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AS - N928 Basic Principles of Anesthesia > IV Fluids > Flashcards

IV Fluids Flashcards

1
Q

Body Fluid Distribution

A

Intracellular 40% (2/3) total body weight 28L
Extracellular 20% (1/3) total body weight 14L
Average weight 70kg
Total 42L

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2
Q

Extracellular

A

20% total body weight 14L
Plasma volume 4% 3L
Interstitial volume 16% 11L

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3
Q

↑ Total Body Water

A

Term infants 75%
Premature infants 80-90%
Children
Pregnancy

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4
Q

↓ Total Body Water

A

Elderly 50-55%

Obesity

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5
Q

Average TBW

A

70kg adult male 60% = 42L

70kg adult female 55%

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6
Q

Intracellular Electrolytes

A

Potassium K+
Magnesium Mg2+
Phosphate PO34¯

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7
Q

Extracellular Electrolytes

A

Sodium Na+
Chloride Cl¯
Bicarbonate HCO3¯
Calcium Ca2+

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8
Q

Osmolality

A

Number osmotically active particles per kg H2O

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9
Q

Osmolarity

A

Number osmotically active particle per L solution

Concentration

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10
Q

Tonicity

A

Measures particles capable to exert an osmotic force (pull)

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11
Q

Isotonic

A

Two solutions w/ = osmolarity

No osmotic pressure generated across the cell membrane

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12
Q

Hypotonic

A

Solution w/ ↓osmolarity as compared to plasma

→ cells swell

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13
Q

Hypertonic

A

Solution w/ ↑osmolarity as compared to plasma

→ cells shrink

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14
Q

Starling Forces

A

Pc - capillary hydrostatic pressure
Pt - tissue hydrostatic pressure
πc - capillary plasma oncotic pressure
πt - tissue fluid oncotic pressure

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15
Q

Colloid Oncotic Pressure

A

Osmotic pressure exerted by macromolecules (Albumin, proteins, gamma globulins)
Prevents fluids from leaving plasma & exerts pull from interstitial space

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16
Q

Endothelial Glycocalyx

A

Gel layer in capillary epithelium that creates physiologically active barrier w/in vascular space (keeps fluid intravascular)
Creates barrier b/w blood & vessel
Binds to circulating plasma albumin, preserving oncotic pressure, & ↓capillary permeability to H2O
Contains inflammatory mediators, free radial scavenging, activates anticoagulation factors
Promotes laminar flow (prevents adhesion)

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17
Q

RAAS Impact on Fluid Dynamics

A

Sodium & water reabsorption

ACEi/ARBs ↓fluid volume

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18
Q

ADH

A

Anti-diuretic hormone
Prevents diuresis
Water reabsorption

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19
Q

Atrial Natriuretic Peptide

A

ANP
Natriuresis - sodium excretion
Stimulates kidney to release Na+ & H2O
↓intravascular volume

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20
Q

Crystalloid Volume Expansion

A

3-4L to expand IV compartment 1L
3:1 replacement
Half-life 20-30min intravascular

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21
Q

Normal Plasma Concentrations

A 
Na+ 142mEq/L
K+ 4mEq/L
Cl¯ 103mEq/L
PO43¯ 1.4mEq/L
Mg2+ 2mEq/L
Ca2+ 5mEq/L
pH 7.4
290mOsm/L
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22
Q

Lactated Ringer

A

Buffer = lactate (converted to bicarbonate)
Isotonic (275mOsm/L)
Provides 100mL free H2O per L solution
Lowers Na+
Avoid in ESRD (K+)
Avoid mixing w/ PRBC (Ca2+ binds to citrate)
- Citrate keeps blood anticoagulated

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23
Q

LR Electrolytes

A 
Na+ 130mEq/L
K+ 4mEq/L
Cl¯ 110mEq/L
Ca2+ 3mEq/L
Lactate 28mEq/L
275mOsm/L
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24
Q

