hours but takes 4-8 weeks to fully restore circualting RBC voluem * Albumin synthesis is stimulated in the liver and restores circulating protein levels to normal within a few days * Plasma volume returns to normal within 12-72 hours

Answer 69

* Volume effect is greater during the infusion (prior to redistribution) * During this time, the blood volume may be expanded by 50-70% of the infused volume * This increases stroke volume by increasing preload causing an increase in cardiac output (frank Starling relationship) and blood pressure due to initially normal SVR, and therefore stimulates cardiovascular reflexes

Answer 70

◦ Initially, a short-lived increase in heart rate (Bainbridge reflex, atrial stretch) ◦ Followed by a decrease in heart rate (baroreceptors - aortic arch/carotid sinus) - stimulated by increased pressure/stretch --> decreased outflow to vasomotor centres --> reduced SNS outflow ◦ Decrease in SVRI (baroreceptors) ◦ Decreased secretion of renin by renal juxtaglomerualr cells as increased Na delivery to macula densa, with subsequent decreases in angiotensin and aldosterone - reduced vasoconstriction and reduced afterload, dropping BP and aldosterone reducing sodium reabsorption ◦ Tubuloglomerular feedback activation: increased salt delivery to the nephron results in decreased glomerular blood flow, which decreases salt delivery (i.e. this is a negative feedback mechanism) ◦ Natriuretic peptide release increases due to atrial stretch ◦ Brief period of pressure diuresis possible, and a brief drop in circulating ADH while plasma volume expansion >10% before returning to normal with redistribution - affected by RAAS also

Answer 71

◦ Tubuloglomerular feedback activation: increased salt delivery to the nephron results in decreased glomerular blood flow, which decreases salt delivery (i.e. this is a negative feedback mechanism)

Answer 72

* Redistribution begins immediately, and is complete within 25-30 minutes Distribution * VOD=0.2L/kg, basically confined to the extracellular fluid * (thus: 25% remains intravascular, 75% becomes interstitial)

Answer 73

Changes in electrolytes and osmolality * Change in osmolality: minimal (<1%) ; unnoticed by osmoreceptors (saline is isotonic) * Change in plasma oncotic pressure: Dilution of plasma proteins increases the fraction of filtered water at the glomerulus, increasing the urine output (i.e. excretion of both water and sodium) * Change in biochemistry: ◦ trivial sodium elevation (~0.5-.0 mmol/L) ◦ nontrivial chloride elevation (up to 3 mmol/L) ◦ decrease in bicarbonate and base excess (also up to 3 mmol/L) ◦ Metabolic acidosis (this fluid has SID = 0)

Answer 74

Increased free water excretion due to ◦ Decreased peritubular capillary oncotic pressure causing ◦ Reduced water reabsorption from proximal tubule ◦ Therefore the degree to which plasma is concentrated by increased filtration or dilution of plasma proteins before reaching the kidney determines reabsorptino

Answer 75

* 900mosm/kg --> 3x that of plasma * Na remains in ECF, water will distribute according to osmolality, Cl remains in ECF

Answer 76

70kg person with TBW of 42L. ICF is 23L and ECF 19L with osmolality 290mosm/kg Before infusion * Total body solute content = 42L x 290 = 12 180 mosm * ECF solute content - 19 x 290 = 5510 * ICF solute content = 23 x 290 = 6670 mosm After infusion * 43L of total body water * ECF solute content = 5510 + 900 = 13 080 * ICF solute content = 6670 (unchanged) Therefore osmolality = 13080/42 = 304 mosm/kg ECF volume 21.1 L and ICF volume 21.9L * Decreased ICF volume * Interstitial volume expansion insufficient to cause oedema, interfere with gas transfer or nutrient or waste transfer * ECF increased by 2.1L with 1/4 or so intravascular 500mls. ◦ Blood volume increased by 10% --> 7-10% is the trigger for volume receptors --> ANP ‣ ANP promotes sodium excretion at the kidney and inhibits renin secretion ‣ Decreased renin stimulation (high Na content delivery to DCT) * Aldosterone inhibition - reduced Na reabsorption * Decreased angiotensin - reduced Na reabsorption, increased GFR ◦ This will also lower the sensitivity of the volume receptors and will inhibit ADH secretion ◦ Volume receptors more powerful than osmoreceptor response * Plasma osmolality increased by 4.8% --> triggers osmoreceptors ++ and ADH secretions increases to retain water and driving thirst ◦ This will slow down the rate of excretion of excess water

