Fluids and Blood (Connie) Flashcards
Intravascular half-life of a crystalloid solution is ____.
20 – 30 minutes
Intravascular half-life of most colloid solutions is ____.
3 – 6 hours
In anesthetized patients, an acute HTR (hemolytic transfusion reaction) is manifested by ___.
hyperthermia, tachycardia, hypotension, hemoglobinuria (1st sign), oozing in surgical field.
Allogenic transfusion of blood/blood products may diminish ___.
immunoresponsiveness and promote inflammation.
The most common cause of nonsurgical bleeding following massive transfusion is ____.
dilutional thrombocytopenia
Total body weight = ____water.
60%
(40% intracellular, 20% extracellular)
Extracellular is further divided into interstitial (15%) and plasma (5%) fluid outside of the cells.
The most severe transfusion reaction you will see is from ___.
ABO incompatibility
Major ICF cations
Potassium (K), Magnesium (Mg), Phosphate (P04)
Major ECF cations
Sodium (Na+), Calcium (Ca), Chloride (Cl-), Bicarbonate (HCO3-)
Fluid Movement within the body (general facts)
Constant circulation to maintain homeostasis
Exchange between compartments to compensate for gains or losses
Dependent on hydrostatic and osmotic pressures
- Tonicity versus osmotic activity
- Isotonic, hypotonic, and hypertonic solutions
What is the calculation of osmolarity?
Osmolarity = (Na+ x 2) + (Glucose/18) + (BUN/2.8)
Isotonic Solutions
LR, 0.9% NaCl, Plasmalyte A, 5% albumin, Voluven 6%, and Hespan 6%
Hypotonic Solutions
D5W, 0.45% NaCl – no colloids
Hypertonic Solutions
NaCl 3%, D5 NaCl 0.9%, D5 NaCl 0.45%, D5 LR, and Dextran 10%
What are three main mechanisms of fluid/electrolyte imbalances?
1) Disorders of intake or elimination impairment
* Resulting imbalance exceeds body’s compensatory ability
2) Kidney
* Primary organ regulating electrolyte and fluid imbalance
3) Systems serving as a catalyst for imbalance
* Neurologic, cardiovascular, liver
Fluid distribution will vary based on what factors?
gender and age, muscle mass, fat composition, and body water
How do we evaluate intravascular volume in our patients?
Patient history (Intake & output)
Physical examination (Skin turgor, Vital signs, UOP)
Laboratory evaluation (H&H – ABGs – urinary specific gravity or osmolality – electrolytes – BUN & creatinine)
Hemodynamic monitoring (CVP - PA)
What is GDFT?
Goal directed fluid therapy
- LIDCO – Vigileo – Flo Trak
- Esophageal doppler
- TEE or TTE
(these noninasive devices use arterial pulse contour to provide an estimate of stroke volume variation to provide you with an understanding of whether the patient will be responsive to fluid)
What is the link between water and sodium?
Chloride attraction to sodium
Sodium (General Facts)
- Most significant cation
- Most prevalent electrolyte within ECF
- Controls serum osmolality and water balance
- Helps maintain acid-base balance when combined with bicarbonate
- Regulated by kidneys and sympathetic nervous system
- Sodium-potassium pump for transport across cell membrane
- Primarily brought into body through dietary intake
- Consider plasma osmolarity and ECF volume
Clinical Manifestations of Hypernatremia
Lethargy, headache, confusion, irritability, seizures, and coma
Osmosis is defined as ___.
The movement of water across a semi-permeable membrane
Hyponatremia
Similar neuromuscular manifestations
Gastrointestinal symptoms with 130 mEq/L
Most common electrolyte disturbance in hospitalized patients
Osmolality
The # osmoles per kilogram of a solvent
Osmolarity
The number of osmoles per liter of a solvent
Diagnosis of sodium imbalances is based on ___.
serum levels
Management of sodium imbalances focus on ___.
- focused on treating underlying cause
- Rapid correction of hyponatremia may lead to osmotic demyelination syndrome (“locked-in” syndrome, acute paralysis, inability to speak, issues with myocardial contractility)
Potassium (general facts)
- Primary intracellular cation
- Role in electrical conduction, acid-base balance, and metabolism
- Serious issues from fluctuation
- Diet as main source
- Imbalance affects several body systems
- Chemistry panel as diagnostic test
- Determining reason for alteration
If we exhaust our body’s physiologic system, it becomes __.
Pathophysiologic (which is what it refers to when we say the body couldn’t compensate any longer)
Hyperkalemia > 5 mEq/L management
Increase excretion
Treatment of acidosis
Management of Hypokalemia < 3.5 mEq/L
Increasing potassium
Oral or intravenous administration
Crystalloids
Initial resuscitation fluid
*If you give too much NS it may cause hyperchloremic metabolic acidosis & may contribute to perioperative acute kidney injury)
LR and PlasmaLyte
Colloids
Albumin (fluid resuscitation in hemorrhagic shock and in the presence of hypoalbuminemia or in conditions where there is large protein loss)
Which patients have large protein loss? Burns and septic
Hydroxyethyl Starch
- Polysaccharide (6% and 10% solution)
- Volume expansion
- Acute normovolemic hemodilution
- Improve blood rheology
•Side effects = Coagulopathy (dose-dependent decrease in factor VIII and vWF)
Dextran
Water soluble glucose polymer
•Clinical use
- Colloid osmotic pressure of 350 mOsm/L
- Remains in intravascular space for 12 hours
- Replacement of intravascular volume
•Side effects
- Allergic reactions
- Increased bleeding time (decreases platelet adhesion)
- Non-cardiogenic pulmonary edema
Universal Donor
RBC = 0- (because it does not contain any antigens)
Plasma = AB+ (also no antibodies)
Universal Acceptors
RBC = AB+
Plasma = O-
If you have a change in sodium, you will also have a change in ___
chloride
Once you determine an electrolyte imbalance, what other factor is key to obtain before making a plan to correct the imbalance?
Whether the patient is euvolumic, hypovolemic or hypervolemic
Most common electrolyte imbalance in hospitalized patients =
hyponatremia