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N928 - Basic Principles > Fluid and Blood Therapy > Flashcards

Fluid and Blood Therapy Flashcards

1
Q

Three roles of fluid in the body

A
  1. Transport
  2. Temperature Regulation
  3. Maintain Internal Environment
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2
Q

How does fluid in the body regulate temperature?

A

blood circulation to the skin and sweating increase heat dissipation, helping to keep the body at a constant temperature

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3
Q

Total body fluid of:

Newborn
Toddler
Child
Adult man
Adult woman
Seniors
A

Newborn - 80%

Toddler - 70%

Child - 65%

Adult man - 60%

Adult woman - 55%

Seniors 50-55%

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4
Q

Of the body fluid, how much is intracellular fluid and how much is extracellular fluid?

A

intracellular - 2/3

extracellular - 1/3

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5
Q

Of the extracellular fluid, how much is interstitial fluid and how much is plasma?

A

interstitial fluid- 3/4 (75%)

plasma - 1/4 (25%)

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6
Q

How much fluid is in each compartment of a 100kg man?

A

100kg total weight

fluid = 60L

of the 60L how much is intracellular?

2/3 = 40L

extracellular fluid = 20L

interstitial fluid = 3/4 = 15L
plasma = 1/4 = 5L

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7
Q

To deliver 1L of LR to the plasma, how much should be administered?

A

LR = isotonic

will stay extracellular
LR = 3/4 into interstitial fluid
1/4 into the plasma

1L LR = 250mL stays in the plasma

4L of LR need to be administered to keep 1L in the plasma

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8
Q

Trans-membrane transport; 2 main categories

A
  • passive

- active

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9
Q

What are the categories of passive transport?

A

(diffusion)
1. simple (no carrier)
ie. osmosis of water

  1. facilitated
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10
Q

What are the categories of active transport?

A
  1. carrier
    a. primary
    b. secondary
  2. vesicular
    a. endocytosis
    b. exocytosis
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11
Q

What is an example of primary active transport?

A

Na/K pump

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12
Q

What is an example of secondary active transport?

A

Na/Ca pump

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13
Q

What is an example of facilitated diffusion?

A

glucose via gated / “seesaw” transport protein

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14
Q

What is an example of simple diffusion (via the paracellular route)?

A

K through a channel

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15
Q

What is an example of simple diffusion?

A

O2 through the cell membrane

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16
Q

What are the 4 starling forces?

A
  1. interstitial colloid oncotic pressure
  2. interstitial hydrostatic pressure
  3. plasma colloid oncotic pressure
  4. plasma hydrostatic pressure
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17
Q

Does the BBB have a high or low filtration coefficient?

A

low

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18
Q

What is osmolality?

A

of osmoles of solute in a kg of solvent

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19
Q

What is osmolarity?

A

of osmoles of solute in a liter of solution

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20
Q

Is Osmolality or osmolarity more accurate in the human body?

A

difference in both is minimal

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21
Q

What is osmosis?

A

simple diffusion of water

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22
Q

What is osmotic pressure

A

pressure needed to stop osmosis

  • depends on the NUMBER of molecules, not size
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23
Q

what is P~ n/v

A

osmotic pressure

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24
Q

what is the equation for osmotic pressure?

A

P~ n/v

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25
Q

What is an osmole?

A

the osmosis caused by a mole

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26
Q

What is a millimole?

A

MOLECULAR weight in MILLIgrams

*in the body we deal with milliosmoles (mOsm)

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27
Q

What is a mole?

A

standard unit for measuring large quantities of very small atoms, molecules, or particles

aka avogadro’s number

*the number of atoms, molecules, or particles in a mole is the same for all substances

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28
Q

What is avogadro’s number?

A

a mole

6.022 x 10^23

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29
Q

What is the difference between ionizable and non-ionizable molecules?

A

Can they dissociate in a solute?

ie.
1 mole glucose → 1 mole
2 mole Cl2 → 4 moles

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30
Q

What measure/count does osmotic pressure depend upon?

A

the NUMBER of MOLECULES, not mass

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31
Q

What is the equation to calculate osmolality?

A

2 x Na^2 + (glucose / 18) + (BUN / 2.8)

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32
Q

What is a normal osmolality?

A

29 mOm /L

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33
Q

What are the units for osmolality?

A

mOm / L

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34
Q

What is tonicity?

A

the ability of the combined effect of all the solutes to generate an osmotic driving force that causes water movement

** only includes the effective osmoles

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35
Q

What is the plasma osmolality of hypertonic substances?