Normal Saline

A 
0.9% NaCl in H2O
Isotonic solution
↑Cl¯ → dilutional hyperchloremic metabolic acidosis
Preferred solution to dilute PRBCs
LEAST physiologic isotonic crystalloid
25
Q

NS Electrolyes

A

Na+ 154mEq/L
Cl¯ 154mEq/L
pH 6
310mOsm/L

26
Q

Normosol-R

A 
Isotonic solution
Expensive \$\$$
Most closely replicates physiologic electrolytes
Ideal fluid in neuro patients
Okay to mix w/ blood products
27
Q

Normosol-R Electrolytes

A 
Na+ 140mEq/L
K+ 5mEq/L
Cl¯ 98mEq/L
Mg2+ 3mEq/L
Ca2+ 0
Glucose 0
Acetate 27mEq/L
Gluconate 23mEq/L
pH 7.4
28
Q

D5W

A 
Hypotonic solution (260mOsm/L)
Dextrose rapidly metabolized → only H2O remains
Causes free water intoxication & hyponatremia
Hyperglycemia (except diabetic receiving insulin or neonate)
29
Q

Hypertonic Solutions

A

3% Na+/Cl¯ 513mEq
5% Na+/Cl¯ 856mEq
Bullet 23.4% imminent herniation
Treat hyponatremia
Low volume resuscitation, burns, closed head trauma
Risk hyperchloremia, hypernatremia, & cellular dehydration

30
Q

Colloid Solutions

A

1:1 replacement
Half-life 16hrs
2-3hrs in pathophysiological stress
Goal to pull fluid into intravascular space

31
Q

Albumin

A 
Blood derived colloid solution
Obtained from fractionated human plasma
Available 5% or 25%
Expands IV up to 5x administered volume
Plasma 1/2 life 16hrs
32
Q

Dextran

A

Water-soluble glucose polymers
Enzymatically degraded to glucose
70 - volume expansion
40 - improve microcirculation blood flow & prevent thrombosis
HIGHLY antigenic → anaphylactic reaction
Test dose 10mL
Platelet inhibition, non-cardiac pulmonary edema, interference w/ cross-matching

33
Q

Hydroxyethyl Starch 6%

A 
Hespan (0.95% NaCl)
Hextend (balanced electrolyte solution)
NOT blood derivative
Less effective than albumin to expand volume, but less expensive
Primary renal excretion
Coagulopathy d/t dilutional thrombocytopenia
Max dose <20mL/kg/day
Oncotic pressure 30
34
Q

Maintenance IV Fluids

A

MIVF 4-2-1
4mL/kg/hr 1st 10kg = 40mL/hr
2mL/kg/hr 2nd 10kg = 20mL/hr
1mL/kg/hr each additional kg

Any patient >20kg
Weight + 40 = mL/hr
120kg + 40 = 160mL/hr

35
Q

Fluid Deficit Replacement

A

NPO replacement
Replace 1/2 deficit 1st hour + MIVF
Replace 1/4 deficit 2nd hour + MIVF
Remaining 1/4 deficit 3rd hour + MIVF

36
Q

Fluid Deficit Calculation

A 
Calculated MIVF x hours NPO
120kg NPO 12hr
160mL/hr x 12hr = 1,920mL
960mL replace 1st hour
480mL replace 2nd & 3rd hours
37
Q

Evaporative 3rd Space Loss

A

Minimal 0-2mL/kg/hr
Moderate 3-5mL/kg/hr
Severe 6-9mL/kg/hr
Emergency 10-12mL/kg/hr

38
Q

Minimal

A

Eye, lap chole, hernia, knee scope

0-2mL/kg/hr

39
Q

Moderate

A

Open chole or appendectomy

3-5mL/kg/hr

40
Q

Severe

A

Bowel surgery
Total hip replacement

6-9mL/kg/hr

41
Q

Emergency

A

Gunshot
MVA

10-12mL/kg/hr

42
Q

Estimated Blood Loss

A 
1 gram = 1cc
Soaked 4x4 gauze = 10cc
Ray-tech = 10-20cc
Soaked laparotomy pads = 100-150cc
Wet sponges 20-30% dry value
Floor spills 1" = 5cc
2" = 20cc
3" = 45cc
4" = 80cc
1:1 replacement
43
Q