Answer 77

* ECF increased by 2.1L with 1/4 or so intravascular 500mls. ◦ Blood volume increased by 10% --> 7-10% is the trigger for volume receptors --> ANP ‣ ANP promotes sodium excretion at the kidney and inhibits renin secretion ‣ Decreased renin stimulation (high Na content delivery to DCT) * Aldosterone inhibition - reduced Na reabsorption * Decreased angiotensin - reduced Na reabsorption, increased GFR ◦ This will also lower the sensitivity of the volume receptors and will inhibit ADH secretion ◦ Volume receptors more powerful than osmoreceptor response * Plasma osmolality increased by 4.8% --> triggers osmoreceptors ++ and ADH secretions increases to retain water and driving thirst ◦ This will slow down the rate of excretion of excess water

Answer 78

* ECF increased by 2.1L with 1/4 or so intravascular 500mls. ◦ Blood volume increased by 10% --> 7-10% is the trigger for volume receptors --> ANP ‣ ANP promotes sodium excretion at the kidney and inhibits renin secretion ‣ Decreased renin stimulation (high Na content delivery to DCT) * Aldosterone inhibition - reduced Na reabsorption * Decreased angiotensin - reduced Na reabsorption, increased GFR ◦ This will also lower the sensitivity of the volume receptors and will inhibit ADH secretion ◦ Volume receptors more powerful than osmoreceptor response * Plasma osmolality increased by 4.8% --> triggers osmoreceptors ++ and ADH secretions increases to retain water and driving thirst ◦ This will slow down the rate of excretion of excess water

Answer 79

Absorption is near-complete ~98.5% bioavailability, rapid, and mainly occurs in the proximal small bowel * As water enters it becomes isotonic by mixing with saliva, stomach juices and intestinal fluids * Most of the diffusion is transcellular ◦ It is driven by osmotic mechanisms (active absorption of other electrolytes, especially sodium) Distribution is equal into all body fluid compartments, and proportional to their relative sizes: * 66% into the intracellular fluid * 340ml or 33% to extracellular fluid ◦ 25.5% into the interstitial fluid ◦ 8.5% into the circulating blood volume --> 80ml Elimination is by renal excretion, where the filtered fraction is reabsorbed by a highly regulated mechanism. Hlaf life of a litre of water is about an hour

Answer 80

Absorption is near-complete ~98.5% bioavailability, rapid, and mainly occurs in the proximal small bowel * As water enters it becomes isotonic by mixing with saliva, stomach juices and intestinal fluids * Most of the diffusion is transcellular ◦ It is driven by osmotic mechanisms (active absorption of other electrolytes, especially sodium) Distribution is equal into all body fluid compartments, and proportional to their relative sizes: * 66% into the intracellular fluid * 340ml or 33% to extracellular fluid ◦ 25.5% into the interstitial fluid ◦ 8.5% into the circulating blood volume --> 80ml Elimination is by renal excretion, where the filtered fraction is reabsorbed by a highly regulated mechanism. Hlaf life of a litre of water is about an hour

Answer 81

Osmolality decreases * For one litre of pure water, this would be a 2.5% decrease in osmolality (40L of fluid diluted by 1L) ◦ Osmolality drop from 280 to 273 * This is sensed by the osmosensitive circumventricular organs (OVLT); even 1% would be enough ◦ Organum vasculosum of lamina terminalis * Afferent --> fibres from osmoreceptors decrease vasopressin release in posterior pituitary --> reducing V2 receptor stimulation and reduced apical expression of aquaporin in the collecting duct of nephrons reducing water reabsorption and promoting diuresis

Answer 82

Absorption is near-complete ~98.5% bioavailability, rapid, and mainly occurs in the proximal small bowel * As water enters it becomes isotonic by mixing with saliva, stomach juices and intestinal fluids * Most of the diffusion is transcellular ◦ It is driven by osmotic mechanisms (active absorption of other electrolytes, especially sodium) Distribution is equal into all body fluid compartments, and proportional to their relative sizes: * 66% into the intracellular fluid * 340ml or 33% to extracellular fluid ◦ 25.5% into the interstitial fluid ◦ 8.5% into the circulating blood volume --> 80ml Elimination is by renal excretion, where the filtered fraction is reabsorbed by a highly regulated mechanism. Hlaf life of a litre of water is about an hour

