Access: Acid-Base, Fluids, and Electrolytes - part 1 pdf

[...]... FLUID COMPARTMENTS 1 11 Dextran as a Plasma Volume Expander 12 1 12 Albumin as a Plasma Volume Expander 12 1 13 Adverse Effects of Crystalloids and Colloids 13 General Principles 13 1 14 General Rules for Correction of the Fluid Deficit 13 1 15 Basics of Fluid Choice (Colloid vs Crystalloid) 14 1 16 Electrolyte Content of Body Fluids 14 1 17 Insensible Losses and Maintenance Requirements 15 Assessing... Volume 15 1 18 Assessment of ECF Volume 15 Fluid Resuscitation 16 1 19 Monitoring Fluid Resuscitation 16 Clinical Examples of Fluid Resuscitation 17 1 20 The Septic Patient 17 1 21 Crystalloids versus Colloids in the Septic Patient 18 1 22 The Cardiac Surgery Patient 18 1 23 Albumin versus Hetastarch in CPB 19 BODY FLUID COMPARTMENTS BODY FLUID COMPARTMENTS TABLE 1 1: Body Fluid Compartments An understanding... failure TABLE 1 16 : Electrolyte Content of Body Fluids Na؉ (mEq/L) K؉ (mEq/L) Cl؊ (mEq/L) HCO3؊ (mEq/L) Sweat 30–50 5 50 — Gastric 40–60 10 10 0 0 Pancreatic 15 0 5 10 80 70–80 Duodenum 90 10 –20 90 10 –20 Ileum 40 10 60 70 Colon 40 90 20 30 BODY FLUID COMPARTMENTS 15 TABLE 1 17 : Insensible Losses and Maintenance Requirements Insensible water losses average 500 10 00 mL/day or approximately 10 mL/kg/day... TABLE 1 10 : Characteristics of Albumin and Hetastarch Albumin Hetastarch Molecular weight 69,000 670,000 Made from Human sera Starch Compound Protein Amylopectin Preparations 25% and 5% 6% 12 BODY FLUID COMPARTMENTS TABLE 1 11 : Dextran as a Plasma Volume Expander Dextrans are glucose polymers (MW ≈ 40–70 kDa) with anticoagulant properties Decrease risk of postoperative deep venous thrombosis and pulmonary... air and higher in febrile patients Daily maintenance requirements for Na+ are 50 10 0 mEq/day, K+ are 40–80 mEq/day, and glucose are 15 0 g/day ASSESSING EXTRACELLULAR FLUID VOLUME TABLE 1 18 : Assessment of ECF Volume Symptoms and signs, in particular BP changes, are employed to assess ECF volume Symptoms • Thirst, dry mouth, and dizziness Signs • Diminished axillary sweat, decreased capillary refill, and. .. than crystalloids TABLE 1 7: Replacement Fluid Options: Crystalloid Solutions Solution Osm Glucose Na؉ Cl؊ Lactate D5W 252 50 — — — 0.9% NS 308 — 15 4 15 4 — 0.45% NS 15 4 — 77 77 — Ringer’s lactate 272 — 13 0 10 9 28 Abbreviations: Osm, osmolality; D5W, 5% dextrose in water; NS, normal saline Units: Osm, mOsm/L; glucose, g/L; Na+, Cl−, and lactate, mEq/L BODY FLUID COMPARTMENTS TABLE 1 8: Replacement Fluids:... degree of substitution and a high C2/C6 ratio BODY FLUID COMPARTMENTS 11 TABLE 1 9 (Continued) Hetastarch (type of HES) characteristics • Large MW (670 kDa) • Slow elimination kinetics • Increased risk of bleeding complications after cardiac and neurosurgery due to these characteristics • Increased risk of acute kidney injury in septic and critically ill patients and in brain-dead kidney donors • HES... between ICF and ECF (see Figures 1 1 and 1 2) • Water flows from low osmolality to high osmolality • Solute addition to the ECF raises osmolality ■ Water flows out of ICF until the gradient is gone ■ Water moves into and out of cells, resulting in cell swelling or shrinking Abbreviations: TBW, total body water; ECF, extracellular fluid; ICF, intracellular fluid 3 4 BODY FLUID COMPARTMENTS FIGURE 1 1: Body... concentrations of von Willebrand factor and factor VIII:c Enhance fibrinolysis and protect plasmin from the inhibitory effects of α2-antiplasmin Increase blood loss after prostate and hip surgery Increase acute kidney injury in acute ischemic stroke Abbreviations: MW, molecular weight TABLE 1 12 : Albumin as a Plasma Volume Expander Available in two different concentrations • 5% solution: albumin (12 .5 g) in 250... albumin (12 .5 g) in 50 mL of normal saline has a COP of 10 0 mmHg One liter of 5% albumin expands the intravascular space by 500 10 00 mL Compared with crystalloid, albumin increases mortality risk in certain patient groups, but the data are mixed Mortality concerns and cost limit albumin use Abbreviations: COP, colloid osmotic pressure BODY FLUID COMPARTMENTS TABLE 1 13 : Adverse Effects of Crystalloids and . FLUID COMPARTMENTS 1 11 . Dextran as a Plasma Volume Expander 12 1 12 . Albumin as a Plasma Volume Expander 12 1 13 . Adverse Effects of Crystalloids and Colloids 13 General Principles 13 1 14 . General. Fluid Volume 15 1 18 . Assessment of ECF Volume 15 Fluid Resuscitation 16 1 19 . Monitoring Fluid Resuscitation 16 Clinical Examples of Fluid Resuscitation 17 1 20. The Septic Patient 17 1 21. Crystalloids. Correction of the Fluid Deficit 13 1 15 . Basics of Fluid Choice (Colloid vs. Crystalloid) 14 1 16 . Electrolyte Content of Body Fluids 14 1 17 . Insensible Losses and Maintenance 15 Requirements Assessing