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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
What is an osmole?
the osmosis caused by a mole
26
What is a millimole?
MOLECULAR weight in MILLIgrams *in the body we deal with milliosmoles (mOsm)
27
What is a mole?
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
28
What is avogadro's number?
a mole 6.022 x 10^23
29
What is the difference between ionizable and non-ionizable molecules?
Can they dissociate in a solute? ie. 1 mole glucose → 1 mole 2 mole Cl2 → 4 moles
30
What measure/count does osmotic pressure depend upon?
the NUMBER of MOLECULES, not mass
31
What is the equation to calculate osmolality?
2 x Na^2 + (glucose / 18) + (BUN / 2.8)
32
What is a normal osmolality?
29 mOm /L
33
What are the units for osmolality?
mOm / L
34
What is tonicity?
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
35
What is the plasma osmolality of hypertonic substances?
>295 mOsm / L
36
What is the plasma osmolality of an isotonic solution?
275 - 295 mOsm / L
37
What is the plasma osmolality of a hypotonic solution?
< 275 mOsm / L
38
What is special about sodium?
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
39
Is the concentration of Na higher or lower in the ECF or ICF?
ECF Na > ICF Na d/t the Na/K pump
40
Serum Na is proportional to what?
TBNa / TBW
41
TBNa / TBW is proportional to what?
serum Na
42
what are 3 fluid disorders?
1. isotonic fluid disorders 2. hypotonic fluid disorders 3. hypertonic fluid disorders
43
What are 2 isotonic fluid disorders?
1. isotonic loss of fluid | 2. isotonic gain of fluid
44
What are 3 hypotonic fluid disorders?
1. hypertonic loss of Na 2. gain of pure water 3. hypotonic gain of Na
45
What are 4 hypertonic fluid disorders?
1. hypotonic loss of Na 2. loss of pure water 3. hypertonic gain of Na 4. hyperglycemia
46
What happens during an isotonic fluid disorder?
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
47
During an isotonic fluid disorder, does the ICF compartment change?
NO
48
What is one example of an isotonic loss of fluid?
hemorrhage
49
What is the direction change of the following during an isotonic loss of fluid? ECF serum Na serum osmolality ICF
ECF ↓ Serum Na - normal Serum osmolality - normal ICF - normal
50
What is the clinical change in an isotonic loss of fluid?
ECF volume depletion
51
During an isotonic loss of fluid, what is the: ``` HR BP cap refill UOP vasculature & perfusion? ```
HR ↑ BP ↓ cap refill ↓ UOP ↓ vasoconstriction; inadequate perfusion to organs / tissues
52
What is the treatment for isotonic loss of fluid?
administration of isotonic fluid
53
What happens during an isotonic gain of fluid? ie. one example
excessive administration of isotonic fluid
54
During an isotonic gain of fluid, does the ICF compartment change?
NO
55
What is the direction change of the following during an isotonic gain of fluid? ECF serum Na serum osmolality ICF
ECF ↑ serum Na - normal serum osmolality - normal ICF - normal
56
What is the clinical change in an isotonic gain of fluid?
ECF volume overload
57
During an isotonic loss of fluid, what is the: HR BO body weight vascultaure & perfusion
HR ↑ BP ↑ body weight ↑ dependent pitting edema inadequate perfusion to organs / tissues
58
What is the treatment of an isotonic gain of fluid?
restrict fluids, diuretics
59
What happens during a hypotonic fluid disorder?
plasma osmolality is low, caused by a low serum Na = osmotic gradient water shifts from the ECF to the ICF ** cells SWELL
60
How does water shift in a hypotonic fluid disorder?
water shifts from the ECF to the ICF ** cells SWELL
61
What are 3 examples of hypertonic loss of Na?
1. diuretics ( LOOP, Thiazide) 2. Addison's disease (↓ aldosterone) 3. 21-hydroxylast deficiency (↓ aldosterone)
62
What is a hypertonic loss of Na?
Lose a bucket of water with a LOT of salt
63
During a hypertonic loss of Na, what happens to the following: ECF serum Na serum osmolality ICF
ECF ↓↓ serum Na ↓ serum osmolality ↓ ICF ↑↑
64
What is the clinical change during a hypertonic loss of Na?
