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Tim CP3 @ UoN - Medicine & Surgery > Surgery - Fluids & Electrolytes > Flashcards

Surgery - Fluids & Electrolytes Flashcards

1
Q

What are the physiological limits of normal blood gases?

A 
pH = 7.35-7.45
PaO2 = >10.6kPa
PaCO2 = 4.7-6.0kPa
HCO3- = 22-26mmol/L
BE = +/-2mmol/L
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2
Q

What are the electrolyte values in serum?

A 
Na = 135-145
K = 3.5-5
Ca = 2.2-2.6
Cl = 94-111
Latate = 1-2
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3
Q

What proportion of an adult body is water?

A

60%

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4
Q

What proportion of body water is ICF/ECF?

A 
ICF = 2/3 (40% mass)
ECF = 1/3 (20% mass)
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5
Q

What proportion of ECF is IF/Plasma/TCF?

A

Interstitial Fluid = 3/4 (15% mass)
Plasma = 1/4 (5% mass)
Transcellular Fluid = <0.5L

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6
Q

What are sensible losses?

A

Urinary fluid losses

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7
Q

What are insensible losses?

A

Losses from sweat, lungs & faeces

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8
Q

What are additional losses?

A

Losses from NG tubes, drains, stomas, 3rd space losses

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9
Q

What is the MOVU and how is it calculated?

A

Minimum obligatory volume of urine

0.5ml/kg/hr (1L/day)

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10
Q

How much fluid is lost as insensible losses?

A

Lungs + Faeces = 500ml

Sweat = 500ml

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11
Q

What is the average fluid requirement for an adult patient?

A

3L/day

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12
Q

What is the average electrolyte loss per day?

A 
Na = 2mmol/kg/day
K = 1mmol/kg/day
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13
Q

What is the average electrolyte requirement per day?

A 
Na = 100mmol/day
K = 60mmol/day
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14
Q

What is the standard fluid maintenance regime?

A

1 SALTY 2 SWEET
1L normal saline w/ 20mmol KCL over 8h
1L 5% dextrose w/ 20mmol KCL over 8h
1L 5% dextrose w/ 20mmol KCL over 8h

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15
Q

How much fluid should be added to the standard regimen for pyrexic patients?

A

10% per degree of fever

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16
Q

What are the main endogenous factors controlling Na & water excretion?

A

RAAS

ADH secretion from post pituitary

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17
Q

Describe RAAS

A

Decreased EABV –> decreased renal blood flow at juxta-glomerular apparatus –> release of renin
Renin cleaves Angiotensinogen –> AT1 –> ATII via ACE
ATII

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18
Q

What are the effects of Angiotensinogen II?

A 
Efferent renal artery constriction
Peripheral vasoconstriction
Proximal Na reabsorption
SNS activation
Aldosterone release
Thirst + ADH release --> CD water reabsorption
19
Q

What are the Sx of dehydration?

A

Mild - headache, lack of energy, tiredness
Mod - dry mouth, decreased alertness, sunken eyes, muscle cramps
Sev - confusion, disorientation, tachycardia, tachypnoea, low BP

20
Q

What is the electrolyte composition of 0.9% saline?

A 
Osmolarity = 208
Na = 154mmol/L
Cl- = 154mmol/L
21
Q

What is the electrolyte composition of Ringers lactate/Hartmann’s?

A 
Osmolarity = 278
Na = 131mmol/L
K = 5mmol/L
Ca = 2mmol/L
Cl = 111mmol/L
Lactate = 29mmol/L
22
Q

What is the electrolyte composition of 5% dextrose in water?

A

50g dextrose in 1L pure water

23
Q

What is the electrolyte composition of dextrose saline?

A

4% dextrose/0.18% saline
Osmolarity = 283
Na = 30mmol/L
Cl=30mmol/L

24
Q

What is the electrolyte composition of 5% albumin?

