This document discusses fluid therapy and body fluid compartments. It covers the following key points:
1) The human body contains two main fluid compartments - intracellular fluid (ICF) and extracellular fluid (ECF). ECF is further divided into interstitial fluid, intravascular fluid, and transcellular fluid.
2) Fluid movement between compartments is governed by diffusion, osmosis, osmolality, tonicity, and oncotic pressure. Renal, neuroendocrine, and other physiological systems help regulate fluid balance.
3) Perioperative fluid needs include maintenance requirements, replacing deficits from fasting or losses, accounting for third spacing of fluids, and replacing blood loss.
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
Common fluids used in anaesthesia and fluid therapyArowojolu Samuel
common fluids used in anaesthesia. fluid therapy in anaesthesia and theatre. emergency fluid replacement. calculation of fluid by anaesthetist. colloids and crystalloids, indication in anaesthesia
Brief review of basic human fluid physiology, different types of fluids used in different clinical settings specially in surgical patients. Very useful for all medical students.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
This PPT gives an idea to MBBS students about the Type of fluids, Calculating the daily requirements as well as the drop rate to be used in day today clinical practice.
Common fluids used in anaesthesia and fluid therapyArowojolu Samuel
common fluids used in anaesthesia. fluid therapy in anaesthesia and theatre. emergency fluid replacement. calculation of fluid by anaesthetist. colloids and crystalloids, indication in anaesthesia
Brief review of basic human fluid physiology, different types of fluids used in different clinical settings specially in surgical patients. Very useful for all medical students.
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
This slide share includes definition,indications,dehydration status,types of fluids,when to administer which fluid,how to calculate the fluid to be administered and how to monitor fluid therapy.Hope its helpful.
Fluid and electrolyte management in surgical patients.KETAN VAGHOLKAR
Fluid and electrolyte management has to be aggressive. It is pivitol in speedy recovery in GI surgery. Changes should be anticipated and treated promptly. A detailed knowledge of this is essential for optimum management especially in the ICU.
Fluid and electrolyte balance in oral surgeryPunam Nagargoje
• ELECTROLYTE BALANCE
• Def: - concentration of individual electrolytes in the body fluid compartments is normal and remains relatively constant.
• Electrolytes are dissolved in body fluids
• Sodium predominant extracellular cation, and chloride is predominant extracellular anion. Bicarbonate also in extracellular spaces
• Electrolyte balance
• Na + (Sodium)
– 90 % of total ECF cations
– 136 -145 mEq / L
– Pairs with Cl- , HCO3- to neutralize charge
– Low in ICF
– Most important ion in regulating water balance
– Important in nerve and muscle function
• Electrolyte imbalances: Sodium
• Hypernatremia (high levels of sodium)
– Plasma Na+ > 145 mEq / L
– Due to ↑ Na + or ↓ water
– Water moves from ICF → ECF
– Cells dehydrate
• HYPERATREMIA
• Hypernatremia Due to:
– Hypertonic IV soln.
– Oversecretion of aldosterone
– Loss of pure water
• Long term sweating with chronic fever
• Respiratory infection → water vapor loss
• Diabetes – polyuria
– Insufficient intake of water .
• Clinical manifestations
of Hypernatremia
• Thirst
• Lethargy
• Neurological dysfunction due to dehydration of brain cells
• Decreased vascular volume
• TREATMENT OF HYPERNATREMIA:
• Lower serum Na+
– Isotonic salt-free IV fluid [5% dextrose]
– Oral solutions preferable
• Hyponatremia
• Overall decrease in Na+ in ECF
• Two types: depletional and dilutional
• Depletional Hyponatremia
Na+ loss:
– diuretics, chronic vomiting
– Chronic diarrhea
– Decreased aldosterone
– Decreased Na+ intake
• Clinical manifestations of Hyponatremia
• Neurological symptoms
– Lethargy, headache, confusion, apprehension, depressed reflexes, seizures and coma
• Muscle symptoms
– Cramps, weakness, fatigue
• Gastrointestinal symptoms
– Nausea, vomiting, abdominal cramps, and diarrhea
• Tx – limit water intake or
• discontinue medicines such as diuretics
• TREATMENT OF HYPONATREMIA
• Hyponatremia which develops quickly should be treated quickly & vice-versa
• Patients with severe hypoNa (<115) are at risk of neurological damage
• Too rapid correction causes CENTRAL PONTINE MYELINOLYSIS.