Answer 83

Absorption is near-complete ~98.5% bioavailability, rapid, and mainly occurs in the proximal small bowel * As water enters it becomes isotonic by mixing with saliva, stomach juices and intestinal fluids * Most of the diffusion is transcellular ◦ It is driven by osmotic mechanisms (active absorption of other electrolytes, especially sodium) Distribution is equal into all body fluid compartments, and proportional to their relative sizes: * 66% into the intracellular fluid * 340ml or 33% to extracellular fluid ◦ 25.5% into the interstitial fluid ◦ 8.5% into the circulating blood volume --> 80ml Elimination is by renal excretion, where the filtered fraction is reabsorbed by a highly regulated mechanism. Hlaf life of a litre of water is about an hour

Answer 84

Plasma sodium concentration decreases * This increases the stimulus for angiotensin and aldosterone release * The net effect of these is to increase the reabsorption of sodium in the nephron

Answer 85

Blood volume increases (very slightly) * For one litre of pure water, this would be a 80ml increase in volume, or about 1.6% * This change is below the sensitivity threshold of the cardiovascular regulatory reflexes, and should not lead to any change in blood pressure for a normal healthy person

Answer 86

Losing 1L is the loss of 1.4% of total body weight for a 70kg patient * The loss fo water from any one compartment rapidly is corrected by inflow of water from another compartment. ◦ 80mls lost from intravascular space ◦ 250ml lost from interstitial fluid ◦ 670ml from intracellular fluid * Osmolality change 2.5%, and 1.6% change in volume ◦ Sufficient to trigger the osmoreceptor but not he baroreceptors --> ADH release * Electrolyte changes ◦ Na rise from 140 --> 143 * No baroreceptor response as 2% change insufficient * Glomerulotubular balance - Intravascular protein concentration increases reabsorption of fluid from the proximal tubule retaining water

Answer 87

* Dehydration results in haemoconcentration, and haemoconcentration predictably leads to increased blood viscosity, though the relationship is unpredictably non-linear - whole blood viscocity increases markedly more than linearly would be predicted from haemoconcentration and plasma viscocity increases * Heart has to work harder due to decreased circulatory volume in exercise + having to perfuse the areas it would shut down (skin/muscle) in haemoarrhage i.e. uncompensate hypovolaemia

Answer 88

* Intracellular Fluid = 33% of total body mass ( 23.1 litres) ; this volume is regulated by the movement of free water. ◦ 55% of total body water ◦ 70% of intracellular contents is water, and viscocity is very near water but diffusion through this compartment takes 4x longer

Answer 89

* Extracellular Fluid = 27% (18.9 litres); this volume is regulated by the movement of sodium. and 45% of total body water

Answer 90

◦ Plasma volume (2.8L) (1/4 of ECF/ 7.5% of total fluid) ‣ Red cells 2.5% of body mass, 4.5% of total fluid (nearly 2L) BUT inside cells ‣ Blood volume is 12% of total fluid or 7% of body mass ◦ Interstitial and lymph fluid ‣ 12% of body mass, 20% of total fluid 8.4L ◦ Dense connective tissue and bone ‣ 15% of total body fluid, 9% of total mass however slow to mobilise and dose not participate in infusion physiology. The rest is functional ECF ◦ Adipose tissue

Answer 91

◦ Plasma volume (2.8L) (1/4 of ECF/ 7.5% of total fluid) ‣ Red cells 2.5% of body mass, 4.5% of total fluid (nearly 2L) BUT inside cells ‣ Blood volume is 12% of total fluid or 7% of body mass ◦ Interstitial and lymph fluid ‣ 12% of body mass, 20% of total fluid 8.4L ◦ Dense connective tissue and bone ‣ 15% of total body fluid, 9% of total mass however slow to mobilise and dose not participate in infusion physiology. The rest is functional ECF ◦ Adipose tissue

