8/13/13 anesth FLUID AND ELECTROLYTES 5- 6 L- volume -same amount being pumped by the heart per minute which

is equivalent to cardiac output 2 COMPARMENTS 1. Minor 2. Major- extracellular/ interstitial fluid- 20% -intracellular fluid- 40% BODY FLUID REQUIREMENTS are computed as ff: >100 ml/kg/day for the first ten kg or 1000 ml >50 ml/kg/day for the second 10 kg or 500 ml > 20 ml/ kg/ day for the remaining 20 kg or 400 ml So in a 40 kg patient, daily fluid req is 1900 ml or 2 bottles of dextrose in 24 hours IN A PATIENT: 1. Do history taking, clinical abstract -patient is NPO, hx of vomiting, diarrhea, use of diuretics, bowel prep -3 L in 24 hours 2. Take V/S pulse,bp,rr,cvp,uo,crea- determinants if patient is dehydrated S/SX dehydration thirsty-MILD Sweating, tachycardia, hypotension, decrease UO, mental confusion -Coma-SEVERE CLASSIFIED TERMS FOR FLUID LOSS ASSOCIATED WITH FLUID LOSS 1. Hyponatremia- diminished sodium, common in patient developed severe diarrhea and vomiting 2. Hypernatremia- sodium- seen in patients with renal failure and diabetes insipidus, severe fluid losses tx: dextrose containing Na 3. 4. 5. 6. Hyperkalemia- potassium Hypokalemia- diminished potassium Metab acidosis- ph less than 7.45 Hypocalcemia- diminished calcium

OSMOLARITY- number of osmoles of solute/liter of solution OSMOLALITY- number of osmoles of solute/ kg of solvent, heavier DIABETES INSIPIDUS- Deficiency of ADH, always urinating, rare case CAUSES: Vasopressin deficiency, idiopathic,trauma,tumor,granuloma,infection, brain damage SIADH- due to non-osmotic relase of ADH ALDOSTERONE- mineralocorticoid responsible for precise control of Na secretion Decrease in systemic renal failure as well as hypovolemia, hypernatremia Juxta glumerular cells in kidney, precursor angiotensin I,II,III Responsible of sodium retention Sodium retains water Patient suffering kidney dse, leads to hypertension

BT/ HEMOTHERAPHY Given prior, during surgery 2 types: HOMOLOGOUS, AUTOLOGOUS- ex. Ectopic pregnancy, blood is taken in peritoneal cavity Indications: anemia, hypovolemic patient following trauma, CA, bleeding SIDE EFFECTS 1. 2. 3. 4. 5. 6. 7. 8. TRANSFUSION REACTIONS fever, chills, hematuria, shock HEPATITIS B,C,D,E blood contains virus HEP C- most common MALARIA SYPHILIS TRANSMISSION OF VENEREAL DSE ALLERGIC REACTIONS FEVER,CHILLS HIV

COMPLICATIONS OF MASSIVE BT 1. Coagulopathy- blood does not clot, bleeding 2. Hyperkalemia- cardiac arrest 3. Hypothermia FLUIDS: crystalloid- dextrose, colloids- albumin, dextran, blood