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Fluid Management > Fluid Managment > Flashcards

Fluid Managment Flashcards

1
Q

Intracellular ; Extracellular water volume ratio

A

2:1

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2
Q

Goal of perioperative fluid management

A

Maintain intravascular volume and cardiac preload
Maintain O2 carrying capacity
Maintain acid-base homeostasis and electrolyte balance

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3
Q

Acid-Base balance

A

Mechanism the body uses to keep its fluids close to neutral pH

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4
Q

Functions of fluids

A

Dissolve and transport substances
Account for blood volume
Maintain body temperature
Protect and lubricate body tissue

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5
Q

Functions of Electrolytes

A

Regulate fluid balance
Help nerves respond to stimuli
Signal muscles to contract

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6
Q

Daily water intake

A

2500ml

2200 - food
300 - byproduct of metabolism

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7
Q

Daily water loss

A

2500ml

1500 - urine
400 - respiratory tract evaporation
400 - skin evaporation
100 - sweat
100 - feces
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8
Q

Sensible water loss

A

Loss that can be perceived by the senses and can be measured

Urination, Defecation, Wound drainage

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9
Q

Insensible water loss

A

Loss through evaporation from skin or lung during exhalation

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10
Q

Percentage of (xxx) as percent of body weight

ICF
ECF
ISF
IVF

A

40%
20%
15%
5%

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11
Q

Percentage of (xxx) as percent of total body water

ICF
ECF
ISF
IVF

A

67%
33%
25%
8%

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12
Q

Percentage of water in

Lean tissue
Bone
Fat

A

60-80%
20-25%
10-15%

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13
Q

Most important determinant of intracellular osmotic pressure

A

K

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14
Q

Most important determinant of extracellular osmotic pressure

A

Na

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15
Q

Permeability of cell membrane to most protein

A

Impermeable

High Intracellular protein concentration

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16
Q

Composition of plasma vs interstitial fluid

A

Same composition except protein (higher in plasma)

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17
Q

Composition of interstitial fluid

A

Association with extracellular proteoglycans

Forms gel

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18
Q

Interstitial fluid pressure

A

-5 mmHg

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19
Q

ICF% and ECF% as percentage of body weight for

Neonate
Infant
Adult male
Adult female
Elderly female
A 
40 + 35
40 + 30
40 + 20
35 + 20
30 + 15
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20
Q

Diffusion

A

Random movement of molecules due to their KE

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21
Q

Factors that affect rate of diffusion

A

Permeability of substance through membrane
Concentration difference
Pressure difference
Electrical potential difference

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22
Q

Carrier proteins

A

Carry substance from one side of a membrane to another

Glucose, Amino acids

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23
Q

Channel proteins

A

Water-filled pores that enable charged substances to diffuse through membrane

Ions

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24
Q

Capillary fluid exchange

Arterial End

A

CHP > 30
IHP > 5
IOP > 6
POC > -28

Net > 28

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25
Q

Capillary fluid exchange

Venous End

A

CHP > 10
IHP > 5
IOP > 6
POC > -28

Net > -7

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26
Q

Normal osmolarity of body fluids

A

300 mosm/L

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27
Q

ADH

A

Hormone that prevents fluid loss and promote conservation of body water

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28
Q

Stimulus for ADH release + Reaction

A

Stimulus
Increase in blood osmolarity

Reaction
Increase reabsorption in distal convoluted tubules and collecting ducts

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29
Q

Cause for Diabetes insipidus + Result

A

Cause
Absence of ADH

Result
Decreased water reabsorption
Large volumes (25L) of dilute urine excretion

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30
Q

Aldosterone

A

Hormone that regulates blood sodium level

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31
Q

Stimulus for Aldosterone release

A

Increase in K (primarily)
Decrease in Na
RAAS

32
Q

Stimulus for renin release

A

Decrease in blood volume and/or pressure

33
Q

Major actions of Angiotensin II

A

Stimulate release of Aldosterone

Vasoconstriction

34
Q

ANP

A

Hormone that promotes both fluid and sodium loss by the kidney

35
Q

Major effects of ANP

A

Decrease Aldosterone release
Decrease ADH release
Decrease thirst

36
Q

Osmolarity

Osmolality

A

Measurement of solute concentration per unit volume

Measurement of solute concentration per unit mass

37
Q

Determinants of serum (and intracellular) osmolarity

A

Na (K)
Glucose
Urea

38
Q

Plasma osmolality calculation

A

[Na]x2 + BUN/2.8 + Glu/18

39
Q

Tonicity

A

Measure of osmotic pressure gradient between two solutions

40
Q

Filtration

A

Movement of water and solute molecules across membrane due to hydrostatic pressure

41
Q

Tools used for estimation of Intravascular volume

A

Patient history
Physical examination
Laboratory analysis

42
Q

Important factors to consider in patient history

A 
Recent oral intake
Vomiting or Diarrhea
Significant blood loss
Significant wound drainage 
Hemodialysis
43
Q

