Fluids, volume regulation and volume disturbance

Question 1

Extracellular fluid component (2)

Answer 1

1) Interstitial

2) Intravascular

Question 2

90% of fluid returns via?

Answer 2

Venules

The rest through the lymphatic system

Question 3

How are body water and tonicity regulated?

Answer 3

ADH

Question 4

Hypothalamic osmoreceptors have an osmotic threshold of about ___ mOsm/kg. Above this level ADH release is stimulated.

Answer 4

289

Question 5

Hypothalamic thirst center neurons is activated when (3)

Answer 5

1) Increase in plasma sodium of 2 mEq/L
2) increase in plasma osmolality of 4 mOsm/L
3) loss of potassium from thirst center neurons and
angiotensin II

Question 6

3 criteria of SIADH

Answer 6

1) The patient must be euvolemic or hypervolemic
2) The urine must be inappropriately concentrated (plasma osmolality <280 mOsm/kg, urine osmolality >100 mOsm/kg)
3) Renal, cardiac, hepatic, adrenal, and thyroid function must be normal

Question 7

The primary therapy for SIADH is?

Answer 7

Water restriction

Demelocycline

Question 8

Where is angiotensinogen produced?

Answer 8

Liver

Question 9

Intravascular space half-life of colloids?

Answer 9

3-6 hours

Question 10

There are two albumin preparations?

Answer 10

5%

25%

Question 11

Colloid osmostic pressure under normal circumstances?

Answer 11

20 mmHg

Question 12

The heterogeneous preparation contains polymerized

molecules with molecular weights of between 20,000 and 100,000 daltons.

Answer 12

HES 6%

Question 13

HES is metabolized by?
HES accumulates where?
HES is excreted where?

Answer 13

Amylase
Reticuloendothelial cells
Kidneys

Question 14

What clotting factor is prolonged when HES is aministered?

Answer 14

Partial thromboplastin time

It has dilutional effects on clotting factors, and the hetastarch molecules can move into organizing fibrin clot.

Question 15

Recommended dose of HES?

Answer 15

not more than 20 mL/kg

Question 16

A fluid preparation with water-soluble, polymerized glucose molecules. It has 2 preparations namely?

Answer 16

Dextran

Dextran 40 and 70 (molecular weights of the respective solutions are 40 and 70 kilodaltons)

Question 17

Nice to know

What situations might be appropriate for the use of hypertonic saline?

Answer 17

Hypertonic saline (usually 3%) has been used 
extensive cancer resections; for hypovolemic shock, slow correction of symptomatic chronic hyponatremia, transurethral resection of the prostate syndrome, and increased intracranial pressure; and to reduce peripheral edema after major fluid resuscitations. It has been used in far forward combat situations and in trauma patients with prolonged transportation times
(rural areas), but its use is still not extremely common.

Question 18

A large laparotomy sponge is equivalent to know much blood?

Answer 18

100 mL

Question 19

How much fluid is:

1) Liber fluid administration
2) Restrictive fluid administration

Answer 19

1) 12 to 15 ml/kg/hr

2) 4 to 8 ml/kg/hr

Question 20

Blood pressure is not significantly affected until approximately ___ of blood volume is lost.

Answer 20

30%