• Targeted rate of correction: 0.5-1.0 mEq/L/hour
• Raise plasma Na by <10-12 mEq/L on first day
• Correction @ rate >25mEq/L places at high risk for central pontine myelinolysis
• Hypokalemia
• Normal serum k+ conc is 3.5 to 5.0 mEq/l
• Serum K+ < 3.5 mEq /L
• Beware if diabetic
– Insulin gets K+ into cell
– Ketoacidosis – H+ replaces K+, which is lost in urine
• β – adrenergic drugs or epinephrine
• Causes of Hypokalemia
• Decreased intake of K+
• Increased K+ loss
– Chronic diuretics
– Acid/base imbalance
– Trauma and stress
– Increased aldosterone
– Redistribution between ICF and ECF
• Treatment of hypokalamia
• Metabolic acidosis increases serum K+ levels & vice versa
• Post-op patients on fluid therapy should receive approx 60mEq/day to prevent hypokalemia
• 1mEq/L fall in serum K+= 200-400 mEq total body K+ deficit
• Failure to ↑ Sr. K+ even after sufficient correction should
general presentation and management of Fluid & Electrolyte.pptxNatnael21
Discussion about physiology of fluid balance in human and clinical presentation and general management principles of major electrolyte abnormality like hypernatremia hyponatremia hyperkalemia and hypokalemia
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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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
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
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
5. Composition of Body Fluids:
Ca 2+
Mg 2+
K+
Na+
Cl-
PO4
3-
Organic
anion
HCO3
-
Protein
0
50
50
100
150
100
150
Cations Anions
ECFICF
Units : meq/l
6. PHYSICOCHEMICAL LAWS FOR FLUID
MOVEMENT
• DIFFUSION: movement of solute particles
along concentration gradient.
• OSMOSIS: movement of solvent across a
semipermeable membrane into regions of
higher solute concentration.
Osmolarity = solute/(solute+solvent)
(normal 280-310mosm/L)
7. OSMOLALITY: = solute/solvent (285-290mosm/kg)
Plasma osmolality= 2x(Na) + (Glucose/18) + (Urea/2.8)
•TONICITY: effective osmolality with respect to a semipermeable
membrane.
Plasma tonicity = 2 x (Na) + (Glucose/18)
Important in determining distribution of fluids across a cell
membrane and sensed by hypothalamic osmoreceptors.
•ONCOTIC PRESSURE
8. Regulation of Fluids:
Renal sympathetic nerves
Renin-angiotensin-
aldosterone system
Atrial natriuretic peptide (ANP)
9. COLLOIDS
• Fluids containing
molecules sufficiently large
enough to prevent transfer
across capillary
membranes.
• Solutions stay in the space
into which they are
infused.
• SEMISYNTHETIC COLLOID:
– GELATINS
– HYDROXYETHYL STARCHES
– DEXTRANS
• HUMAN PLASMA
DERIVATIVES
10. CRYSTALLOIDS
• Combination of water and
electrolytes
- Balanced salt solution:
electrolyte composition and
osmolality similar to
plasma; example: lactated
Ringer’s, Plasmlyte.
- Hypotonic salt solution:
electrolyte composition
lower than that of plasma;
example:D5W
- Hypertonic salt solution:
2.7% NaCl.
- Dextrose containing fluids
11.
12.
13.
14. PATHOPHYSIOLOGIC FLUID
ALTERATION IN PERIOPERATIVE
PHASE
• PREOPERATIVE:
– DIRECT INTRAVASCULAR DEPLETION
– LOSS FROM GI TRACT
– INFLAMMATION RELATED REDISTRIBUTION
– FLUID SEQUESTRATION IN THIRD SPACE LOSSES
• INTRAOPERATIVE:
– ALTERED DISTRIBUTION OF INTRAVASCULAR VOLUME.
– DIRECT LOSS OF INTRAVASCULAR VOLUME.
– INSENSIBLE LOSSES.
15. – INFLAMMATION RELATED REDISTRIBUTION.
