Fluids and electrolytes

Question 1

What is Third spacing?

Answer 1

Fluid in interstitium; Edema or paralytic bowel following surgery

Question 2

When does third spacing occur post-op?

Answer 2

Usually around POD 3

Question 3

Classic signs of third spacing

Answer 3

Tachycardia

Decreased urine output

Question 4

Tx for third spacing

Answer 4

IV hydration w/ isotonic fluid

once resolved switch to hypotonic fluid to prevent fluid overload once the fluid begins to return to intravascular space

Question 5

Surgical Causes of Metabolic acidosis

Answer 5

Loss of bicarb: diarrhea, ileus, fistula, high output ileostomy, carbonic anhydrase inhibitors
Inc in acid: Lactic acidosis (ischemia), ketoacidosis, renal failure, necrotic tissue

Question 6

Surgical cause of hypocholremic alkalosis

Answer 6

NGT suction, loss of gastric HCl thorugh vomiting/NGT

Question 7

Surgical causes of metabolic alkalosis

Answer 7

Vomiting, NG suction, diuretics, alkali ingestion, meneralocorticoid excess

Question 8

Surgical causes of Resp. Acidosis

Answer 8

Hypoventilation (CNS dep), Drugs (morphine), PTX, Pleural effusion, parenchymal lung dz, acute airway obstruction

Question 9

Surgical causes of resp alkalosis

Answer 9

Hyperventilation (anxiety, pain, fever, vent settings)

Question 10

Classic acid-base finding w/ significant vomiting or NGT suction

Answer 10

Hypokalemic hypochloremic met acidosis

Question 11

What clinical markers can be followed to assess fluid status?

Answer 11

I's and O's
Base deficit
Lactic Acid
VS
Weight changes
Skin turgor
JVD
Mucosal membranes
rales (crackles)
Central venous pressure
PCWP
Chest X-ray findings

Question 12

W/ HyPOvolemia what chages occur in vital signs?

Answer 12

TachyHR
Tachypnea
Initial rise of dBP(because of periph vasoconstriction) eventually converting to drop in both systolic and diastolic BP