Fluid Management & Blood Therapy Flashcards
Etiology hypokalemia
<3.5 mEq/L
Poor intake
GI LOSS: vomitting, diarrhea, NG suction, Kayexalate
Renal loss- dieurtics, metabolic Alkalosis, licorice
Intracellular shift: Beta-2agonist, insulin alkalosis
Etiology hyperkalemia
>5.5 mEq/L Poor excretion: renal failure, K sparing diuretics Extracellular Shift: Acidosis Iatrogenic: Succinylcholine Misc. Tumor Lysis
Presentation/symptoms Hypokalemia
Skeletal muscle cramps=> weakness=> paralysis
Worsens dioxin toxicity
Presentation/symptoms hyperkalemia
Cardiac rhythm disturbances
EKG findings Hypokalemia
hint: short long flat
PR interval- short
QT interval- Long
T wave- flat
U wave visible
EKG findings Hyperkalemia
Early: PR=> long QT=> short T wave => peaked tall Middle: P wave=> flat QRS wide Late: QRS=>sine wave=> VF
Treatment for Hypokalemia
K+ supplementation
Treatment for Hyperkalemia
Calcium (Stabalizes cardiac membrane) insulin + D50 Hyperventilation Bicarbonate Albuterol Potassium wasting diuretics Dialysis
Etiology of Hyponatremia
<135mEq
May exist in various states of hydration hypovolemic, isovolemic, hypervolemic, so you must evaluate plasma osmolarity and ECF volume to determine cause.
Ex. SIADH, CHF, Cirrhosis, TURP syndrome, Cushing’s
Etiology Hypernatremia >145 mEq/L
Hyernatremia may exist in various states of hydration (Hypovolemic, isovolemic, hypervolemic), so you must evaluate plasma osmolarity and ECF volume to determine cause.
Ex: Diabetes inspidus, impaired thirst, NaHCO3 admin
Presentation/ symptoms
Hyponatremia
N/V
Skeletal muscle weakness
Mental status changes=> seizures => coma
Cerebral edema cell swelling
Presentation/ symptoms Hypernatremia
Thirst Mental status changes=> seizures=> coma Cerebral dehydration (Cell shrinkage)
Treatment for Hyponatremia
Treatment depends on specific cause.
The goal is to restore Na+ balance by manipulating serum osmolality fluid balance with H2O restriction IVF selection based on toxicity and diuretics
Treatment for hypernatremia
Treatment depends on specific cases.
Gal is to restore balance Na+ by manipulating serum osmolality and fluid balance with Na++ restriction, IVF selection based on tonicity and diuretics
Etiology Hypocalcemia <8.5 mg/dL
Hypoparathyroidism Vitamin D deficiency Renal Osteodystrophy Pancreatsis Sepsis
Hydercalcemia >10.5 mg/dL
Hyperparathyroidism Cancer Thyrotoxicosis Thiazide diuretics Immobilization
Presentation/ symptoms Hypocalcemia
Skeletal muscle cramps Nerve irritability => paresthesia and tetany Chvostek sign Trousseau sign largyospasm Mental status changss => seizures
Presentation/ symptoms Hypercalcemia
Nausea abdominal pain hypertension psychosis Mental status changes- seizures
Hypocalemia treatment
Calcium Vitamin D
Treatment for Hypercalcemia
0.9 NaCl Loop diuretic (Furosemide)
EKG finding Hypocalcemia
QT long
EKG finding Hypercalcemia
QT interval short
Etiology of Hypomagnesemia < 1.3 mEq/L
poor intake alcohol abuse diuretics Critcal illness common with hypokalemia
Etiology of Hypermagnesemia >2.5 mEq
Excessive administration
Renal failure
Adrenal insufficiency
Presentation/ symptoms of hypomag
Skeletal muscle weakness
Arrhythmias torsades de pointes
Presentation/ symptoms of hypermag
Loss of deep tendon reflex 4-6.5 mEq/L or 10-12 mg/dL
Respiratory depression
6.5-7.5 mEq/L or 18mg/dL
cardiac arrest >10 mEq/L or > 25 mg/dL
Potentiation of neuromuscular blockade (succ & NDNMB
EKG findings with Hypomagnesium
Not significant unless very low-
long QT
EKG findings with hypermagnesium
Not significant unless very high heart block
Treatment for hypomag
give magnesium
Treatment for hypermag
calcium chloride
Influences Fluid Dynamics
Renin-angiotensin-aldosterone-system
Antidiuretic hormone (ADH)
Atrial natriuretic peptide
- Reabsorption of sodium (and water)
- Reabsorption of water
- Stimulated by stretch receptors in the atria
- -Stimulates kidneys to release sodium and water, thereby reducing intravascular volume
- -Inhibits renin and ADH
Assessment of Fluid Volume Status
Preop evaluation
Assessing for fluid volume status
- Skin turgor, mucous membrane, peripheral edema
- Lung sounds
Vital signs
Urine output
HCT
Urine specific gravity
BUN/Creatinine
Acid-base balance (ABG)
Acidosis and cardiac effects
Increased P50(Right=release)
Decreased contractility
Increased risk of dysrthymias
Alkalosis and cardiac effects
Decreased 50 left=love
Decrease coronary blood flow
increase dysrthymias
Acidosis CNS effects
Increase cerebral blood flow
Increase ICP
Alkalosis CNS effects
Decrease cerebral blood flow
Decreased ICP
Acidosis pulmonary effects
Increase pulmonary vascular resistance
Acidosis pulmonary effects
Decreased pulmonary vacuolar resistance
Acidosis on electrolyte
causes hyperkalemia
Alkalosis on electrolyte
Hypokelemia
Decreased ionized calcium
Intravenous fluid therapy: Crystalloids Hypotonic solutions uses and examples
Replaces water loss
called maintenance fluids
examples: D5W
Intravenous fluid therapy Isotonic solutions (Normal Osmolarity 285-295 mOsm/L) uses and examples
Replaces water and electrolyte loss
called replacement fluids
examples: LR, NS
Intravenous fluid therapy Hypertonic solutions uses and examples
For hyponatremia or shock
examples: D5 1/2NS (405 mOsm/L), 3% NS (1026 mOsm/L)
Examples of hypotonic solution
d5w, 0.45% NaCl
cell swells
Examples of Isotonic solutions
LR
0.9 Nacl
plasmalyte A
Colloids:
5% albumin
Voluven6%
Hespen 6%
Examples of hypertonic solutions
D5LR
3% NaCl
cell will shrink
Colloids
Dextran 10%
Describe Normal saline and its ingredients
0.9% NaCl in Water
Isotonic solution (~308 Mosm/L)
Typical solution for diluting PRBCs (cannot use Ca++ containing crystalloids)
In large volumes, NaCl produces high Cl- content, which leads to
dilutional hyperchloremic acidosis
The primary role of NS in modern anesthetic practice is in the administration of small volumes to neurosurgical patients. As a result of its mild hyperosmolality, 0.9% saline is the preferred fluid for patients at risk for cerebral edema. NS may also be indicated in fluid management of patients with anuria and end-stage renal disease who cannot excrete the potassium content of more balanced crystalloid solutions.
The primary role of NS in modern anesthetic practice is in the administration of small volumes to neurosurgical patients. As a result of its mild hyperosmolality, 0.9% saline is the preferred fluid for patients at risk for cerebral edema. NS may also be indicated in fluid management of patients with anuria and end-stage renal disease who cannot excrete the potassium content of more balanced crystalloid solutions.