Estimated Blood Volume

A 
Infants 80mL/kg
Children 75mL/kg
Adult male 75mL/kg
Adult female 65mL/kg
Elderly M 65mL/kg
Elderly F 60mL/kg
44
Q

Allowable Blood Loss

A

[EBV x (starting Hct - allowable Hct)] / starting Hct

45
Q

Blood Type Specific

A

ABO-Rh typing

98% compatible

46
Q

Type + Screen

A

ABO-Rh type + screen
Specific antibodies commonly associated w/ non-ABO hemolytic reactions
99.94% compatible

47
Q

Type + Crossmatch

A

Confirms ABO-Rh typing (<5min)

Detects antibodies to other blood groups & in low titers (up to 45min)

48
Q

When to Transfuse

A

Hgb <6g/dL

Hgb 6-10g/dL transfusion based on patient risk, complications, and inadequate oxygenation S/S

49
Q

Massive Transfusion

A

Replace patient total blood volume in <24hr
Acute admin >1/2 patient EBV in 3hr or less
Transfusion 10units RBCs in 24hr

50
Q

Blood Product Administration Risk

A

Infection - Hep B/C, HIV, bacterial sepsis
Allergic or febrile reactions
TRALI or non-cardiogenic pulmonary edema
Hemolytic reactions
Acute hypotension transfusion reaction
Metabolic complications ↓pH ↑K+
Coagulopathy (after massive transfusion >10units)
Dilutional thrombocytopenia (responds well to platelet transfusion)
↓Factors V/VIII
DIC - clotting system activation
Citrate toxicity

51
Q

Citrate

A

Preservative that acts as anticoagulant in stored blood
Binds to Ca2+
Calcium admin not warranted unless iCal low
Hypocalcemia (clinically significant - resulting in cardiac depression) does not occur unless transfusion rate exceeds 1 unit every 5min

52
Q

PRBCs

A

1 unit ↑Hgb 1g/dL & Hct 2-3%

10mL/kg transfusion ↑Hgb 3g/dL & Hct 10%

53
Q

Autologous Transfusion Complications

A 
Anemia
Preop MI d/t anemia
Administering wrong unit
Require more frequent blood transfusion
Febrile & allergic reaction
54
Q

Cell-Saver

A

Salvage blood from surgical site
Blood processed - washed & separated
Red cells are transfused back to patient
Contraindications include malignancy, infected wounds, sepsis, chemical contaminants

55
Q

Acute Normovolemic Hemodilution

A

Remove blood from patient after induction & replace w/ crystalloid or colloids
After surgical blood loss has slowed or stopped transfuse blood back to patient ↑Hct

56
Q

Platelets

A

1 unit obtain via centrifuging
Used to treat thrombocytopenia, dysfunctional platelets, active bleeding, platelet count <50,000
Volume 200-400cc (multiple donors)
1 unit ↑platelet count 7,000-10,000 one hour after transfusion
↑incidence platelet related sepsis 1:12,000
Bacterial contamination risk 1:2,000

57
Q

Fresh Frozen Plasma

A

Contains clotting factors & plasma proteins (no platelets)
Volume 200-250cc
ABO compatible
Used to treat Warfarin reversal, coagulation factor deficiencies, correct microvascular bleeding ↑PT/PTT
Each unit ↑clotting factor level 2-3%
FFP contraindicated to augment plasma volume or albumin concentration

58
Q

Cryoprecipitate

A

Derived from precipitate remaining after FFP thawed
Contains fibrinogen, factor VIII (hemophilia A), von Willebrand factor, XIII
Used to treat von Willebrand’s disease & fibrinogen deficiencies (i.e. massive transfusions)
ABO compatible
Admin via filter rapidly (200mL/hr) & complete infusion w/in 6hr

AS - N928 Basic Principles of Anesthesia (18 decks)

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