Fluids and electrolytes

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This fluid is associated with metabolic hyperchloremia

0.9% NaCl because the concentration of Cl in the fluid is higher than that in the plasma. May cause need for CRRT

Daily water requirements (L)

1.5-2.5L

Colloid half life is this long

2-16 hours

Extracellular fluid makes up this percentage of total body weight; this percent of total body water

20% TBWt; 33% TBWater

The extracellular fluid accounts for this much (%) of the total body weight

20% of the total body weight is contributed by this fluid compartment. Interstitial makes up 75% of this percentage, and intravascular makes up 25% of this percentage.

Intravascular half life of crystalloids is this long

20-30 minutes

Daily water requirements

20-30 ml/kg/day

HES max dose

20ml/kg

Normal plasma osmolality

280-290 mOsm/kg

Intracellular fluid makes up this percentage of total body weight; this percent of total body water

40% TBWt; 66% TBWater

The intracellular fluid accounts for this much (%) of the total body weight

40% of the total body weight is contributed by this fluid compartment

Daily potassium requirements

40-80 mEq

EBL: Soaked 4x4 Soaked lap

4x4 = 10ml lost lap = 110-150ml lost

Plasma volume constitutes this percentage of total body weight

5% of total body weight is this compartment

Compensatory intravascular volume expansion administration guideline is this. CVE criticism includes these points

5-7ml/kg Hypotension is due to vasodilation - treat with pressors not fluid. Vasodilation and myocardial depression subside quickly after surgery. May end up with hypervolemia.

By age 50, what percentage of total body weight accounts for water in the human body?

50% of total body weight consists of water in the 50-year old.

Daily sodium requirements

50-100 mEq

Daily glucose requirements

50-100g

This percentage of total body weight is made up of water in the adult male; adult female.

60% of total body weight is made up of water in this population; 50% in this population.

Blood*** volume accounts for this percentage of total body weight; percentage broken down by components

7.5% of total body weight ---2.5% red cell mass ---5% plasma mass

Blood volume is estimated in this manner

70 ml/kg is the estimation for this patient characteristic

Neonates have this percentage of their total body weight as water

70-80% of a newborn's TOTAL BODY WEIGHT is made up of this

This percentage of blood volume is distributed in the venous system; arterial system

85% venous 15% arterial

Argument against classical urine loss consideration

ADH hormone is secreted during surgery, so urine output may not be an accurate or dependable guide for fluid management

4-2-1 rule

Add 40ml to the weight - isotonic Only if patient is over 20kg

Side effects of dextran (colloid)

Anaphylactic reaction*** Increased bleeding times at 20mL/kg Rouleaux formation (interferes with blood xm)

Argument against classical vasodilation consideration

Anesthetic-induced vasodilation is better managed with vasopressor and/or lighter anesthesia to maintain peripheral vascular resistance

Dextran provides this function due to this mechanism

Antithrombosis function Reduces factor VIII and vWF - decreases platelet aggregation and function Acts as plasminogen activator

NS is preferred in these types of patients

Brain injury Hyperkalemic hyponatremia Hypochloremic metabolic alkalosis

Hydroxyethyl starch side effects include these

Coagulation disturbance Renal toxicity - large molecules get stuck Anaphylactoid reactions Interferes with vWF, Factor VIII, and platelet function.

Tonicity is defined as this

Compares osmolarity of the solution to osmolarity of plasma Plasma is isotonic to cells

HES should be avoided in these patients

Critically ill patients Renal patients Patients with sepsis Bleeding risk patients

Crystalloid should replace blood loss at this ratio Colloid at this ratio

Crystalloid 3:1 replacement Colloid 1:1

Extracellular fluid is divided into these two compartments and they make up this percentage of ECF** by total body water (%)

Divided into: 1) Plasma volume - 25% TBWater 2) Interstitial volume - 75% TBWater

Argument against classical NPO status consideration

Fluid deficit in elective surgery is negligible, especially because fasting guidelines allow water ingestion right up until 2 hours before surgery.

Replacement calculation from NPO

Hours NPO x hourly maintenance requirement 1st hour: replace 50% of the deficit 2nd hour: replace 25% of the deficit 3rd hour: replace 25% of the deficit Or give deficit volume at 4x maintenance rate until all deficit is given

Purpose of hypotonic solutions Isotonic Hypertonic

Hypo - free water loss (DI), large water loss Iso - maintenance and replacement fluid Hyper - hyponatremia treatment

These are the three classifications of fluids with explanations

Hypotonic - lower osmolarity Isotonic - balanced osmolarity Hypertonic - high osmolarity

List fluid compartments as their percent of body weight

Intracellular - 40% Extracellular - 20% TOTAL 60% of total body wt. ---Interstitial 15%*** ---Intravascular 5%***

List fluid compartments as percent of total body water

Intracellular 67% Extracellular 33% TOTAL 100% total water ---Interstitial 25%*** ---Intravascular 8%***

Argument against classical 3rd space consideration

It is unlikely that the third space exists

These electrolytes are primarily intracellular

K Mg PO4 Proteins

This fluid should not be run with blood

LR - citrate in blood mixes with Ca in the LR and causes thrombosis

This fluid should not be given to renal failure patients

LR - includes potassium

Fluid calculations are based on this type of body weight for this reason

Lean body weight is used to calculate replacement, this is because fat is anhydrous

Isotonic solutions include these

Lr Normosol Plasma-lyte 0.9% NaCl

MABL

MABL = EBV x (start HCT - target HCT) ___________________________________________ Starting HCT

Evaporative loss guidelines include these

Minimal (craniotomy): 2 ml/kg/hr Moderate (thoracotomy): 4 ml/kg/hr Severe (bowel resection): 6 ml/kg/hr

These are the five classical surgical considerations for fluid status evaluation

NPO status Vasodilation from general or regional anesthesia Evaporative losses 3rd spacing (redistribution IVs --> IS) Blood loss

These electrolytes are primarily extracellular

Na Ca Cl HCO3

These are plasma fluid concentrations of electrolytes

Na - 142 K - 4 Mg - 2 Ca - 5 Cl - 103 HCO3 - 25

Body fluid osmolarity is roughly equal to this

Osmolality is roughly equal to this

These are the three methods of categorizing body water in the patient

Percent of total body weight Percent of total body water Fluid volume in liters

Plasma volume makes up this percentage of ECF weight; interstitial volume (%) of ECF weight

Plasma 75% weight of ECF Interstitial 25% weight of ECF

This compartment is made up a high protein content; example; purpose of protein

Plasma volume compartment is made up of this high molecule content. Albumin is an example. The purpose of this molecule is to provide an oncotic pressure of 20mmHg greater than the interstitial fluid

Preterm EBV Newborn Infant Adult male Adult female

Preterm 95 ml/kg Newborn 85 ml/kg Infant 80 ml/kg Adult male 70 ml/kg

HES side effect that is caused by tissue storage is this

Pruritis - large molecules get stuck in the skin

Blood volume is defined as this

Red blood cell volume + plasma volume = X

This compartment has a low protein content

The interstitial fluid has a low content of this

Argument against classical blood loss consideration - that loss should be replaced with three to four times the amount of crystalloid

There should be an assessment of fluid responsiveness to guide administration of fluid after blood loss

Interstitial fluid makes up this percent of total body weight; this percent of ECF

This compartment makes up 15% of the total body weight This compartment makes up 75% of the ECF

Argument against classical evaporative (insensible) losses consideration

With laparoscopic and other minimally invasive surgery, there is little insensible loss

Osmolarity; osmolality

# osmoles/L # osmoles/kg


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