A 
Osmolarity = 300
Na = 150mmol/L
Cl = 150mmol/L
25
Q

What is the difference between cristalloids &; colloids?

A 
Cristalloids = balanced electrolyte comp, expand ECV
Colloids = exert high oncotic pressure, can keep more fluid in intravascular space, can cause anaphylaxis
26
Q

What are the fluid, electrolyte & acid-base abnormalities in excessive vomiting?

A

Hypochloraemic, hypokalaemic metabolic alkalosis

-Na often low

27
Q

How are the fluid, electrolyte & acid-base abnormalities in excessive vomiting managed?

A
  1. 9% saline & 20mmol KCl

- check U&Es frequently

28
Q

What are the fluid, electrolyte & acid-base abnormalities in a high volume Pancreatic/Ileal/Jejunal/Bile Fistula?

A

Bicarb deficiency
Acidosis
Hypokalaemia

29
Q

How are the fluid, electrolyte & acid-base abnormalities in a high volume Pancreatic/Ileal/Jejunal/Bile Fistula managed?

A

Fluid & Bicarbonate replacement

30
Q

What are the fluid, electrolyte & acid-base abnormalities in diarrhoea?

A

Hyperchloraemic metabolic acidosis

  • hypokalaemia if profuse
  • metabolic alkalosis if chronic
31
Q

How are the fluid, electrolyte & acid-base abnormalities in diarrhoea managed?

A

Oral rehydration OR

0.9% saline & 20mmol K+

32
Q

How should a closed head injury be managed w/ regards to fluids & electrolytes?

A

Maintain euvolaemia (reduces risk of 2o brain injury)

  • if pt haemodynamically stable 2/3 maintenance w/ isotonic
  • avoid hypotonic fluids
33
Q

What are the fluid, electrolyte & acid-base abnormalities in acute tubular necrosis?

A 
Hyperkalaemia
Hyperphosphataemia
Hypermagnesia
Hyponatremia
Hypocalcaemia
Metabolic acidosis
   -if vomiting no acidosis
34
Q

What are the fluid, electrolyte & acid-base abnormalities in dehydration?

A

Isonatremic

  • can be hyponatremic if hypertonic fluid lost
  • can be hypernatraemic if hypotonic fluid lost
35
Q

How are the fluid, electrolyte & acid-base abnormalities in dehydration investigated?

A 
FBC
U&amp;Es
Lactate
Glucose
Urinalysis
36
Q

How are the fluid, electrolyte & acid-base abnormalities in dehydration managed?

A

Specific treatment regimens

37
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion

  • decreased water excretion
  • normal sodium excretion
38
Q

What are the fluid, electrolyte & acid-base abnormalities in SIADH?

A

Dilutional hyponatremia

39
Q

What are the causes of SIADH?

A 
Malignancy (SCC, pancreas, prostate)
CNS (meningoencephalitis, haemorrhage, head injury)
Chest (TB, pneumonia, abscess)
Endocrine (hypothyroidism)
Drugs (opiates, psychotropics)
Major surgery
Trauma
Symptomatic HIV
40
Q

How are the fluid, electrolyte & acid-base abnormalities in SIADH investigated?

A 
Na
   -hyponatremia
   -increased urinary Na
   -increased specific gravity
Urea
   -normal/creatinine
41
Q

What is diabetes insipidus?

A

Passage of large volumes of dilute urine (3L/day)

-impaired water resorption by kidney collecting ducts

42
Q

What are the causes of diabetes insipidus?

A

Reduced ADH secretion from post pituitary (cranial)

Impaired response of the kidney (nephrogenic)

43
Q

What are the fluid, electrolyte & acid-base abnormalities in diabetes insipidus?

A

Hypernatraemia

Reduced plasma osmolality

44
Q

What are the fluid, electrolyte & acid-base abnormalities in diabetes insipidus?

A

Dilutional hyponatremia

Hypokalaemia

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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