Indication of hypovolemia in physical examination

A 
Abnormal skin turgor
Dehydration of membrane
Thready peripheral pulse
Increased HR and Decreased BP
Orthostatic HR and BP
Decreased urinary flow
44
Q

Intraoperative physical diagnosis

A

Fullness of peripheral pulse
Urinary flow rate
Indirect signs (response of BP to positive ventilation or vasodilation)

45
Q

Indication of hypervolemia in physical examination

A 
Pitting edema
Increased urinary flow
Tachycardia
Elevated Jugular pulse pressure
Wheezing, cyanosis
Pink, frothy pulmonary secretion
46
Q

Indication of dehydration in Laboratory evaluations

A 
Rising hematocrits
Arterial pH increase (acidosis)
Urinary specific gravity (>1.010) and osmolality (>450 mosm/L)
Urinary Na (<10 mEq/L) concentration
Serum Na
BUN : Serum creatinine  (>10:1)
47
Q

Indications of volume overload in laboratory

A

Increased vascular and interstitial marking (Kerley B lines)

Diffuse alveolar infiltrates

48
Q

Crystalloid solutions

A

Aqueous solutions of ions with or without glucose

49
Q

Colloid solutions

A

Solutions which contain high molecular weight substance such as proteins or large glucose polymer

50
Q

Location of crystalloid and colloid solutions

A

Crystalloid
Rapidly equilibrate and distribute throughout the entire ECF

Colloid
Maintain plasma oncotic pressure and remain mostly intravascularly

51
Q

Maintenance-type solutions

A

For losses primarily involving water

Hypotonic solutions

52
Q

Replacement-type solutions

A

For losses involving both water and electrolytes

Isotonic solutions

53
Q

Conditions where crystalloids are usually considered as initial resuscitation

A

Hemorrhagic and septic shock
Burn patients
Head injury (maintain CPP)
Patients undergoing plasmapheresis and hepatic resection

54
Q

Component and osmolarity of NS

A

Na - 154
Cl - 154

308 mosm/L
Iso-osmolar to normal plasma

55
Q

Indications and use

A 
Intravascular resuscitation
Replacement of salt loss (diarrhea, vomiting)
Diluting drugs
Hyperkalemia
Hyponatremia
Hypochloremic alkalosis
56
Q

Large volume of NS

A

Hyperchloremic metabolic acidosis

57
Q

Component of RL

A 
Na - 130
Cl - 109
K - 4
Ca - 3
L - 28 (converted to bicarbonate in liver)
58
Q

Large volume of RL

A

Hypochloremic alkalosis

59
Q

Component, Indication and risk of Hypertonic salt solution

A

250-1200 mEq/L of Na

Hyponatremia

Hemolysis at point of injection

60
Q

Component, osmolarity and use of D5W

A

50g/L of glucose
No electrolyte

253 mOsm/L

Maintain water balance in NPO
Hypernatremia

61
Q

Half life of crystalloid vs colloid

A

20-30 min

3-6 hrs

62
Q

General indications for colloids

A

Severe intravascular fluid deficit

Severe hypoalbuminemia or large protein loss (burns)

63
Q

All colloids…

A

Derived from either plasma protein or synthetic glucose polymer

Supplied in isotonic electrolyte solution

64
Q

Blood-derived colloid

A 
Albumin (5% and 25%)
Plasma protein (5%)
65
Q

Synthetic colloid

A

Dextrose starch and Gelatin

66
Q

Colloid associated with histamine mediated allergic reaction

A

Gelatin

67
Q

Macrodex vs Rheomacrodex

A

Macrodex
Dextran 70 (average molecular weight)
Better volume expander

Rheomacrodex
Dextran 40
Improve blood flow through microcirculation (decrease blood viscosity)

68
Q

Prolonged bleeding time caused by colloid

A

Dextran (20 mL/kg/day)
+ interfere with blood typing and kidney failure

Hetastarch
Older formulations
more than 1.0 L

69
Q

Why Hetastarch is better than Dextran

A

Highly effective as plasma expander
Less expensive than albumin
Non-antigenic

70
Q

Pre-existing deficit

A

Water imbalance arising from an overnight fast or a periods without fluid intake proportional to its duration

71
Q

What do serial hematocrits or hemoglobin concentration reflect?

A

Ratio of blood cells to plasma

Rapid fluid shifts

72
Q

Third space loss

A

Losses due mainly to evaporation and internal redistribution of body fluids

73
Q

Additional fluid requirement for
Minimal (herniorrhaphy)
Moderate (cholecystectomy)
Severe (bowel resection)

A

0-2
2-4
4-8

74
Q

When is blood transfused to a patient?

A

When the danger of anemia outweighs the risk of transfusion

75
Q

Average blood volumes of

Premature Neonate
Full-term Neonate
Infant
Adult Male
Adult Female
A 
95
85
80
75
65

Fluid Management (1 decks)

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