– RENAL OUTPUT
• POSTOPERATIVE :
– INFLAMMATION AND IMMUNE RESPONSE (IL1,
TNF ALPHA, IL6, SIRS)
– CATABOLIC METABOLISM
– REGULATION OF SALT AND WATER BALANCE WITH
ADH RELEASE
16. PRACTICAL MANAGEMENT OF FLUID
THERAPY
• QUANTITY OF FLUID :
– TARGETTING OVERALL FLUID BALANCE
– GOAL DIRECTED THERAPY: based on
measurements as follows
• pulmonary arterial catheter,
• esophageal doppler monitoring and
• other targets like arterial waveform analysis, cvp,
lactate, echocardiography, oxygen extraction &venous
saturation or central venous saturation etc.
17. Clinical Evaluation of Fluid
Replacement
1. Urine Output: at least 1.0 ml/kg/hr
2. Vital Signs: BP and HR normal.
3. Physical Assessment: Skin and mucous membranes
no dry; no thirst in an awake patient.
. Laboratory tests: periodic monitoring of hemoglobin
and hematocrit.
18. Perioperative Fluid Requirements
The following factors must be taken into
account:
1- Maintenance fluid requirements
2- NPO and other deficits: NG suction, bowel
prep
3- Third space losses
4- Replacement of blood loss
5- Special additional losses: diarrhea
19. 1- Maintenance Fluid Requirements
• “4-2-1 Rule” HOLIDAY SEGAR FORMULA
- 4 ml/kg/hr for the first 10 kg of body weight
- 2 ml/kg/hr for the second 10 kg body weight
- 1 ml/kg/hr subsequent kg body weight
- Extra fluid for fever, tracheotomy, denuded surfaces
20. 2- NPO and other deficits
• NPO deficit = number of hours NPO x
maintenance fluid requirement.
• Bowel prep may result in up to 1 L fluid loss.
• Measurable fluid losses, e.g. NG suctioning,
vomiting, ostomy output, biliary fistula and
tube.
21. 3- Third Space Losses
• Isotonic transfer of ECF from functional body fluid
compartments to non-functional compartments.
• Depends on location and duration of surgical
procedure, amount of tissue trauma, ambient
temperature, room ventilation
• Superficial surgical trauma: 1-2 ml/kg/hr
• Minimal Surgical Trauma: 3-4 ml/kg/hr
- head and neck, hernia, knee surgery
• Moderate Surgical Trauma: 5-6 ml/kg/hr
- hysterectomy, chest surgery
• Severe surgical trauma: 8-10 ml/kg/hr (or more)
- Nehprectomy
22. Blood Loss
• Replace 3 cc of crystalloid solution per cc of
blood loss (crystalloid solutions leave the
intravascular space)
• When using blood products or colloids replace
blood loss volume per volume
23. SPECIAL CONSIDERATION
• PAEDIATRIC:
– Modification in preoperative fasting ( allowing
carbohydrate containing fluids upto 2 hours).
– Glucose free balanced crystalloid solutions to be used
intraoperatively.
– Avoid hypotonic fluids.
– Maintenance fluid using ½ to 2/3 of calculated 4-2-1
formula
– Return to oral fluids as soon as possible.
– Maintenance and ongoing losses to be replaced
seperately.
24. GERIATRIC:
• Decrease in total body water
• Decrease in GFR
• Decrease in urinary concentrating ability
• Increase in antidiuretic hormone (ADH)
• Increase in atrial natriuretic peptide (ANP)
• Decrease in aldosterone
• Decrease in thirst mechanism
• Decrease in free-water clearance
25. – The British Consensus Guidelines on Intravenous Fluid
Therapy for Adult Surgical Patients (GIFTASUP) for fluid
management recommends that “when crystalloid
resuscitation or replacement is indicated balanced salt
solution Ringer’s lactate/acetate or Hartmann’s solution
should replace 0.9% normal saline, except in cases of
hypochloremia for example from vomiting or gastric
drainage.”
– If colloids are indicated and used, lower-molecular-weight
colloids that can maintain adequate oncotic pressure should
be considered.
26. NEUROSURGERY PATIENTS :
Goals :
– maintaining baseline blood volume and cerebral
perfusion
– avoid significant decrease in serum sodium and
osmolality and oncotic pressure.
• Situations requiring specific management:
– Raised ICP- increasing serum osmolarity with
mannitol, hypertonic saline.