Answer 92

◦ Plasma volume (2.8L) (1/4 of ECF/ 7.5% of total fluid) ‣ Red cells 2.5% of body mass, 4.5% of total fluid (nearly 2L) BUT inside cells ‣ Blood volume is 12% of total fluid or 7% of body mass ◦ Interstitial and lymph fluid ‣ 12% of body mass, 20% of total fluid 8.4L ◦ Dense connective tissue and bone ‣ 15% of total body fluid, 9% of total mass however slow to mobilise and dose not participate in infusion physiology. The rest is functional ECF ◦ Adipose tissue

Answer 93

* Transcellular fluid: ~1.5% of body mass or 2.5% of total body fluid (1050ml); fluid formed by the secretory activity of cells,

Answer 94

* to the increase in renal perfusion ◦ Renin, angiotensin and aldosterone secretion is depressed ◦ As the result, the reabsorption of sodium and water in the distal nephron is decreased * to the change in atrial stretch ◦ Natriuretic peptide release increases, as atrial stretch stimulates their release, which in turn stimulates natriuresis and diuresis * to the change in osmolality ◦ The change in osmolality is sensed by the hypothalamus ◦ Vasopressin secretion from the posterior pituitary is then altered to produce the desired change in the urine concentrating function of the distal nephron

Answer 95

* Atrial stretch receptors sense the increase in venous pressure, and briefly increase the heart rate (Bainbridge reflex) - when the patient is hypovolaemic baroreceptor reflex overrides this, seen more with euvolaemia * Baroreceptors sense the increase in arterial pressure generated by the increase in stroke volume, and decrease the heart rate and the systemic vascular resistance, thereby renormalising the blood pressure

Answer 96

500ml of 20% mannitol --> 100g of mannitol. 1100mmol/L. Mannitol distributed evenly into extracellualr fluid but not mechanism of entry into cells.

Answer 97

◦ Intracellular dehydration, including brain parenchyma ◦ Rheological effects of mannitol infusion - improved RBC deformability due to shrinkage --. decreased blood viscocity improving microvascular perfusion ◦ Extracellular volume expansion - redistribution completely equally between interstitial and intravascular (same conc) --> 1100mmol in 14L ECF leads to big rise in osmolality 25mmol/L causing redistribution of fluid --> ‣ IV increase by 360mls --> 7% blood volume increase --> minimal baroreceptor response ‣ interstitial 1L, and ‣ drop in intracellular by 930mls --> 10-12% drop in intracranial pressure in mammals, 30% with hypocapnoea within 5-15 minutes and over 2-3 hours returns to baseline (hyeprtonic saline lasts 130 minutes)

Answer 98

◦ Hyperosmolar hyponatremia ‣ Triggers osmoreceptors --> increased ADH but less effective due to mannitol osmotic effect in tubules (effect diuresis). More water is lost than Na ‣ Increase in free water intravascularly drops Na from 140 to 127mmolL --> as mannitol is excreted though this improves ◦ Hyperkalemia - combination fo solute drag with fluid moving out of cells but also intracellular dehydration increasing K concentraiton favouring movement out

Answer 99

Due to ranging volumes, haematocrit, and duration of storage effects the effect is uncertain. Let us assume 250mls is given of which its haematocrit is 60%. Therefore 150mls of cells, 100mls of fluid. 100ml of water has an osmolality of 340mosm/L so giving 100ml you get 34mmol of electrolytes * Na 15mmol remaining ECF * K 2mmol - note this is just the free extracellualr K, the cells containg 150mmol/L (i.e. 15mmol) * Cl 15mmol ECF * HCO3 1mmol ECF * Lactate 1 mmol metabolised by the liver

Answer 100

Redistribution * Over 15 minutes * ECF now has a slight bump in osmolality causing some minor redistribution from intracaellular fluid ◦ 26ml of water remains intravascular + 150ml of cells ◦ Interstitum has 79mls extra ◦ Intracellular -6mls * Haematocrit change - if haematocrit started at 0.3 then this was 1500ml of 5000 --> increased by 150mls so 6% increase (when measured it is more likely 2% increase) * Hb rises by 10g/L

Answer 101

Response * Osmolality reamins constant as essentially isoosomolar * Baroreceptors - intravascular volume increases by 176mls from 5000 to 5176 a 3.5% change * Electrolytes ◦ Largely stable ◦ Citrate chelates 1mmol of Ca per pRBC and as 31mmol in ECF