This document provides an overview of fluid compartments and electrolytes in the human body. It discusses the intracellular and extracellular fluid compartments, their composition and regulation. Key points covered include osmosis, diffusion, active transport, factors affecting fluid distribution, causes and signs of fluid volume deficits and excesses, and intravenous fluid replacement options.
fluid electrolyte imbalance with the causes, sign and symptoms, pathophysiology, medical management and nursing process.
helpful for the nursing students
fluid electrolyte imbalance with the causes, sign and symptoms, pathophysiology, medical management and nursing process.
helpful for the nursing students
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. 2
Introduction
Body water is distributed between two major fluid
compartments separated by cell membranes:
intracellular fluid (ICF) and extracellualr fluid (ECF).
ECF is subdivided into intravascular and interstitial
compartments. The interstitium includes all fluid that is
both outside cells and outside the vascular endothelium.
5. 5
Intracellular (ICF):
The outer membrane of cells plays an important role in
regulating intracellular volume and composition. A
membrane-bound adenosine triphosphate (ATP)–dependent
pump exchanges Na+ for K+ in a 3:2 ratio. Because cell
membranes are relatively impermeable to sodium and, to a
lesser extent potassium ions, potassium is concentrated
intracellularly, whereas sodium is concentrated extracellularly.
6. 6
Extracellular (ECF)
The principal function of ECF is to provide a medium for
delivery of cell nutrients and electrolytes and for removal of
cellular waste products. Maintenance of a normal
extracellular volume particularly the circulating component
(intravascular volume) is critical, Changes in ECF volume are
therefore related to changes in total body sodium content,
which are regulated by sodium intake, renal sodium
excretion, and extrarenal sodium losses .
7. 7
Intravascular Component
This compartment made by plasma which is fluid portion
of blood & this is made of:
Water.
Plasma proteins.
Small amount of other substances.
Most electrolytes (small ions) freely pass between
plasma and the interstitium, resulting in nearly
identical electrolyte composition.
8. 8
Interstitial component
Which is a fluid (Exactly – lymph) between cells, and
responsible for transport medium for nutrients, gases,
waste products and other substances between blood and
body cells.
Interstitial fluid pressure is generally thought to be
negative (approximately –5 mm Hg). Increases in
extracellular volume are normally proportionately
reflected in intravascular and interstitial volume.
However, as interstitial fluid volume progressively
increases, interstitial pressure also rises and eventually
becomes positive.
9. 9
Transcellular component
Constitute about 1% of ECF which is located in joints,
connective tissue, bones, body cavities, CSF, pericardial,
synovial, intraocular, pleural fluids, sweat, digestive
secretions and other tissues
10. 10
Regulation of Fluids in Compartments
Fluid normally shifts between the ICF and ECF compartment
every day, to help keep our bodies in homeostasis. The principles
involved in this shifting are osmosis, diffusion, and filtration.
Osmosis:
Movement of water through a selectively permeable
membrane from an area of low solute concentration to a
higher concentration until equilibrium occurs,movement
occurs until near equal concentration found, it`s usually
passive process
11. 11
Diffusion:
Movement of solutes from an area of higher concentration
to an area of lower concentration in a solution and/or
across a permeable membrane (permeable for that solute),
movement occurs until near equal state, also it`s passive
process
12. Filtration :
Is the removal or filtering of the toxins and waste products from
the blood by the kidney. They are excreted from the body through
urine. In general, filtration refers to the passing of a liquid through
a filter. In the human body, the kidney functions as a filter
12
13. Factors affectinf rate of diffusion
The rate of diffusion of a substance across a membrane depends
upon
(1) The permeability of that substance through that membrane.
(2) The concentration difference for that substance between the two
sides.
(3) The pressure difference between either side, because pressure
imparts greater kinetic energy.
(4) The electrical potential across the membrane for charged
substances.
13
15. 15
Active Transport
Allows molecules to move against concentration and osmotic
pressure to areas of higher concentration
Active process – energy is expended
16. Diffusion Through Capillary Endothelium
Capillary walls are typically 0.5 μm thick, consisting of a
single layer of endothelial cells with their basement membrane.
Intercellular clefts, 6 to 7 nm wide, sepa rate each cell from its
neighbors. Oxygen, CO2 , water, and lipid-soluble substances
can penetrate directly through both sides of the endothelial cell
membrane. Only low-molecular-weight, water-soluble
substances such as sodium, chloride, potassium, and glucose
readily cross intercellular clefts. High-molecular weight
substances such as plasma proteins penetrate the endothelial
clefts poorly.
