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Surgery > Principles Of Fluid And Electrolyte Therapy > Flashcards

Principles Of Fluid And Electrolyte Therapy Flashcards

1
Q

What are the two main types of fluid

A

Crystalloids
Colloids

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2
Q

Give some examples of crystalloids

A

Normal saline
Ringers lactate
Dextrose saline
Badoe’s solution
5% or 10% dextrose
Fluid 5:4:1 (for cholera)
GIRS
Darrow’s solution

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3
Q

Give some examples of colloids

A

Blood
Plasma
Hemacel
Dextran

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4
Q

Give a difference between a crystalloid and a colloid

A

Crystalloids are small molecules while colloids are large molecules (collagen)

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5
Q

What are some indications for giving IV fluids

A

Dehydration
Shock
Intestinal failure
Surgery
Nutritional TPN
Drug administration

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6
Q

What are some complications of Iv fluids

A

Overload
Embolism
DVT
Immune reactions
Infections
Bleeding (dextran)

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7
Q

How many mls of water can be lost by an average adult through breathing and the skin

A

1700 mls

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8
Q

What is the net loss of water in the average adult

A

3400 mls

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9
Q

In certain conditions such as metabolic acidosis, you cannot give ………….. So you give …………..

A

Ringer’s lactate, Normal saline

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10
Q

In dehydration, water is lost from which compartment

A

ECF

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11
Q

If dehydration becomes chronic, water is lost from the ………….. compartment as well

A

ICF

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12
Q

During burns, there is fluid distribution from the …………. to the ……………

A

Intravascular space to the extravascular space

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13
Q

What are some symptoms of dehydration

A

Sunken eyes
Dry inelastic skin (decreased skin turgor)
Tachycardia
Tachypnoea
Collapsed veins
Capillary refill time (increased)
Altered sensorium
Reduced urine output

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14
Q

What is the urine output of a person

A

0.5/1ml/kg
30-50

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15
Q

On going losses are mostly ……… losses

A

GIT

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16
Q

A person came with a deficit. The doctor decided to calculate the fluid deficit and add it to the maintenance. What is this called

A

On-going losses

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17
Q

What fluid is contraindicated in a dehydrated patient

A

5% dextrose

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18
Q

A patient who is hemodynamically stable is given ………. for maintenance

A

4:2:1/kg/hr

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19
Q

How is hyponateiemua treated

A

It depends on the type whether it is chronic or acute, hypovolemic, hypervolemic or normovolemic

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20
Q

What kinds of saline could be given for hyponatremia

A

Isotonic saline
Hypertonic saline
Fluid restriction
Diuresis??

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21
Q

What are some things that fluid provide

A

Solvent from reactions
pH
Exchange of nutrients
Excretion
Excitability (nerve impulses)
Temperature regulation
Chemical signals

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22
Q

What is the percentage of TBW in men

A

About 60%

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23
Q

What is the percentage of TBW in women

A

About 50%

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24
Q

What is the % of ICF per body weight

A

40% of body weight
2/3 of TBW

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25
Q

What is the % of ECF per body weight

A

20% of body weight
1/3 of TBW

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26
Q

What is the % of TCF per body weight

A

1% of body weight

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27
Q

What is the % of TCF in the ECF

A

5% of the ECF

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28
Q

What is the % of plasma per body weight

A

4% of body weight

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29
Q

What is the % of plasma in the ECF

A

20% of the ECF

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30
Q

What is the % of IF per body weight

A

15% of body weight

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31
Q

What % of IF in found in the ECF

A

75% of the ECF

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32
Q

What are the three main compartments water shift through

A

IC
IVF
ISF

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33
Q

Water in interstitial compartment recirculated by lymphatics and eventually back into the intravascular space
True or false

A

True

34
Q

Mention one ion found in both the ICF and ECF

A

Na
K
Mg

35
Q

What ions are found in the ICF

A

Na
K
Mg
Phosphorus
Proteins

36
Q

What ions are found in the ECF

A

Na
Cl
K
Ca
Mg
HCO3

37
Q

What is the volume of water lost through the urine in a day in the tropics

A

1500

38
Q

What is the volume of water lost through stools by a healthy adult in the tropic region

A

200

39
Q

There is no potassium lost through sweat
True or false

A

True

40
Q

What is the volume of K lost through urine in a day in the tropics

A

50

41
Q

What is the volume of K lost through faeces in a day in the tropics

A

10

42
Q

What is the volume of Na lost through urine in a day in the tropics

A

114

43
Q

What is the volume of Na lost through sweat in a day in the tropics

A

10-16

44
Q

What is the volume of Na lost through faeces in a day in the tropics

A

10

45
Q

What fluid and electrolytes should be given to a surgical patient who is not eating and not passing stool

A

3L of water
130mmol of Na
50mmol of K
100g of Glucose

46
Q

Where is it obtained from

A

1 litre Ringers lactate + 2 litres of 5% dextrose +3g KCl/24hrs
1 litre normal saline + 2 litres of 5% dextrose + 3g KCl /24hrs
Badoes solution 3l / 24hrs

