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Junior Anaesthesia > Fluid & Electrolyte Therapy > Flashcards

Fluid & Electrolyte Therapy Flashcards

1
Q

TBW: BW X _____ (_____ L) = ICF BW X _____(_____ L) + ECF BW X _____ (_____ L)

A

0.6; 42

0.4;28

0.2; 14

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2
Q

ECF BW X ____ ( ____ L) = IVS BW X ____ (____ L) + ISS BW X ____ (____ L)

A

0.2;14

0.05;3

0.15;11

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3
Q

At birth higher % of water is in ECF

  • TBW = BW X _____
    -ECF= BWX _____
A

0.8

0.45

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4
Q

-TBW is _________ in females (BW x _____) because of _____________

A

lesser

0.5

greater fat content

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5
Q

Between ECF and ICF, water moves by _______ across ____________ cell membrane

  • Depends on number of __________________ on either side of membrane
A

osmosis

semi-permeable

osmotically active particles

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6
Q

Fluid movement between IVS and ISS

Between IVS and ISS, water movt. depends on ________ forces at ________ end and _______________________________ forces at ________ end, across semi- permeable cap. memb

A

hydrostatic; capillary

protein- albumin colloid osmotic (oncotic)

venous

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7
Q

Distribution of common electrolytes

ICF : ECF

What are the MAIN ELECTROLYTES

A

Potassium; magnesium; phosphate

Sodium; chloride ; bicarbonate

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8
Q

Fluid Balance, Requirements & Replacement

______________– __________ requirement
_________– ___________
_____________ losses

A

Maintenance; Basal fluid

Deficit; Pre-existing

On-going

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9
Q

In children,
Water – ___mls/kg/hr for the 1st ___ kg,
- then ____mls/kg/hr for the next ____kg - then ____ml/kg/hr for ______ kg.

A

4;10
2;10
1; any extra

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10
Q

Basal/Maintenance Fluid Requirement

  • Adult (70kg)- ____L or ______mls/kg/day -
A

2.5 ; 30-35

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11
Q

Basal/Maintenance Fluid Requirement

Infants req. up to _____mls/kg/day due to
- higher _____________,
- higher ____________ and
- less _____________ ability.

A

100

metabolic rate

insensible loss

renal concentrating

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12
Q

Common Electrolytes Daily Requirements
Electrolytes

  • Na+ – _____ mmol/kg/day . approx ____mmol/day
    K+ – _____mmol/kg/day. Approx ______mmol/day

Mg2+ - ______mmol/kg/day
- Ca2+ - ______mmol/kg/day

A

1-2; 50-80

1-2; 50-80

0.1-0.2
0.1-0.2

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13
Q

1g of NaCl = ____mmol Na+
1g of KCl = _____mmol K+

A

17; 13

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14
Q

Pre-existing Deficits
— — —
________ e.g paeds

Decreased intake – ______,________,_________
Increased loss – _________,_________,___________ losses
- polyuria
-_______ esp in paeds
-____________ into bowel

A

Fasting

nausea, vomiting, coma

vomiting, diarrhoea, NGT

fever; sequestration

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15
Q

On-going Losses

GIT –fluid sequestrated into gut lumen, NGT

Intra-op losses
–__________ loss. Severity depends on extent of surgery
-_________ loss from exposure of viscera
-________ loss

Post-op losses
– Drains- _______,_______,___________
- Vomiting, blood loss, gut fistula, 3rd space loss

A

3rd space; Evaporative; Blood

NGT, peritoneal, chest

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16
Q

3rd Space Loss
— —
— —
_____tonic transfer of fluid from _____ to a _____________,_______________ interstitial/tissue compartment.

Due to surgical trauma, infection, burns. Loss depend on degree of t/s trauma
Results in depletion of ———— volume. Should be replaced with ———-tonic fluid – _____,______

Reverts by ______ as fluid moves back into circulation.

A

Iso; ECF

non-fxnal ; non- communicating

plasma; N/S, R/L

72hrs

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17
Q

3rd space loss

Caution in _____,_____when replacing the loss

Minimal trauma –______mls/kg/hr
Moderate trauma – _____mls/kg/hr
Severe trauma - _____mls/kg/hr

A

Cardiac failure; renal failure

0-2

2-4

4-8

18
Q

3rd Space and evaporative losses can approximate _______mls/kg/hr in highly invasive, manipulative and surgically exposing procedures
Actual replacement needs vary from pt to pt based on other confounding factors

A

10-15

19
Q

Preoperative management

HX- source of loss, duration and amount presence of _______
urine volume/output – aim at ____ml/kg/hr
Abd distension –[ gut secretes ____ of fluid which is all reabsorbed except for ____ mls in faeces –site for potential massive fluid loss]

A

fever; 1; 5L; 100

20
Q

Pre-operative management

EXAM- _____ lips, _______ tongue, dry mucous membrane, _____ eyes,
 loss of ________ , __________ extremities
 Altered _———, lethargy, confusion
 _____tension, _____cardia, vaso_________, oliguria

A

Dry; furred; sunken

skin tugor; cold clammy

LOC; hypo; tachy

constriction

21
Q

Treatment/Resuscitation
—
—
Resuscitate with _________ solutions

____,______ for loss of water and electrolyte
_______ for loss of water only
__________ if fluid loss is severe or blood loss