A

> 295 mOsm / L

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36
Q

What is the plasma osmolality of an isotonic solution?

A

275 - 295 mOsm / L

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37
Q

What is the plasma osmolality of a hypotonic solution?

A

< 275 mOsm / L

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38
Q

What is special about sodium?

A
  1. most abundant electrolyte in the ECF
  2. responsible for most of the osmotic activity of the ECF
  3. alterations of the ECF Na greatly affects the movement of water across the cell membrane
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39
Q

Is the concentration of Na higher or lower in the ECF or ICF?

A

ECF Na > ICF Na

d/t the Na/K pump

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40
Q

Serum Na is proportional to what?

A

TBNa / TBW

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41
Q

TBNa / TBW is proportional to what?

A

serum Na

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42
Q

what are 3 fluid disorders?

A
  1. isotonic fluid disorders
  2. hypotonic fluid disorders
  3. hypertonic fluid disorders
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43
Q

What are 2 isotonic fluid disorders?

A
  1. isotonic loss of fluid

2. isotonic gain of fluid

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44
Q

What are 3 hypotonic fluid disorders?

A
  1. hypertonic loss of Na
  2. gain of pure water
  3. hypotonic gain of Na
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45
Q

What are 4 hypertonic fluid disorders?

A
  1. hypotonic loss of Na
  2. loss of pure water
  3. hypertonic gain of Na
  4. hyperglycemia
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46
Q

What happens during an isotonic fluid disorder?

A

isotonic loss or gain of fluid → NO change in serum Na

No osmotic gradient = NO water shift across membranes

NO change in the ICF compartment

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47
Q

During an isotonic fluid disorder, does the ICF compartment change?

A

NO

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48
Q

What is one example of an isotonic loss of fluid?

A

hemorrhage

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49
Q

What is the direction change of the following during an isotonic loss of fluid?

ECF
serum Na
serum osmolality
ICF

A

ECF ↓
Serum Na - normal
Serum osmolality - normal
ICF - normal

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50
Q

What is the clinical change in an isotonic loss of fluid?

A

ECF volume depletion

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51
Q

During an isotonic loss of fluid, what is the:

HR
BP
cap refill
UOP
vasculature & perfusion?
A

HR ↑
BP ↓
cap refill ↓
UOP ↓

vasoconstriction; inadequate perfusion to organs / tissues

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52
Q

What is the treatment for isotonic loss of fluid?

A

administration of isotonic fluid

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53
Q

What happens during an isotonic gain of fluid?

ie. one example

A

excessive administration of isotonic fluid

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54
Q

During an isotonic gain of fluid, does the ICF compartment change?

A

NO

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55
Q

What is the direction change of the following during an isotonic gain of fluid?

ECF
serum Na
serum osmolality
ICF

A

ECF ↑

serum Na - normal

serum osmolality - normal

ICF - normal

56
Q

What is the clinical change in an isotonic gain of fluid?

A

ECF volume overload

57
Q

During an isotonic loss of fluid, what is the:

HR
BO
body weight
vascultaure & perfusion

A

HR ↑
BP ↑
body weight ↑

dependent pitting edema
inadequate perfusion to organs / tissues

58
Q

What is the treatment of an isotonic gain of fluid?

A

restrict fluids, diuretics

59
Q

What happens during a hypotonic fluid disorder?

A

plasma osmolality is low, caused by a low serum Na = osmotic gradient

water shifts from the ECF to the ICF

** cells SWELL

60
Q

How does water shift in a hypotonic fluid disorder?

A

water shifts from the ECF to the ICF

** cells SWELL

61
Q

What are 3 examples of hypertonic loss of Na?

A
  1. diuretics ( LOOP, Thiazide)
  2. Addison’s disease (↓ aldosterone)
  3. 21-hydroxylast deficiency (↓ aldosterone)
62
Q

What is a hypertonic loss of Na?

A

Lose a bucket of water with a LOT of salt

63
Q

During a hypertonic loss of Na, what happens to the following:

ECF
serum Na
serum osmolality
ICF

A

ECF ↓↓

serum Na ↓

serum osmolality ↓

ICF ↑↑

64
Q

What is the clinical change during a hypertonic loss of Na?

A

ECF volume depletion

65
Q

What happens to the following during a hypertonic loss of Na?

HR
BP
cap refill
UOP
neuro
A

HR ↑
BP ↓
cap refill ↓
UOP ↓

confusion, mental status change

66
Q

What is the treatment of a hypertonic gain of Na?