16
17. Fluid exchange across capillaries differs from that across cell
membranes in that it is governed by significant differences in
hydrostatic pressures in addition to osmotic forces. These
forces are operative on both arterial and venous ends of
capillaries, with a tendency for fluid to move out of
capillaries at the arterial end and back into capil laries at the
venous end
17
19. 19
Osmolality
The osmolality of ECF is equal to the sum of the concentrations
of all dissolved solutes. Na+ and its anions account for nearly
90% of these solutes
It can be measured by serum and urine. The main solutes
measured are urea, glucose, and sodium.
20. 20
Osmolality
So serum osmolality =
(serum Na x 2) + BUN/2.8 + Glucose/18 (Osm/kg)
Normal serum value - 280-300 mOsm/Kg
Serum <240 or >320 is critically abnormal
Normal urine Osm – 250 – 900 mOsm / kg.
Total body osmolality =
Na x 2 (extracellular comp.) + (Kx 2 intracellual comp.)
TBW
21. Factors that affect Osmolality
Serum
– Increasing Osm
• Free water loss
• Diabetes Insipidus
• Na overload
• Hyperglycemia
• Uremia
– Decreasing Osm
• SIADH
• Renal failure
• Diuretic use
• Adrenal
insufficiency
22. Factors that affect Osmolality
Urine
– Increasing Osm
• Fluid volume
deficit
• SIADH
• Heart Failure
• Acidosis
– Decreasing Osm
• Diabetes Insipidus
• Fluid volume
excess
– Urine specific gravity
• Factors affecting
urine Osm affect
urine specific
gravity identically
22
23. 23
Fluid Volume Shifts
Fluid normally shifts between intracellular and extracellular
compartments to maintain equilibrium between spaces
Fluid not lost from body but not available for use in either
compartment – considered third-space fluid shift (“third-
spacing”)
Enters serous cavities (transcellular)
24. 24
Causes of Third-Spacing
Burns
Peritonitis
Bowel obstruction
Massive bleeding into joint or cavity
Liver or renal failure
Lowered plasma proteins
Increased capillary permeability
Lymphatic blockage
25. 25
Assessment of Third-Spacing
More difficult – fluid sequestered in deeper structures
Signs/Symptoms
– Decreased urine output with adequate intake
– Increased HR
– Decreased BP, CVP
– Increased weight
– Pitting edema, ascites
26. 26
Treatment of 3rd space loss
Treat underlying cause if possible
Monitor I & O more frequently
Daily weights
Measure abdominal girth in ascites
Measure extremities if necessary
Monitor lab values
albumin level important
28. 28
Fluid volume deficit
When Output > Input Water extracted from ECF
• When ECF osmolality increases, these cells shrink and
release ADH from the posterior pituitary. ADH
markedly increases water reabsorption in renal
collecting tubules, which tends to reduce plasma
osmolality back to normal. Decreased ECF volume
adrenal glands secrete Aldosterone which lead to Na &
water reabsorption.
29. 29
Signs and Symptoms of volume deficit
Acute weight loss
Decreased skin turgor
Oliguria
Concentrated urine
Weak, rapid pulse
Capillary filling time elongated
Decreased BP
Increased pulse
Sensations of thirst, weakness, dizziness, muscle cramps
30. 30
Significant Points
Dehydration – one of most common disturbances in infants
and children
Additional sign & symptoms:
Sunken eyeballs
Depressed fontanels
Significant wt loss
31. 31
Labratory tests
Increased HCT
Increased BUN out of proportion to Cr
High serum osmolality
Increased urine osmolality
Increased specific gravity
Decreased urine volume, dark color
32. 32
Management
Major goal is to correct abnormal fluid volume status
before ARF occurs, this done by :
IV fluids: Isotonic solutions (0.9% NS or LR) until BP
back to normal.
Monitor input & output , urine specific gravity, daily
weights.
Monitor skin turgor
Monitor mental status.
