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Periop > Fluids > Flashcards

Fluids Flashcards

1
Q

Normal physiology

A

Total 42L water
14L ECF- 1L transcellul, 3.5L plasma, 9.5L interstit
28L ICF

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2
Q

Insensible loss

A

Unaware and diffic to quantify, cant be elim-
Transdermal diffus and evap
Resp evap
Sweat?

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3
Q

Sensible loss

A

Can be seen, felt and measured-
Urine
Defecation
Wounds

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4
Q

Osmotic press

A

Abil of a solute to attract water.

Or press needed to reverse osmosis.

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5
Q

Oncotic press

A

Press by prots to draw water into BV

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6
Q

Hydrostatic press

A

Press of incomp fluid on sealed container eg BV

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7
Q

Osmolality

A

Osmoles per kg of solvent

Plasma 280-305mOsmol/kg

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8
Q

Osmolarity

A

Osmoles per L of solution

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9
Q

Osmoles

A

Number of moles of solute that contrib to osmotic press

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10
Q

tonicity

A

Effective osmolarity of solution

Same fluid can be hyper or hypotonic dep on where put it

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11
Q

forces

A 
Osmotic forces act across all compartments
Stalrings forces (oncot and hstat) act btw intra vasc and interstit fluid
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12
Q

Veins vs arteries

A

MABP 80-100mmHg- high hstat press, high prot oncotic press.
Venous press 10mmHg- low hstat press, high oncotic
In sepsis capills leak prot so high oncot press into tiss so draws fluid out.

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13
Q

Imp ion concs

A 
Na- plasma 137-147, interstit 144, IC 10
K- plasma 3.5-5, interstit 4, IC 160
Gluc- plasma 3.9-6.1
Prot- plasma 10
Cl- plasma 110
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14
Q

4/2/1 rule for baseline maint fluid only

A

1st 10kg- 4ml/kg/hr
2nd 10kg- 2ml/kg/hr
Subseq mass- 1ml/kg/hr
Often simplif to 1-2ml/kg/hr in adults

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15
Q

Na and K reqs for adult

A

Na- 1-1.5mmol/kg/day

K- 0.7-1mmol/kg/day

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16
Q

Regulation

A

ADH- opens CD aquapaorins. More rel if high Na.
High A and BNP predictor of HF.
RAAS

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17
Q

NICE

A

Asses the pt
5 Rs- resus, routine maint, repl, redistrib, reass
Less fluid, less Na, more K

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18
Q

Types

A

Crystalloid dissolved salt and sugar eg saline, hartmanns. Hypo, iso and hypertonic.
Colloid susp not dissolved eg gelatin, starch, alb. Draw fluid into BV. Rarely used now.
Blood products.

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19
Q

Contents

Isotonic fluids 300mOsM

A

0.9% saline- 154mmol/L Na, 154 Cl
5% dextrose- 50g/L gluc
Dextrose saline- 30 Na, 30 Cl, gluc
Hartmanns- 130 Na, 109 Cl, 4K
Can get KCl 20 or 40mmol/L to saline, dextrose and dextrose saline. Given by infusion pump. Req cardiac monit if central V.
Can give 10mmol/hr K via norm V, more can burn. Big vein up to 20mmol/hr.

20
Q

Clinical assess

A 
ABCDE, EWS
Reason for fluids
Hx
Diag
Dehyd- last food and fluid
Losses- diarr, vom, burns
Thirst
Postural symps
Urine output and col
Drugs eg diuretics
Weight
Pulse
Cap refill
Mucous mems
JVP
Visible oedema
Pmh- DM, CCF, CKD
UE, Cr, Hb, haematocrit
urine biochem
ECG
21
Q

Bolus

A

500ml bolus crystalloid eg hartmanns
Give fast with press bag attached
Asses resp
If inadeq give further bolus 250-500ml up to 2L total. Then seek help.
Tx cause
Fluid chall- 500ml in 10-30 mins. 20-30mk/kg/hr.