47
Q

Dehydration is a state of negative fluid balance. It strictly means loss of water alone but usually accompanied by Na.
It is characterized by loss of ECF, but ICF may be involved
True or false

A

True

48
Q

What are some causes of dehydration

A

Decreased fluid intake
Increase losses via renal, GIT or insensible losses
Fluid shift (ascites, effusions and capillary leak states such as burns and sepsis)

49
Q

What are the various forms of dehydration

A

Acute or chronic
Mild or moderate or severe
Isonatraemic or hypernatraemic or hyponatraemic

50
Q

Some clinical manifestations of dehydration is related to

A

Intravascular volume depletion
Physiologic compensation attempts that takes place

51
Q

For patients who are unstable with ongoing losses (eg peritonitis), IV is given at what rate

A

A faster rate (with a wide bore cannula)

52
Q

What are some types of fluid to be given to a dehydrated patient

A

Ringer’s lactate
Normal saline
Dextrose saline

53
Q

How is deficit given

A

1L in 30-45 mins

54
Q

What are some parameters to assess in a patient with dehydration

A

BP, RR, pulse
Veins
Sensorium
Oxygen saturation
Urine Output
Temperature

55
Q

What is the amount of fluid you should give to a hemodynamically stable patient

A

100: 50: 20ml /kg – in 24 hours or
4:2:1/kg/hr in an hour

56
Q

What is the equation for flow rate (min)

A

Flow rate duration(min) = Volume (ml) x drop factor

57
Q

What are some electrolytes which give us problems

A

Na
K
Mg
Ca

58
Q

What is the normal range for sodium

A

135-145 mmol/l

59
Q

What are some causes of hyponatremia

A

Diarrhoea
Vomiting
Peritonitis
Fistulae
Burns
Wounds
Severe hyperglycaemia
Dehydrated patient infused with Na free fluids

60
Q

What is the range for mild hyponatremia

A

130-134 mmol/L

61
Q

What is the range for severe hyponatremia

A

< 125 mmol/L or (<120mmol/L)

62
Q

What is the normal range for moderate hypokalemia

A

125-129 mmol/L (or 120-129 mmol/L)

63
Q

What are some symptoms of hyponatremia

A

Nausea
Headache
Lethargy
Seizures
Coma
Underlying disease

64
Q

How do you treat hyponatremia

A

You correct the dehydration or shock by replacing the Na deficit

65
Q

In the treatment of Na deficit, how do you calculate to know the Na deficit

A

Na deficit = TBW * (Na goal - Na in plasma)
= 0.6 * your weight * (Na goal - Na plasma)

66
Q

What are some lab investigations to be done in hyponatremia

A

BUE
Cr

67
Q

What are some signs in hyponatremia

A

Shock
Dehydration

68
Q

In a serious symptomatic hyponatremia, what is the infusion given to the patient

A

IV infusion of hypertonic saline target increase of 6 mmol/L over 24 hours (not exceeding 12 mmol/L)

69
Q

For patients with reduced circulating volume, extracellular volume should be restored with what

A

An IV infusion of 0.9% saline or a balanced crystalloid solution at 0.5 to 1.0 mL/kg per hour

70
Q

What is hypernatremia

A

A rise in serum sodium concentration to a value exceeding 145 mmol/L

71
Q

What is the greatest risk factor for hypernatremia

A

Age older than 65 years

72
Q

What are some renal causes of hypernatremia

A

Loop diuretics
Polyureic phase of ATN
Post obstructive diuresis of kidney
Nephrologist diabetes insipidus

73
Q

What are some common causes of hypernatremia

A

Endocrine syndromes
Failure of renal tubular cells to respond to ADH
Increase salt intake or infusion
Water loss

74
Q

What are some extra renal causes of hypernatremia

A

Endocrine syndromes
Vomiting
Diarrhoea
NGT suctioning
Sweating
Fever
Infusion of HTS/increased salt intake

75
Q

What are some symptoms of hypernatremia

A

Muscle weakness
Lethargy
Restlessness
Insomnia
Coma in severe cases (central pontine myelinolysis)

76
Q

What are some investigations to be done in hypernatremia

A

Serum electrolytes (Na+, K+, Ca2+)
BUN
Glucose level
Urine electrolytes (Na+, K+)
Urine and plasma osmolality

77
Q

Treatment of hypernatremia depends on …………… status

A

Volume

78
Q

How do you treat hypervolemic patients with hypernatremia

A

When using diuretics, tread cautiously

79
Q

How do you treat non-volemic patients with hypernatremia

A

Free water replacement with hypotonic fluids

80
Q

How do you treat hypovolemic patients with hypernatremia

A

Use isotonic fluid to offset deficit

81
Q

What are general things to consider in hypernatremia patients

A

In asymptomatic patients, don’t correct too rapidly (cerebral edema)
Acute (no more than 1-2 mmol/hr)
Chronic (no more than 0.5-1 mmol/hr)
Sodium levels should not be corrected at a rate more than 8 mmol/day
Acute (< 24hours, chronic > or =24 hours)

82
Q

What is the normal range for potassium in the body

A

3.5-5.5 mmol/L or 3.6-5.2 mmol/L

Surgery (25 decks)

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