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Electrolytes/Fluids

CAPA Fluid and Electrolyte imbalances

QuestionAnswer
What is the normal rquired daily fluid intake 2L
What population may become significantly dehydrated and hypoglycemic pre-operatively? Children (NPO status)
Percentage of body water decreases with what? age (muscle decreases, fat increases, kidney function decreases - ability to conserve fluid)
Percentage of body water is less in ____________ patients. Obese (also elderly)
Third spacing of fluid causes what problems? hypovolemis and ongoing hypotension (fluid is migrating OUT of vascular spaces)
Edema (esp. around eyelids, fingers, and ankles) is signs of what fluid problem? Second spacing
What causes in increased risk of apnea in preterm infants less than 60 weeks old who are having surgery? Hematocrit less than 30%
Name some complications of post op N/V. Increased risk for hypovolemia, delays discharge, increases cost of care.
What populations dehydrate easily? Infants, children, and elderly patients.
Post Op N/V is highly associated with what types of surgeries? Laparoscopy, strabismus correction, and ear surgery
What effect does anesthestic medications have on the vascular and fluid levels? They dilate the vasculature and expand the Extracellular fluid capacity (eases fluid overload and improves diastolic filling in the heart)
What types of events may cause electrolyte imbalances? 1. Transient mild resp acidemia related to anesthetic-induced hypoventilation and sedation. 2. Preoperative hypokalemia related to bowel preps or chronic meds such as diuretics or digoxin. 3. Physiologic stress related to surgery (anxiety increases sodium
What is the function of Sodium? Regulates fluid balance and reflects serum osmolality.
Na+ and K+ have what type of relationship? Inverse.
What electrolyte is an immediately available acid-base buffer? Bicarbonate
Chloride competes with waht other electrolyte to combine with sodium? Bicarbonate
What cations (positively charged ions) are critical for cardiac function? Potassium, Magnesium, and Calcium
Bicarbonate to carbonic acid ratio must be maintained at what ratio? 20 to 1
List the chemical buffers. Phosphate, hemoglobin, and protein
Low protein causes what problem? Third spacing (fluid leaks from vascular spaces due to low osmalality)
Where are changes in osmolality sensed in the body? Baroreceptors at right atrium
How is osmalality primarily adjusted? ADH (antidiuretic Hormone)
What is the most important determinant of osmalality? Serum Sodium. (Water follows sodium and will go wherever the sodium is higher concentrated)
What governs FLUID movement between ECF and ICF? Osmosis
What governs SOLUTE distribution through a selectively permeable membrane? Diffusion
Normal value for Sodium? 135-145
Normal value for Chloride 96-106
Normal Potassium value 3.5-5.0
Normal value for Magnesium 1.5-2.5
Normal value for Calcium 4.5-5.3
Normal Phosphate value? 1-2
What does ADH do to blood volume? adjust serum osmalality and concentrates electrolytes
What causes the body to increase ADH secretion? increased serum osmalality
Other than osmolality, what other factors can cause increased ADH secretion? Stress such as pain, trauma, surgery, hypovolemia, opioids, hypoxia, or hypercapnia
A hypophysectomy may cause what disorder? Diabetes Insupidus (inability to concentrate urine from a decrease in ADH)
What does a decrease in ADH result in? a promotion of water elimination (results in dilute urine)
What stimulates the Renin-angiotensin system to be activated? Blood flow changes at the glomerulus
How does renin-angiotensin regulate the circulating blood volume? changing the flomerular filtration rate (GFR) in the kidneys.
Release of renin is the kidneys effort to do what? Raise blood pressure and GFR
Angiotensin II is what type of chemical A Potent Vasoconstrictor to peripheral blood vessel and the lungs.
What stimulates the adrenal cortex to release aldosterone? Fluid volume status and renal perfusion (GFR)
What is the function of Aldosterone? It regulates SODIUM REABSORPTION (increases total body water). It acts at the kidney's renal tubule.
What is the end result of Aldosterone regulation? Prevention of Hypovolemia and Hypotension.
Aldosterone causes Sodium to be retained and what to be excreted? Potassium or hydrogen ions (to maintain ion balance)
A decrease in Aldosterone has what effect? excretion of sodium and water, retention of potassium
What fluid concern can rewarming after intraoperative hypothermia cause? Peripheral vasodilation, expnasion of the vascular compartment and significant hypotension. (Treatment with fluid volume expansion)
Spinal and epidural anesthesitc techniques have what effect on the fluid balance? They expand the ECF by dilating peripheral vasculature.
What interventions may be needed post operatively until anesthetic effects have resolved? Vasopressors and fluid volume expansion may be needed until normal vessel tone has returned
When is the reabsorption phase following fluid shift post surgery or trauma? within 72 hours post surgery or injury
What are signs and symptoms of Dehydration and hemoconcentration? Thirst, oliguria (<15 ml/hr), poor skin turgor, dry skin and mucous membranes, decreased cardiac output, inadequate cerebral perfusion (confusion, lethargy)
What are some causes of Hypervolemia? renal failure, congestive heart failure, and remobilization of third space fluid postoperatively, excess sodium intake (IV or hyperadlosteronism)
Created by: keviannk
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