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Anaesthetics > Perioperative Fluid Mx > Flashcards

Perioperative Fluid Mx Flashcards

1
Q

What is total body water

A

TBW 60% of body weight 70kg man - 42L

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2
Q

What does total body water separate into what compartments

A

Intracellular fluid - 40% of that 28L and

Extra cellular fluid - 20% of that 14 L

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3
Q

What doesECF separate into

A

Interstitial fluid 10L

Intravascular fluid -4L 60-70ml per kg

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4
Q

What happens to body water as we age

A

Decreases

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5
Q

How does fluid shift

A

Between the body and the outside world
- intake and output
Between fluid compartment
- osmosis, diffusion and active transport

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6
Q

What is osmosis

A

Movement of a solvent (water) across a membrane to a region of higher concentration of solute
The of movement is dependent on the number of particles in the solution

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7
Q

What is osmotic pressure

A

The hydrostatic pressure that must be applied to the solution of greater concentration to prevent water movement across a semi-permeable membrane separating 2 aqueous solution os unequal concentrations

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8
Q

What is osmolarity

A

Number of osmoles per L

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9
Q

What is osmolality

A

Number of osmolality per kg

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10
Q

What is plasma osmolality

A

Posm = 2[Na] + glucose + urea = 290mosmol/kg

Note the absence on plasma proteins (albumin) and colloid osmotic pressure

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11
Q

Consideration is practical fluid balance

A

Composition of the IV fluid
Assessment of the hydration state
Rules for fluid therapy
Tackling electrolyte imbalance

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12
Q

What are crystalloids

A

Small molecules/solutes
Water +salt +/- sugar
They are sterile, safe, cheap and have short intra-vascular half life

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13
Q

Where does 0.9% NaCl remain

A

ECF
Good for resus
Interstitial:intravascular 2:1

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14
Q

Where does 5 % dextrose distribute to

A

All compartments following metabolism of glucose

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15
Q

What is Hartman’s

A

Compounds sodium lactate much similar in physiological composition to plasma

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16
Q

What are colloid solution

A 
Used for plasma expansion but are less used these days 
they are large MW compounds 
Non-synthetic such as albumin
Synthetic - gelatin, dextran or starch
Suspended in isotonic fluid (NaCl)
Longer intravascular half life
1:1 volume replacement
17
Q

What is the problem with synthetic colloids

A

Anaphylaxis
Affect coagulation - anti-thrombotic
Deposit in the reticule-endothelial system causing pruritis
Renal function can be affected (starch)

18
Q

How to asses fluid status

A 
History - thirst 
Exam
Mucous men - dry 
Dec skin turgor
Dec cap refill
Dec JVP
Dec Blood pressure
Dec urine output
19
Q

Mild dehydration is what and causes what

A

4% of TBW
3L
Reduced skin turgor
Dry membranes

20
Q

Moderate dehydration is what and causes what

A

5-8% TBW
4-6L
Oliguria, tachycardia
Hypotension

21
Q

What is severe dehydration

A

8-10%
7 L
CVS compromise
Confusion/coma

22
Q

Investigations of dehydration

A 
FBC 
Haemoconcentration 
Anaemia
Transfusion requirement blood loss +dehydration can make it difficult to work out how much to transfuse as if dehydrated Hb may be higher than it actually is 
Creatinine U&E
Dehydration inc Na inc urea 
Electrolyte imbalance 
Renal dysfunction inc creatinine and inc urea
23
Q

What happen to the sodium infused in

A

Remain in the ECF

24
Q

What does glucose and water do

A

Expands the entire TBW

25
Q

Indication for dextrose 5%

A

Dehydration

Going to be dehydrated

26
Q

What are the electrolyte requirements

A

Sodium requirement =2mmol/kg/day
150mmol in 1000mls 0.9% saline
Potassium requirement = 1mmol/kg/day
60-70mmols in 24 hrs

27
Q

Potassium replacement

A

Hypokalaemia can be a highe loss if chronic is acute can be a small losss due to only the extracellualr being measurable cannot tell the actual deficit
Correct slowly is asymptomatic
20-40mmol KCL/l 0.9% saline
Reestimate by doing the U and Es frequently
Aim for high normal levels in arrhythmias

28
Q

Forms you can get plasma in

A 
FFP - contains plasma proteins, labileclotting factors, stored -30 for >1year 
ABO and Rh compatible 
HAS - 4.5%, 20% 
Controversy over sue 
pasteurised - glass bottle 
Recombinant 
Flexible packs
29
Q

Platelets how many donation needed per bag

A

4-6 donation= 1 adult pack

30
Q

Storage of platelet

A

22 degrees

5 days

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