33. 33
Fluid Volume Excess (FVE)
Hypervolemia
Isotonic expansion of ECF caused by abnormal retention
of water and sodium
Fluid moves out of ECF into cells and cells swell
34. 34
Causes
Cardiovascular – Heart failure
Urinary – Renal failure
Hepatic – Liver failure, cirrhosis
Other – Cancer, thrombus, PVD, drug therapy (i.e.,
corticosteriods), high sodium intake, protein malnutrition
35. 35
Signs/Symptoms
Physical assessment
Weight gain
Distended neck veins
Periorbital edema, pitting edema
Adventitious lung sounds (mainly crackles)
Dyspnea
Mental status changes
Generalized or dependent edema
36. 36
Signs / Symptoms
CVS
High CVP/PAWP
↑ cardiac output
Lab data
↓ Hct (dilutional)
Low serum osmolality
Low specific gravity
↓ BUN (dilutional)
38. 38
Interventions
Sodium restriction (foods/water high in sodium)
Fluid restriction, if necessary
Closely monitor IVF
If dyspnea or orthopnea > Semi-Fowler’s
Strict I & O, lung sounds, daily weight, degree of edema,
reposition q 2 hr
Promote rest and diuresis
39. 39
Normal Water balance
The normal adult daily water intake averages 2500.
Daily water loss averages 2500 mL and is typically accounted
for by 1500 mL in urine, 400 mL in respiratory tract
evaporation, 400 mL in skin evaporation, 100 mL in sweat, and
100 mL in feces.
Evaporative loss is very important in thermoregulation because
this mechanism normally accounts for 20% to 25% of heat loss
40. 40
Other Causes of Water Loss
Fever
Burns :The largest contributor to abnormal loss is burns because
of the loss of natural skin barrier.
Diarrhea
Vomiting
N-G Suction
Fistulas
Wound drainage
41. 41
Other causes of water loss
Mechanical ventilation
Increased metabolism
Diabetes Insipidus
Uncontrolled DM:(water needed to dilute sugar for CHO
metabolism)
Acute tubular necrosis: (increased urination secondary to
inability to concentrate urine)
42. 42
IV Fluid Replacement
Intravenous fluid therapy may consist of infusions of
crystalloids, colloids, or a combination of both.
Crystalloid solutions are aqueous solutions of ions
(salts) with or without glucose, whereas colloid
solu tions also contain high-molecular-weight
substances such as proteins or large glucose polymers.
43. 43
IV Fluid Replacement
Colloid solutions help maintain plasma colloid oncotic
pres sure and for the most part remain intravascular, whereas
crystalloid solutions rapidly equilibrate with and distribute
throughout the entire extracellular fluid space.
44. Crystalloids
Although the intravascular half-life of a crystalloid solution
is 20 to 30 min, Crystalloids are often considered as the initial
resuscitation fluid in patients with:
o hemorrhagic and septic shock.
o burn patients.
o head injury (to maintain cerebral perfusion pressure).
o intraoperative fluid losses are usually isotonic loss ,so
isotonic crystalloid solutions such as normal saline or
balanced electrolyte solutions such as lactated Ringer’s
solution or PlasmaLyte are most commonly used for
replacement
44
45. Crystalloids have three types:
1. Isotonic Crystalloid Solution
The isotonic crystalloid solution is a crystalloid solution with
a concentration that is very close to that of normal bodily
fluids. They are electrolyte and water-based solutions that
mimic the body's fluid composition. It can also be used to
replace fluids or maintain a stable bodily state. Isotonic
crystalloid solutions have the advantages of being readily
available, having no side effects, and being inexpensive.
Common isotonic crystalloids examples are 0.9% sodium
chloride and lactate Ringer's solution.
45
46. 2. Hypotonic Crystalloid Solution
The hypotonic crystalloid solution is a crystalloid solution
with a concentration lower than that of normal bodily fluids.
Electrolyte concentrations in hypotonic solutions are lower
than 250 mEq/L. Hypotonic solutions cause water to flow
into cells, making them an effective treatment for some types
of dehydration. Examples of hypotonic solutions are 0.45%
sodium chloride and 0.25% sodium chloride.
46
47. 3. Hypertonic Crystalloid Solution
The hypertonic crystalloid solution is a crystalloid solution with
a concentration higher than that of normal bodily fluids.
Hypertonic solutions are specialized solutions that aid in the
recovery of a patient following or during a severe illness.
Electrolyte concentrations in hypertonic solutions are greater than
350 mEq/L. For hypotonic solutions, the concentration of sodium
chloride will be less than 0.9%. Examples of hypertonic solutions
are 10% dextrose in water, 3% sodium chloride, and 5% sodium
chloride.