A

administration of isotonic fluid

67
Q

What is one example of a gain of pure water?

A

SIADH

68
Q

During the gain of pure water, what happens to the following:

ECF
serum Na
serum osmolality
ICF

A

ECF ↑

serum Na ↓

serum osmolality ↓

ICF ↑↑

69
Q

What is the clinical change during a gain of pure water?

A

confusion
drowsiness
mental status change

70
Q

What is the treatment of the gain of pure water?

A

restrict water

treat underlying problem

71
Q

What is an example of a gain of hypotonic solution?

A

absorption of an electrolyte-free irrigation solution

TURP or endometrial ablation

72
Q

What are 2 examples of procedures that can result in the absorption of electrolyte-free irrigation solution

A
  1. TURP

2. endometrial ablation

73
Q

During the gain of a hypotonic solution, what happens to:

ECF
serum Na
serum osmolality
ICF

A

ECF ↑

serum Na ↓

serum osmolality ↓

ICF ↑↑

74
Q

What is the clinical change during the gain of hypotonic solution?

A

seizures

pulmonary edema

difficulty ventilating

cerebral edema

75
Q

What is the treatment of a gain of hypotonic solution?

A

diuresis

3% NS

76
Q

What are 4 examples of a hypotonic gain of Na?

A
  1. overload states
  2. cirrhotic
  3. nephrotic
  4. CHF
77
Q

During a hypotonic gain of Na, what happens to:

ECF
serum Na
serum osmolality
ICF

A

ECF: ↑

serum Na ↓

serum osmolality ↓

ICF ↑

78
Q

What is the clinical change during a hypotonic gain of Na?

A 
dependent, pitting edema
cavity effusions (ascites)
SOB
↑↑ body weight
mental status change
79
Q

What is the treatment of hypotonic gain of Na?

A

restrict salt & water

diuretics

80
Q

What happens during hypertonic fluid disorders?

A

high serum Na or glucose cause high plasma osmolality → osmotic gradient

water shifts from ICF to ECF

**ICF volume contracts (cell shrinks)

81
Q

How does fluid shift in a hypertonic fluid disorder?

A

water shifts from ICF to ECF

82
Q

What happens to cells in a hypertonic fluid disorder?

A

cells shrink

83
Q

What are 4 examples of hypotonic loss of Na?

A
  1. sweating (marathon)
  2. osmotic diarrhea
  3. osmotic diuresis
  4. vomiting
84
Q

In hypotonic loss of Na, what happens to:

ECF
serum Na
serum osmolality
ICF

A

ECF ↓

serum Na ↑

serum osmolality ↑

ICF ↓↓

85
Q

What is the clinical change in a hypotonic loss of Na?

A 
dry skin & mucous membranes
dizzy
confusion
mental status change
HR ↑
86
Q

What is the treatment of a hypotonic loss of Na?

A

administration of isotonic fluid (to maintain BP), then switch to hypotonic fluid (0.45%NaCl)

87
Q

What are 2 examples of loss of pure water?

A
  1. diabetes insipidus

2. excessive water evaporation off of the skin (fever, burns, insensible fluid loss)

88
Q

In loss of pure water, what happens to:

ECF
serum Na
serum osmolality
ICF

A

ECF ↓

serum Na ↑

serum osmolality ↑

ICF ↓

89
Q

What is the clinical change in loss of pure water?

A

confusion
drowsiness
mental status change

90
Q

What is the treatment of the loss of pure water?

A

administer water D5W

treat underlying problem

91
Q

What are 4 examples of hypertonic gain of Na?

A
  1. NaHCO3 infusion
  2. infusion of hypertonic saline
  3. antibiotics that contain Na
  4. sodium modeling in hemodialysis
92
Q

In a hypertonic gain of Na, what happens to:

ECF
serum Na
serum osmolality
ICF

A

ECF ↑

serum Na ↑

serum osmolality ↑

ICF ↓

93
Q

What is the clinical sign in a hypertonic gain of Na?

A

mental status change

94
Q

What is the treatment of hypertonic gain of Na?

A

stop the infusion

95
Q

What are 2 examples of hyperglycemia?

A
  1. diabetic ketoacidosis (type 1 DM)

2. hyperosmolar non-ketotic coma (type 2 DM)

96
Q

During hyperglycemia, what happens to:

ECF
serum Na
serum osmolality
ICF

A

ECF ↓

serum Na ↓↓

serum osmolality ↑↑

ICF ↓

97
Q

What is the clinical change in hyperglycemia?

