Fluid/Blood Replacement Flashcards
What is the difference between hypovolemia and
dehydration?
Hypovolemia describes the loss of extracellular fluid.
Dehydration is a disorder of electrolyte concentration in which
there is not enough water relative to the sodium level.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 383.
Why are isotonic crystalloids the fluid of choice for
most cases of hypovolemia?
Most cases of hypovolemia (including blood loss) are isotonic
losses of extracellular fluid. Thus, the most appropriate
replacement solution in most cases is an isotonic crystalloid.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 384.
What is the intravascular half-life of intravenous
crystalloids?
Crystalloid solutions remain in the circulation for about 20-30
minutes.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1165.
What is the treatment of choice for hyponatremia in a patient with low total body sodium?
In patients with a decreased total body sodium content and
hyponatremia, the treatment of choice is 0.9% saline. In
patients with hyponatremia and a normal or elevated total body
sodium content, the treatment of choice is water restriction.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1117-1118.
Rank the hypertonic crystalloids D5NS, D51/2NS,
3% Saline, 7.5% NaHCO3, and D5LR from least to
greatest according to their tonicity.
D51/2NS (432 mOsm/L), D5LR (525 mOsm/L), D5NS (586
mOsm/L), 3% Saline (1026 mOsm/L), and 7.5% NaHCO3 (1786
mOsm/L)
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1164.
How will large volumes of normal saline affect pH
and electrolyte balance?
Normal saline contains 154 mEq/L of both sodium and chloride.
Because the body’s bicarbonate concentration decreases as
chloride increases, large volumes of saline can produce
dilutional hyperchloremic acidosis.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1165.
What is the electrolyte composition of Plasmalyte
solution?
Na: 140 mEq/L, Cl: 98 mEq/L, K: 5 mEq/L, Mg: 3 mEq/L,
Acetate: 27 mEq/L, Gluconate: 23 mEq/L
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1164.
What is the glucose content of D5W?
50 grams/liter
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1164.
Name four crystalloid solutions considered to be
isotonic.
Normal saline (308 mOsm/L), D51/4NS (355 mOsm/L),
Lactated Ringer’s solution (273 mOsm/L), and Plasmalyte (295
mOsm/L)
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1164.
Name three hypotonic crystalloid solutions
D5W (253 mOsm/L), 1/2 NS (154 mOsm/L), and 1/4 NS (77
mOsm/L)
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1164.
As a percent of body weight, how much fluid loss
would you estimate a patient to have lost if they
exhibit an orthostatic increase in heart rate by 15
bpm and decrease in blood pressure by 10 mmHg?
When patients begin to exhibit increases in heart rate by 15
bpm and a decrease in blood pressure by 10 mmHg when
moving from lying to sitting, you can estimate that they have lost
15% of their body weight in fluid.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1162.
What are the pulmonary and radiographic signs of
hypervolemia?
Pitting edema, increased urine flow (if renal and cardiac
function is normal), tachycardia, pulmonary crackles, pink frothy
secretions, wheezing, and cyanosis are all signs of fluid volume
overload. Prominent pulmonary vascular and interstitial
markings known as Kerly “B” lines are radiographic signs of
hypervolemia.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1162-1163.
What are the laboratory signs of dehydration?
Rising hematocrit (due to concentration of cells in the vascular
space), metabolic acidosis, a urine specific gravity greater than
1.010, BUN:creatinine ratio that exceeds 10:1, hypernatremia,
urine sodium less than 10 mEq/L, and a urine osmolarity
greater than 450 mOsm/Kg.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1162-1163.
Is cross-matching performed on fresh frozen
plasma? Why or why not?
No, fresh frozen plasma (FFP) is evaluated for atypical
antibodies and should be the same type as the patient. Crossmatching
however, is not necessary. Rh typing is not always
matched because an immune response to the Rh antigen has
rarely been seen as a result of the transfusion of FFP.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1443.
What are the indications for administration of
unmatched blood?
If a patient is exsanguinating and their blood type is known,
then an abbreviated crossmatch (that typically takes less than 5
minutes) may be performed. If there is not time to perform any
testing, then Type O Rh-negative blood may be administered.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1170.
What is the incidence of nonhemolytic transfusion
reactions and what are the most common symptoms?
Nonhemolytic transfusion reactions occur in about 1-5% of all
transfusions. The patient typically exhibits symptoms such as
fever, urticaria, and chills.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 398.
What are the signs and symptoms of a hemolytic
transfusion reaction?
Fever, chills, nausea, vomiting, diarrhea, hypotension, and
tachycardia. The histamine response may result in flushing and
bronchospasm. Cytokine release may result in chest and back
pain. The patient may also develop hemoglobinuria. As many
of these signs are masked during anesthesia, hypotension and
signs of microvascular bleeding may be the only symptoms
evident.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 426.
What are the primary reasons that blood products
should be warmed when administered in large
quantities?
One unit of PRBCs at 4 degrees Celsius will drop the core
temperature of a 70 Kg patient by about 0.25 degrees Celsius.
Administering large quantities of cold blood products can
produce hypothermia.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 429.
How does the administration of stored blood affect
the recipient’s oxygen delivery mechanism?
The storage of blood is associated with a progressive decrease
in adenosine triphosphate (ATP) and 2,3 DPG levels. This
results in a leftward shift in the oxyhemoglobin dissociation
curve in the red blood cells. Even though the administration of
hemoglobin will increase the ability of the blood to transport
oxygen, the longer the blood is stored and the more of it that is
given, the more the patient’s oxyhemoglobin dissociation curve
shifts to the left, thereby decreasing the effectiveness of the
blood given.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia,
How much blood will a full-soaked 4X4 sponge hold?
10 mL
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1167.
Why are packed red blood cells mixed with a
combination of dextrose and adenine (Nutricell or AS-
3) or a combination of dextrose, adenine, and
mannitol (Adsol or AS-1)?
Packed red blood cells are mixed with about 100 mL of either
combination which extends the shelf-life of the blood to 42 days
and gives the fluid flow properties similar to that of whole blood.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1439.
Which presents the greatest risk of transfusionrelated
infection, HIV, Hepatitis B, or Hepatitis C?
Hepatitis B carries the greatest risk with an incidence of about 1
in 205,000 per unit administered. Hepatitis C carries an
incidence between 1:1,935,000 and 1:3,100,000. No new HUV
infections have been attributed to screened blood products
since the 1980s.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1448.
How can infusions of large amounts of banked blood
administration affect the patient’s ionized calcium
level?
Banked blood contains an anticoagulant containing sodium
citrate which binds to calcium in the bloodstream. As a result,
the administration of large quantities of banked blood can result
in sharp decreases in the patient’s ionized calcium level.
Normally, however, a healthy, normothermic patient can
metabolize the amount of citrate found in 20 units of blood per
hour.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 397.
What immunoglobulin is primarily responsible for the
antibodies associated with a transfusion reaction?
The antibodies produced against a blood type that does not
match the recipient’s are primarily IgM antibodies.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 1169.
