Fluid & Electrolyte Therapy Flashcards
TBW: BW X _____ (_____ L) = ICF BW X _____(_____ L) + ECF BW X _____ (_____ L)
0.6; 42
0.4;28
0.2; 14
ECF BW X ____ ( ____ L) = IVS BW X ____ (____ L) + ISS BW X ____ (____ L)
0.2;14
0.05;3
0.15;11
At birth higher % of water is in ECF
- TBW = BW X _____
-ECF= BWX _____
0.8
0.45
-TBW is _________ in females (BW x _____) because of _____________
lesser
0.5
greater fat content
Between ECF and ICF, water moves by _______ across ____________ cell membrane
- Depends on number of __________________ on either side of membrane
osmosis
semi-permeable
osmotically active particles
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
hydrostatic; capillary
protein- albumin colloid osmotic (oncotic)
venous
Distribution of common electrolytes
ICF : ECF
What are the MAIN ELECTROLYTES
Potassium; magnesium; phosphate
Sodium; chloride ; bicarbonate
Fluid Balance, Requirements & Replacement
______________– __________ requirement
_________– ___________
_____________ losses
Maintenance; Basal fluid
Deficit; Pre-existing
On-going
In children,
Water – ___mls/kg/hr for the 1st ___ kg,
- then ____mls/kg/hr for the next ____kg - then ____ml/kg/hr for ______ kg.
4;10
2;10
1; any extra
Basal/Maintenance Fluid Requirement
- Adult (70kg)- ____L or ______mls/kg/day -
2.5 ; 30-35
Basal/Maintenance Fluid Requirement
Infants req. up to _____mls/kg/day due to
- higher _____________,
- higher ____________ and
- less _____________ ability.
100
metabolic rate
insensible loss
renal concentrating
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
1-2; 50-80
1-2; 50-80
0.1-0.2
0.1-0.2
1g of NaCl = ____mmol Na+
1g of KCl = _____mmol K+
17; 13
Pre-existing Deficits
________ e.g paeds
Decreased intake – ______,________,_________
Increased loss – _________,_________,___________ losses
- polyuria
-_______ esp in paeds
-____________ into bowel
Fasting
nausea, vomiting, coma
vomiting, diarrhoea, NGT
fever; sequestration
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
3rd space; Evaporative; Blood
NGT, peritoneal, chest
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.
Iso; ECF
non-fxnal ; non- communicating
plasma; N/S, R/L
72hrs
3rd space loss
Caution in _____,_____when replacing the loss
Minimal trauma –______mls/kg/hr
Moderate trauma – _____mls/kg/hr
Severe trauma - _____mls/kg/hr
Cardiac failure; renal failure
0-2
2-4
4-8
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
10-15
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]
fever; 1; 5L; 100
Pre-operative management
EXAM- _____ lips, _______ tongue, dry mucous membrane, _____ eyes,
loss of ________ , __________ extremities
Altered _———, lethargy, confusion
_____tension, _____cardia, vaso_________, oliguria
Dry; furred; sunken
skin tugor; cold clammy
LOC; hypo; tachy
constriction
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
crystalloid; N/S, R/L
D/W; Colloid
Treatment /Resuscitation
Volume Deficit
= Plasma _____ - _____ X _______
——————————-
______
Na; 140; TBW
140
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)
arrhythmias
3.5 - 5.5
Deficit; Weight; 0.4
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.
20; ECG monitoring
500; central
peripheral; 40; thrombophlebitis
maintenance
Hyperkalaemia
____________(tall tented T waves, wide QRS & dep. ST segment) , __________ and __________ weakness, Nausea, vomiting, diarrhoea, abd colic
Arrhythmias
skeletal muscle and cardiac muscle
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-
Ca 2+ gluconate
Na HCO3
Glucose; Insulin
HCO3- deficit (Acidosis)-
Base deficit x _____ x____
Give ______ then recheck ABG.
Wt; 0.3
1⁄2 t
Intraoperative
Consider ________, _________ losses, __________ loss
Blood loss >____% of EBV (Paed > ____%)
___________________ point, consider transfusion.
Postoperative
Losses from _________,________,________, ______________ loss, continuing ______ loss
maintenance, on-going
3rd space ; 15; 10
Transfusion trigger
drains, fistulae, catheter, 3rd space
blood
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 ___________
lactated Ringers’ ; 0.9% Saline; 3-4
Colloids; 1:1
whole blood
TTP is often calculated preoperatively Using the ___________, _____________
Generally, TTP is after EBL is >______% of _____.
PCV/[Hb]
Estimated Blood Vol. (EBV)
10-20; EBV
Guidelines for TTP
Estimated Blood Volume (EBV) calculation –
Neonate
- preterm = ____ml/kg
- Full term = ____ ml/kg
95 ;85
EBV Calculations
Infants = ______ml/kg
Adults
- male =____ ml/kg
- female = ____ ml/kg
80
75;65
Calculating max allowable Blood loss for TTP
Gross’s formula
Using preop PCV, EBV
MABL =__________ - ____________ X _______
—————————————————
___________
Preop PCV – lowest allowable PCV
EBV
Average PCV
The EBL necessary for PCV to fall from 35% to 30% in a man weighing 70 kg
=??
= (35 – 30) x (75x70) = 807.7mls
——————————-
32.5
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.
2-3 ;1
10; 3
Crystalloids vs Colloids
Initial expansion of vascular compartment, extent depends on ability to _______________
cross vascular endothelium
(Crystalloids or Colloids?) do not freely cross – may draw water into vascular space by osmosis
Colloids
(Crystalloids or Colloids?) are Plasma expanders.
Fluids move from IVS to ISS at ratio of ______ in plasma :____ in ISS
Colloids
1⁄4; 3⁄4
Colloids- volume infused expands vascular compartment –ideal for ______________
plasma/ blood loss
___________,__________________ – 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.
Saline 0.9% , Hartmann’s solution (Lactated Ringers’ solution)
1⁄4 ; 3/4; ECF
5% dextrose; 1; 2; water
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