ECF volume depletion
65
What happens to the following during a hypertonic loss of Na? ``` HR BP cap refill UOP neuro ```
HR ↑ BP ↓ cap refill ↓ UOP ↓ confusion, mental status change
66
What is the treatment of a hypertonic gain of Na?
administration of isotonic fluid
67
What is one example of a gain of pure water?
SIADH
68
During the gain of pure water, what happens to the following: ECF serum Na serum osmolality ICF
ECF ↑ serum Na ↓ serum osmolality ↓ ICF ↑↑
69
What is the clinical change during a gain of pure water?
confusion drowsiness mental status change
70
What is the treatment of the gain of pure water?
restrict water treat underlying problem
71
What is an example of a gain of hypotonic solution?
absorption of an electrolyte-free irrigation solution TURP or endometrial ablation
72
What are 2 examples of procedures that can result in the absorption of electrolyte-free irrigation solution
1. TURP | 2. endometrial ablation
73
During the gain of a hypotonic solution, what happens to: ECF serum Na serum osmolality ICF
ECF ↑ serum Na ↓ serum osmolality ↓ ICF ↑↑
74
What is the clinical change during the gain of hypotonic solution?
seizures pulmonary edema difficulty ventilating cerebral edema
75
What is the treatment of a gain of hypotonic solution?
diuresis | 3% NS
76
What are 4 examples of a hypotonic gain of Na?
1. overload states 2. cirrhotic 3. nephrotic 4. CHF
77
During a hypotonic gain of Na, what happens to: ECF serum Na serum osmolality ICF
ECF: ↑ serum Na ↓ serum osmolality ↓ ICF ↑
78
What is the clinical change during a hypotonic gain of Na?
``` dependent, pitting edema cavity effusions (ascites) SOB ↑↑ body weight mental status change ```
79
What is the treatment of hypotonic gain of Na?
restrict salt & water diuretics
80
What happens during hypertonic fluid disorders?
high serum Na or glucose cause high plasma osmolality → osmotic gradient water shifts from ICF to ECF **ICF volume contracts (cell shrinks)
81
How does fluid shift in a hypertonic fluid disorder?
water shifts from ICF to ECF
82
What happens to cells in a hypertonic fluid disorder?
cells shrink
83
What are 4 examples of hypotonic loss of Na?
1. sweating (marathon) 2. osmotic diarrhea 3. osmotic diuresis 4. vomiting
84
In hypotonic loss of Na, what happens to: ECF serum Na serum osmolality ICF
ECF ↓ serum Na ↑ serum osmolality ↑ ICF ↓↓
85
What is the clinical change in a hypotonic loss of Na?
``` dry skin & mucous membranes dizzy confusion mental status change HR ↑ ```
86
What is the treatment of a hypotonic loss of Na?
administration of isotonic fluid (to maintain BP), then switch to hypotonic fluid (0.45%NaCl)
87
What are 2 examples of loss of pure water?
1. diabetes insipidus | 2. excessive water evaporation off of the skin (fever, burns, insensible fluid loss)
88
In loss of pure water, what happens to: ECF serum Na serum osmolality ICF
ECF ↓ serum Na ↑ serum osmolality ↑ ICF ↓
89
What is the clinical change in loss of pure water?
confusion drowsiness mental status change
90
What is the treatment of the loss of pure water?
administer water D5W | treat underlying problem
91
What are 4 examples of hypertonic gain of Na?
1. NaHCO3 infusion 2. infusion of hypertonic saline 3. antibiotics that contain Na 4. sodium modeling in hemodialysis
92
In a hypertonic gain of Na, what happens to: ECF serum Na serum osmolality ICF
ECF ↑ serum Na ↑ serum osmolality ↑ ICF ↓
93
What is the clinical sign in a hypertonic gain of Na?
mental status change
94
What is the treatment of hypertonic gain of Na?
stop the infusion
95
What are 2 examples of hyperglycemia?
