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7- Surgery > Fluid And Electrolytes Imbalance > Flashcards

Fluid And Electrolytes Imbalance Flashcards

1
Q

Factors requiring fluid therapy

A

Disease preventing oral intake - peritonitis, surgery

Intestinal resection

Surgical and medical conditions - intestinal obstruction, diarrhea, vomiting

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2
Q

Percentage of total body water of adult male from weight

A

60%

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3
Q

Percentage of total body water of adult female from weight

A

50%

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4
Q

Determinants of total body water

A

Age
Sex
Degree of obesity

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5
Q

2 compartments of water distribution

A

Intracellular - 40% or 2/3 of TBW (28L)
Extracellular - 20% or 1/3 of TBW ( 14L)

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6
Q

Extracellular division in TBW

A

Intravascular
Extravascular

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7
Q

Amount of potassium in the cells

A

140 mmol per liter

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8
Q

Amount of sodium in extracellular

A

135-145 mmol/l

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9
Q

Most important cations and onions in the intracellular compartment

A

Potassium 140
Magnesium 15
phosphate 26
proteins 9

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10
Q

Most important onions and cations in the extracellular compartment

A

Sodium 135-145
chloride 95-105
bicarbonate24-29

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11
Q

Water gained and lost every day in tropical and temperate regions

A

3400 mL
2700ml

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12
Q

Amounts of water necessary in fluid therapy in the tropic and temperate regions in surgical patients who is expected not to pass stool

A

Reduced to 3L in tropics
2300ml in temperate

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13
Q

How do we compensate in flu therapy for high temperature Leading to more sweating

A

12% of the daily requirement in fluid added added for every 1°C rise

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14
Q

Sodium lost in the tropics and temperate regions

A

Tropics - 130-140mmol
Temperate - 90-120mmol

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15
Q

Potassium lost in the tropics and temperate regions

A

Tropics - 60mmol
Temperate - 70mmol

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16
Q

Sodium replacement therapy in tropics and temperate regions

A

Tropical - 130
Temp.- 80-110

17
Q

Potassium replacement therapy in tropics and temperate regions

A

Tropical - 50
Temp.- 60

18
Q

Amount of glucose given daily to surgical patients to reduce gluconeogenesis and minimize acidosis

A

2 L of 5% glucose daily

19
Q

Type of sugar given because it can be infused in concentration of up to 30% peripherally and provide more energy

A

Sorbitol

20
Q

Amount of glucose given exogenously if IV therapy is prolonged

A

5 g/ kilogram / day

21
Q

Amount of vitamin C required daily for supplementation

A

100 to 200 mg

22
Q

Summarized daily requirement in the tropic of surgical patient

A

3 L of water
130 mmol of sodium
50 mmol potassium
100 g of carbohydrates

23
Q

Which IV solution can provide the daily requirement in the tropical surgical patient

A

1 L of ringers lactate
2 L of 5% dextrose
50mmol of potassium chloride

Or

3L badoes maintenance solution

24
Q

which patients are not eligible for badoes maintenance solution

A

Patient with liver disease or acidosis
neonate

25
Q

How to calculate water infusion rates

A

4 mL/kg/hr for first 10 kg + 2 mL/kg/hr for the next 10 kg + 1 mL/kg/hr for remaining body weight

26
Q

Sodium infusion / day calculation

A

1 or 2 mmol /kg/day

27
Q

Daily requirements in surgical patient in temperate regions

A

2.5 L of water
80-100mmol of sodium
60 mmol of potassium
100 g of carbohydrates

28
Q

Solution given for fluid replacements in surgical patient of temperate region

A

Half liter of NS
2 L of 5% dextrose
3 g of potassium chloride
vitamin B and C

29
Q

DISEASE with rapid dehydration

A

Acute intestinal obstruction
peritonitis
diarrhea

30
Q

Dx with slow dehydration

A

Gastric outlet Obstruction

31
Q

Causes of dehydration

A

Vomiting or nasal gastric aspiration
diarrhea
internal fluid shift as in burns , peritonitis , , paralytic ileus, mechanical intestinal obstruction , pancreatitis
Enterocutaneous fistula
excessive sweating
polyuria

32
Q

Main clinical features of dehydration

A

Dry inelastic skin ,loss of turgor
dry mouth
Sunken eyes
collapsed veins
tachycardia
scanty highly concentrated urine
Metabolic alkalosis (gastric juice loss) or acidosis ( diarrhea )
shock with hypotension and sweating

33
Q

Bio chemistry of dehydration

A

High hematocrit ,hemoglobin ,blood urea

reduced sodium,potassium and chloride levels in serum

concentrated urine , high osmolality
Low or absent sodium
normal or elevated potassium

34
Q

Goal of urine output in treatment of dehydration

A

30-50 mL per hour

35
Q

Amount of fluid needed in shock

A

3.5 L

36
Q

Clinical features of water overload

A

Added breath sounds
central venous pressure higher
increased intracranial pressure symptoms like headache, nausea ,vomiting ,weakness ,lethargy, confusion ,drowsiness ,convulsions

symptoms of cardiac failure like tachypnea, tachycardia, hypoxia, pulmonary and peripheral edema ,distended jugular vein

pulmonary congestion on cxr

37
Q

Treatment of water of overload

A

Diuretics - furosemide , ethacrynic acid
Mannitol

7- Surgery (13 decks)

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