47
48. 1. Plasma Lyte solution
It mimics human plasma in its content of electrolytes,
osmolality, and pH. These solutions also have additional
buffer capacity and contain anions such as acetate, gluconate,
and even lactate that are converted to bicarbonate, CO2, and
water. The advantages of PlasmaLyte include volume and
electrolyte deficit. It shares the same problems as most other
crystalloid fluids (fluid overload, edema with weight gain,
lung edema, and worsening of the intracranial pressure).
48
50. 2. Normal saline
Normal saline, when given in large volumes, produces
hyperchloremic metabolic acidosis because of its high
chloride content and lack of bicarbonate . In addition,
chloride-rich crystalloids such as normal saline may
contribute to perioperative acute kidney injury. Therefore, we
prefer balanced salt solutions for most intraopera tive uses.
Normal saline is the preferred solution for hypochloremic
metabolic alkalosis and for diluting packed red blood cells
prior to transfusion.
50
51. Colloids solution
The osmotic activity of high-molecular-weight sub stances in
colloids tends to maintain these solutions intravascularly. most
colloid solutions have intravascular half-lives between 3 and 6 h.
51
52. Indication of colloids infusion
1. Fluid resuscitation in patients with severe intravascular
fluid defi cits (eg, hemorrhagic shock) prior to the arrival
of blood for transfusion.
2. Fluid resuscitation in the presence of severe
hypoalbuminemia or condi tions associated with large
protein losses such as burns.
3. Colloid solutions in conjunction with crystalloids when
fluid replace ment needs exceed 3 to 4 L prior to
transfusion.
52
53. All are derived from either plasma proteins or syn thetic
glucose polymers and are supplied in isotonic electrolyte
solutions. Blood-derived colloids include albumin (5% and
25% solutions) and plasma protein fraction (5%). Both are
heated to 60°C for at least 10 h to minimize the risk of
transmitting hepatitis and other viral diseases
53
54. Plasma protein fraction contains α- and β-globulins in addition to
albumin and has occasionally resulted in hypotensive allergic
reactions. Synthetic colloids include gelatins and dextrose
starches. Gelatins (eg, Gelofusine) are associated with histamine-
mediated allergic reactions. Dextran is a complex polysaccharide
available as dextran 70 & 40 , which have average molecular
weights of 70,000 and 40,000, respectively.
Dextran is used as a volume expander but also reduces blood
viscosity, von Willebrand factor antigen, platelet adhesion, and
red blood cell aggregation
54
55. Infusions exceeding 20 mL/kg per day can interfere with blood
typing, may prolong bleeding time, and have been associated
with bleeding com plications. Dextran has been associated with
acute kidney injury and failure
55
56. Hetastarch (hydroxyethyl starch) is available in multiple
formulations , Hetastarch is highly effective as a plasma expander
and is less expensive than albumin. Allergic reactions are rare, but
anaphylactoid and anaphylactic reac tions have been reported.
Hetastarch can decrease von Willebrand factor antigen levels, may
prolong the prothrombin time, and has been associated with
hemorrhagic complications. It is potentially neph rotoxic and
should not be administered to patients at risk for acute kidney
injury
56
57. Perioperative fluid replacement
1. Replacement of fasting: replacement 4,2,1 regimen /kg body
weight. Type of fluid?why?
2. Abnormal fluid losses frequently contribute to preoperative
deficits. Preoperative bleeding, vomit ing, nasogastric suction,
diuresis, and diarrhea
3. Blood Loss: most important loss should be replace, this done
after assessment of amount of loss by many methods.what are
these methods ?
4. Internal redistribution of fluids often called third-spacing can
cause massive fluid shifts and severe intravascular depletion in
patients.
57
58. Replacing Blood Loss Ideally, blood loss should be replaced with
sufficient crystalloid or colloid solutions to maintain
normo volemia until the danger of anemia outweighs the risks of
transfusion. At that point, further blood loss is replaced with
transfusion of red blood cells to maintain hemoglobin
concentration
58
59. Below a hemoglobin concentration of 7 g/dL, the resting
cardiac output increases to maintain a nor mal oxygen delivery.
An increased hemoglobin con centration may be appropriate
for older and sicker patients with cardiac or pulmonary disease,
particu larly when there is clinical evidence (eg, a reduced
mixed venous oxygen saturation and a persisting tachycardia)
that transfusion would be beneficial
59