1. diabetic ketoacidosis (type 1 DM) | 2. hyperosmolar non-ketotic coma (type 2 DM)
96
During hyperglycemia, what happens to: ECF serum Na serum osmolality ICF
ECF ↓ serum Na ↓↓ serum osmolality ↑↑ ICF ↓
97
What is the clinical change in hyperglycemia?
mental status change, diabetic coma
98
What is the treatment of hyperglycemia?
treat underlying cause
99
What are 6 preoperative alterations of fluid balance?
1. burns 2. vomiting 3. diarrhea 4. fever 5. gastric suction 6. bowel prep
100
What are 4 intraoperative alterations of fluid balance?
1. hemorrhage 2. evaporative loss 3. third spacing 4. hypo-osmolar irrigation
101
What are 4 alterations of fluid balance with anesthesia?
1. vasodilation 2. release of ADH 3. increase of evaporative loss from ventilation 4. mobilization of third-space fluids on POD #3
102
What is ADH?
Anti-diuretic hormone, vasopressin *nonapeptide synthesized in the hypothalamus
103
When is ADH released and where from?
in response to stress, released from the posterior pituitary
104
Where is ADH synthesized?
the hypothalamus
105
What is the MOA of ADH?
reabsorption on the collecting duct in kidneys causing water retention
106
What causes increased reabsorption of water in the collecting duct of the kidneys?
ADH; vasopressin
107
How does the body UTILIZE ADH in the pre-op period
offsetting the hypovolemic effect of fasting
108
Can UOP be used as an indicator of circulating blood volume?
no, too many factors can alter it.
109
What is the recommendation of using UOP for fluid management?
isolated low UOP should NOT trigger fluid therapy and extensive diagnostic efforts
110
How is goal directed fluid therapy different?
maximizing cardiac flow parameters as a surrogate for oxygen delivery
111
What is the primary objective of perioperative fluid therapy?
maintenance of normovolemia in order to maintain adequate tissue perfusion
112
How can a fluid challenge indicate intravascular fluid status?
CO will usually increase in response to a fluid challenge
113
In the traditional method of fluid therapy management, what 3 things are calculated?
1. surgical loss 2. deficit 3. maintenance
114
What is plasmanate?
protein-containing colloid
115
What are the indications for plasmanate administration?
1. hypovolemic shock (ESP burn shock) | 2. hypoproteinmia
116
What are the adverse reactions to plasmanate?
1. chills 2. fever 3. urticaria 4. N/V
117
How is plasmanate supplied?
5% solution; 250mL or 500mL bags
118
What is the duration of plasmanate?
24-36 hours
119
What is dextran?
artificial colloid; polysaccharide molecules
120
When is dextran utilized/
during bypass
121
What are the indications for dextran?
improve microcirculatory flow during microsurgeries; ECMO during cardio-pulmonary bypass
122
What are the adverse reactions for dextran?
1. anaphylaxis 2. coagulation abnormalities 3. interference with cross-match blood 4. precipitation of acute renal failure
123
How is dextran supplied?
dextran 70 - 6% solution average MW 70,000 dextran 40 - 10% solution average MW 40,000
124
What is the duration of dextran?
6-12 hours
125
What is one BAD thing about hetastarch?
WILL CAUSE BLEEDING / COAGULATION ISSUES
126
What is hetastarch?
synthetic - made from plant starch
127
What is the indication for hetastarch?
hypovolemia
128
What is the maximum dose of hetastarch?
20mL/kg
129
What are adverse reactions associated with hetastarch? (5)
1. hypersensitivity 2. coagulopathy 3. hemodilution 4. circulatory overload 5. metabolic acidosis
130
How is hetastarch supplied?
hespan 6% solution in NS
131
What is the duration of hetastarch?
24-36 hours
132
What is hextend?
6% hetastarch in a buffered solution
133
What are the 3 additives to hetastarch to make hextend?
1. lactate buffer 2. balanced electrolytes 3. physiologic glucose
134
Can Hextend can be given in volumes > what?
20mL/kg
135
What is Voluven?
colloid smaller molecule than other HES solutions * less plasma accumulation * less coagulopathy (fewer effects) SAFER in patients with RENAL IMPAIRMMENT
136
Who is voluven safer for?
renal impairment patients

N928 - Basic Principles (22 decks)

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