Monitor B.P, HR, U/O, CVP
– fluid challenge, capillary refill, level of consciousness

A

crystalloid; N/S, R/L

D/W; Colloid

22
Q

Treatment /Resuscitation

Volume Deficit

= Plasma _____ - _____ X _______
——————————-
______
—

A

Na; 140; TBW

140

23
Q

K+ Deficit (Hypokalaemia)

Must be corrected. May result in __________ (prolonged PR & QT intervals, low/inverted T waves), difficulty in reversing NMB, labile BP, renal dysfunction, paralytic ileus

Normal – _________ mEq/L

______ X______ X_____ (0.4 is ICF fraction)

A

arrhythmias

3.5 - 5.5

Deficit; Weight; 0.4

24
Q

K+ Deficit ( hypokalemia)

Max rate of infusion is _____mmol/hr which must be done under_____________ (Max._____ mmol/day), via a ________ line.

With __________ line, do not exceed ____ mmol/L to prevent ——————

NOTE: Add __________ requirement, when correcting deficit.

A

20; ECG monitoring

500; central

peripheral; 40; thrombophlebitis

maintenance

25
Q

Hyperkalaemia

____________(tall tented T waves, wide QRS & dep. ST segment) , __________ and __________ weakness, Nausea, vomiting, diarrhoea, abd colic

A

Arrhythmias

skeletal muscle and cardiac muscle

26
Q

HyperKalemia

______________ 5-10mls of 10% to antagonise cardiac effect
__________–45meq (1-2 mEq/Kg) causing Alkalosis

________ (30-50g) + ________ (10 units) infusion
Dialysis – Peritoneal- or Haemo-

A

Ca 2+ gluconate

Na HCO3

Glucose; Insulin

27
Q

HCO3- deficit (Acidosis)-

Base deficit x _____ x____

Give ______ then recheck ABG.
— —

A

Wt; 0.3

1⁄2 t

28
Q

Intraoperative
— —
— — —Consider ________, _________ losses, __________ loss
Blood loss >____% of EBV (Paed > ____%)

___________________ point, consider transfusion.

Postoperative
Losses from _________,________,________, ______________ loss, continuing ______ loss

A

maintenance, on-going

3rd space ; 15; 10

Transfusion trigger

drains, fistulae, catheter, 3rd space

blood

29
Q

Determining Transfusion Trigger Point
—

In practice, intra-operatively –
Initial fluid replacement for Estimated blood loss (EBL) is with _____________ soln/ _________. _______ times d vol. of EBL OR with _________ ___:___until TTP is reached.

Thereafter, blood loss is replaced unit for unit with ___________

A

lactated Ringers’ ; 0.9% Saline; 3-4

Colloids; 1:1

whole blood

30
Q

TTP is often calculated preoperatively Using the ___________, _____________

Generally, TTP is after EBL is >______% of _____.

A

PCV/[Hb]

Estimated Blood Vol. (EBV)

10-20; EBV

31
Q

Guidelines for TTP
—

Estimated Blood Volume (EBV) calculation –
Neonate
- preterm = ____ml/kg
- Full term = ____ ml/kg

A

95 ;85

32
Q

EBV Calculations

Infants = ______ml/kg

Adults
- male =____ ml/kg
- female = ____ ml/kg

A

80

75;65

33
Q

Calculating max allowable Blood loss for TTP

Gross’s formula
Using preop PCV, EBV

MABL =__________ - ____________ X _______
—————————————————
___________

A

Preop PCV – lowest allowable PCV

EBV

Average PCV

34
Q

The EBL necessary for PCV to fall from 35% to 30% in a man weighing 70 kg

=??

A

= (35 – 30) x (75x70) = 807.7mls
——————————-
32.5

35
Q

1 unit of blood will ↑ PCV/Hb by _____%/__g/dL resp. in adults

A 10 ml/kg blood transfusion, in children will ↑ the PCV/Hb by ____%/__g% resp.

A

2-3 ;1

10; 3

36
Q

Crystalloids vs Colloids
— —
— —
Initial expansion of vascular compartment, extent depends on ability to _______________

A

cross vascular endothelium

37
Q

(Crystalloids or Colloids?) do not freely cross – may draw water into vascular space by osmosis

A

Colloids

38
Q

(Crystalloids or Colloids?) are Plasma expanders.

Fluids move from IVS to ISS at ratio of ______ in plasma :____ in ISS

A

Colloids

1⁄4; 3⁄4

39
Q

Colloids- volume infused expands vascular compartment –ideal for ______________

A

plasma/ blood loss

40
Q

___________,__________________ – expand ECF (____ in plasma : _____ in ISS) and are ideal for ______ losses

____________ expands TBW (___/3 ECF & ___/3 ICF). Replaces _____ deficit.

Only ___/12 of infused vol. remains in vascular compartment.

A

Saline 0.9% , Hartmann’s solution (Lactated Ringers’ solution)

1⁄4 ; 3/4; ECF

5% dextrose; 1; 2; water

1

Junior Anaesthesia (17 decks)

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