A

mental status change, diabetic coma

98
Q

What is the treatment of hyperglycemia?

A

treat underlying cause

99
Q

What are 6 preoperative alterations of fluid balance?

A
  1. burns
  2. vomiting
  3. diarrhea
  4. fever
  5. gastric suction
  6. bowel prep
100
Q

What are 4 intraoperative alterations of fluid balance?

A
  1. hemorrhage
  2. evaporative loss
  3. third spacing
  4. hypo-osmolar irrigation
101
Q

What are 4 alterations of fluid balance with anesthesia?

A
  1. vasodilation
  2. release of ADH
  3. increase of evaporative loss from ventilation
  4. mobilization of third-space fluids on POD #3
102
Q

What is ADH?

A

Anti-diuretic hormone, vasopressin

*nonapeptide synthesized in the hypothalamus

103
Q

When is ADH released and where from?

A

in response to stress, released from the posterior pituitary

104
Q

Where is ADH synthesized?

A

the hypothalamus

105
Q

What is the MOA of ADH?

A

reabsorption on the collecting duct in kidneys causing water retention

106
Q

What causes increased reabsorption of water in the collecting duct of the kidneys?

A

ADH; vasopressin

107
Q

How does the body UTILIZE ADH in the pre-op period

A

offsetting the hypovolemic effect of fasting

108
Q

Can UOP be used as an indicator of circulating blood volume?

A

no, too many factors can alter it.

109
Q

What is the recommendation of using UOP for fluid management?

A

isolated low UOP should NOT trigger fluid therapy and extensive diagnostic efforts

110
Q

How is goal directed fluid therapy different?

A

maximizing cardiac flow parameters as a surrogate for oxygen delivery

111
Q

What is the primary objective of perioperative fluid therapy?

A

maintenance of normovolemia in order to maintain adequate tissue perfusion

112
Q

How can a fluid challenge indicate intravascular fluid status?

A

CO will usually increase in response to a fluid challenge

113
Q

In the traditional method of fluid therapy management, what 3 things are calculated?

A
  1. surgical loss
  2. deficit
  3. maintenance
114
Q

What is plasmanate?

A

protein-containing colloid

115
Q

What are the indications for plasmanate administration?

A
  1. hypovolemic shock (ESP burn shock)

2. hypoproteinmia

116
Q

What are the adverse reactions to plasmanate?

A
  1. chills
  2. fever
  3. urticaria
  4. N/V
117
Q

How is plasmanate supplied?

A

5% solution; 250mL or 500mL bags

118
Q

What is the duration of plasmanate?

A

24-36 hours

119
Q

What is dextran?

A

artificial colloid; polysaccharide molecules

120
Q

When is dextran utilized/

A

during bypass

121
Q

What are the indications for dextran?

A

improve microcirculatory flow during microsurgeries;

ECMO during cardio-pulmonary bypass

122
Q

What are the adverse reactions for dextran?

A
  1. anaphylaxis
  2. coagulation abnormalities
  3. interference with cross-match blood
  4. precipitation of acute renal failure
123
Q

How is dextran supplied?

A

dextran 70 - 6% solution

average MW 70,000

dextran 40 - 10% solution

average MW 40,000

124
Q

What is the duration of dextran?

A

6-12 hours

125
Q

What is one BAD thing about hetastarch?

A

WILL CAUSE BLEEDING / COAGULATION ISSUES

126
Q

What is hetastarch?

A

synthetic - made from plant starch

127
Q

What is the indication for hetastarch?

A

hypovolemia

128
Q

What is the maximum dose of hetastarch?

A

20mL/kg

129
Q

What are adverse reactions associated with hetastarch? (5)

A
  1. hypersensitivity
  2. coagulopathy
  3. hemodilution
  4. circulatory overload
  5. metabolic acidosis
130
Q

How is hetastarch supplied?

A

hespan 6% solution in NS

131
Q

What is the duration of hetastarch?

A

24-36 hours

132
Q

What is hextend?

A

6% hetastarch in a buffered solution

133
Q

What are the 3 additives to hetastarch to make hextend?

A
  1. lactate buffer
  2. balanced electrolytes
  3. physiologic glucose
134
Q

Can Hextend can be given in volumes > what?

A

20mL/kg

135
Q

What is Voluven?

A

colloid

smaller molecule than other HES solutions

  • less plasma accumulation
  • less coagulopathy (fewer effects)

SAFER in patients with RENAL IMPAIRMMENT

136
Q

Who is voluven safer for?

A

renal impairment patients

N928 - Basic Principles (22 decks)

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