22
Q

Resus vs repl

A

Resus- ongoing fluid loss

Repl- previous loss, reqs repl

23
Q

Hypovol

A

Fluid chall- 500ml saline or hartmanns fast as poss

The reass

24
Q

Crystalloid

A

Maint and hydration

25
Q

colloid

A 
Acute resus or repl. 250-500ml.
Can worsen oedema if inflamm.
Coagulopathic in trauma.
Risk anaph.
Expensive
Crustalloid if in doubt. 
Main 3 are volplex gelatin, albumin, blood products.
26
Q

confused pt

A

Exclude hypoxia and dehyd first

27
Q

Key Qs

A 
Pt size and weight
Comorbidiy- heart, lung, renal
Situation- resus vs maint
Why in hosp- eg how far post op
Most recent UE
Underlying physiol
What are they losing and how much- eg diarr, pancreatitis, open wound, perforat, obstruc cause loss electrolyte rich fluid.
28
Q

fluid func

A

Maint SV and hence perfus
MABP= tpr x CO
CO= HR x SV
Low BP must be due to one of these facs eg dehyd, meds, sepsis
Too much fluid over time causes overload and HF

29
Q

dextrose

A

Pure water not for resus

Good for maint just water

30
Q

hartmanns

A

Good for resus
Still only 1/6 of it gets to plasma
May need lot in resus phase

31
Q

sedentary av adult maint

A

2.5-3L/ day
150mmol Na per day
60mmol K per day

32
Q

Renal dis

A

Cant excrete K- hyperK

33
Q

fluids need to be isotonic

A

300 mOsM approx

34
Q

Maint regimens if start IN BAL
Eg after resus
UE norm, still NBM

A

Loads of saline causes acidosis
Regimen 1- 1L saline 8hr, 1L 5% dextrose 8hr, 1L 5% dextrose 8hr.
Regimen 2- 1L dex/saline 8hr, three times.
Adjust acc to UO and UE.

35
Q

resp to surgery

A

Incr ADH as stress- reduc UO, Na reten.
Incr aldoserone and cortisol- Na reten, loss K and H.
Incr catecholamines
Incr renin
K rel by damaged tiss. So dont us give supplem K during 1st 48 hr post op.

36
Q

IV K risks

A

Renal comprom
K sparing diuretics
HypoK- VF
HyperK- asystole

37
Q

K regimens if start IN BAL

A

Regimen 1- 1L saline 8hr 20M K, 1L 5% dextrose 8hr 20M K, 1L 5% dextrose 8hr.
Regimen 2- 1L dex/saline 20M K 8hr TWICE, then 1L dex/saline 8hr.
Over 20mmol/hr needs uspervis by senior and controlled pump.

38
Q

UO

A 
Oliguria under 400ml/day
Anuria under 100
Sensitive indicator hydrat status
Normal 0.5ml/kg/hr
Hourly monit post op. Us bit low. If unus low then small bolus top ups and monit. Also check BP, catheter, UO, drug chart.
39
Q

dehyd signs

A 
Sunken eyes
Reduc ocular press
Reduc skin turgor
Dry mucous mem
Low UO
Thirst
Late- cap refill, tachc, low BP
40
Q

Equation

A

Vol (ml)/ time (mins) x giving set= drops per min

41
Q

Reasons

A

Resus- want to stay in IV space
Maint- want fluids to distrib to all comparts
Repl

42
Q

fluid overload

A

JVP
Periph and pulm oedema
Late- tachyc/p, hypoxia
Monitor- UO, UE, weight.

43
Q

daily reqs

A

25ml/kg/day water
1mmol/kg/day Na
1mmol/kg/day K
50g/day glucose

44
Q

Fluid chall

Eg anyone with low UO

A

250 or 500ml hartmanns over 1hr

But account for pt facs

45
Q

ongoing losses Qs

A 
Thrid space loss
Is there diuresis
Tachyp
Temp
Amnt of stool
Are they losing electrolyte rich fluid
Egs- dehyd (high urea to Cr ratio and high PCV), vom (low K, low Cl, alkalosis), diarr (low K, acidosis)
46
Q

Monitoring

A

Fluid bal
Weight
UE

Periop (21 decks)

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