Fluids Flashcards

1
Q

Discuss calculating maintenance requirements

A

Maintenance requirements

  • replace insensible loss
  • replace ongoing abdnormal loss
  • attend to specific o2 carrying, coagulation, electrolyte or acid-base and nutritional requirements

Average
Water: 30ml/kg/day
sodium: 2mmol/kg/day
Potassium:1mmol/kg/day

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2
Q

Discuss insensible losses

A

Faeces 100ml/day
lungs 400ml/day
skin 600ml/day

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3
Q

Discuss common sites of abnormal fluid loss in ICU

A

Stoma, drains, fistula
Vomiting and diarrhoea
polyuria
gastric aspirates

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4
Q

Discuss use of cyrstalloids

A

Essentially sterile water with the addition of electrolyes
may be hypo, iso or hypertonic

Advantages

  • Cheap
  • nil need for cross matching
  • no anaphylaxis
  • resus ECF
  • promotes urine output

Disadvantages

  • only 25% remains in circulation rest enters the interstium
  • risk of peripheral and pulmonary oedema
  • requires large resus volumes up to 3 x
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5
Q

Discuss use of coloid

A

examples include albumin, 6% hetastarch and 10% pentastarch

Advantage:

  • 50-100% remain intravascular
  • spares pulmonary and interstitial space

Disadvantage

  • expensive
  • does not retore interstitial volume
  • enters interstitial space if leaky
  • immune reaction and problem with cross matching
  • long tissue half life
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6
Q

Discuss FFP

A

Usually for non-specific coagulation disturbances
FFP has an INR of 1.6 and cannot lower the INR lower then 1.7
Contains vitamin K dependent factors in a ratio of 1unit per ml
FFP contains all coagulation factors in normal concentrations.

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7
Q

Discuss prothrombinex

A

The 3 factor prothrombin complex contrate

provision of factors II, IX and X

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8
Q

Discuss the use of platelets

A

Both thrombocytopenia and platelet function disorders are an indication for platelet transfusion

Aim to keep above 100 if active bleeding

IN sepsis threshold for transfusion is <5 in all patient and <30 in patient with additional risk of bleeding

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9
Q

Discuss TRALI

A

Defined as hypoxia and bilateral pulmonary oedema in the absence of other causes such as cardiac failure

Pathophys:
2 hit” model: lung capillaries are primed by an underlying illness then triggered by exposure to irritant in blood transfusion
— Step 1: underlying illness -> complement activation -> pulmonary sequestration of neutrophils
— Step 2: transfusion -> neutrophil activation -> endothelial cell damage and capillary leak syndrome

Diagnosis

  • acute onset ALI(within 6 hours of a transfusion
  • hypoxia (PaO2/FiO2 <= 300mmHg regardless of PEEP or SpO2)
  • bilateral pulmonary infiltrates
  • not cardiogenic in origin (PAWP < 18mmHg)
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