– Cerebral vasospasm – triple H( hypervolemia,
hemodilution, hypertension).
– Intacranial pathologic condition associated with
cerebral salt wasting, diabetes insipidus, SIADH.
27. • ORGAN FAILURE:
– HEART FAILURE: goals –
• Preserve cardiac output with limited preload.
• Minimise cardiac work . Avoid hypovolemia.
• Optimisation of electrolyte and fluid disturbances.
– Renal failure:
• Avoid both hypo- and hypervolemia.
• Dialysis day before surgery for euvolemia.
• Avoid large boluses of isotonic saline.
• Fluids available- potassium free HCO3- buffered dialysis
solution>potassium containing balanced crystalloids.
• Colloids- volume effect and potential toxicities
exaggerated.
28. – HEPATIC FAILURE
RELATIVE intravascular volume depletion with salt and water
retention.
– Careful assesement of volume status along with cardiac
output monitoring.
– Replace losses with isotonic crystalloids, colloids or blood.
– Avoid salt and water retention due to excessive volumes of
saline.
– Metabolism of lactates and other buffered solutions is
slowed.
– Hypertonic saline may be used in hepatic encephalopathy.
29. SEPSIS AND ACUTE LUNG INJURY
• INITIAL RESUSCITATION (<6 HRS) with targets-
– CVP8-12 mm hg
– MAP >65 mm hg
– u/o >0.5 ml/kg/hr
– Scvo2 >70% or mixed venous o2 saturation> 65%.
• Prefer crystalloids over colloids.
30. TRAUMA:
– APPROACH- permissive hypovolemia with fluids
targetted to achieve cerebration rather than
normotension.
– Early replacement with blood and blood products.
– After Clot stabilisation, now restore normal circulating
volume and tissue perfusion.
31. • BURNS :
– I.V. FLUIDSinstituted for burns >15% BSA(adults), >10%
BSA( children)
– Prefer crystalloids over colloids.
– Based on PARKLAND FORMULA:
• 1ST 8hrs- 2ml/kg * % TBSA( RL )
• Next 16hrs - 2ml/kg * % TBSA( RL)
• Next 24 hrs – 0.8ml/kg %TBSA (5%DEXTROSE) +
0.015ML/KG *%TBSA ( 5% ALBUMIN)
32. OBSTETRICS; PREECLAMPSIA
• Reduced plasma volume in contrast to volume
expansion as in normal pregnancy.
• Hypoalbuminemia and endothelial dysfunction.
• Management
– Restricted volume of crystalloid including drug
diluents.
– Blood loss in peripartum or perioperative period to be
replaced with appropriate volumes of blood, colloids
& crystalloids.
– Invasive monitoring required.
– Oliguria in presence of normal renal function not to
be treated with fluid boluses.
33. UPPER GI LOSS
• Fluid and electrolyte abnormalities:
dehydration, hypochloremic metabolic
alkalosis with paradoxically acid urine and
hypocalcaemia.
• Correction: gradual rehydration with normal
saline and potassium supplementation.
• Surgery to treat gastric outlet obstruction to
be scheduled after correction of acid base
status.
34. References
• Miller’s anesthesia 8th edition. MARK R.
EDWARDS, MICHEAL P. W. GROCOTT
• Lippincott’s ANESTHESIA REVIEW2015; PAUL
SIKKA .
• British Consensus Guidelines on Intravenous Fluid
Therapy for Adult Surgical Patients GIFTASUP
2011 REVISED
• SITES http://ceaccp.oxfordjournals.org/content
• http://www.ncbi.nlm.nih.gov/pubmed/19302633
35. 1. All of the following are signs of dehydration
except:
A. Progressive metabolic acidosis.
B. Urinary specific gravity >1.010
C. Urine osmolality <300mOsm/kg
D. Urine sodium <10 meq/l
36. C. When dehydrated, patients with normal
renal function will retain sodium and produce
a concentrated urine. Urine osmolality is
typically greater than 450 mOsm/kg in this
setting. Urine sodium will be low, and specific
gravity will be high.
37. 2. Regarding central venous pressure monitoring:
A. Low values of <5mm hg may be considered
normal in the absence of other signs of
hypovolemia.
B. CVP readings can be interpretated
independently of clinical setting.
C. CVP monitoring is never indicated in patients
with normal cardiac & pulmonary function.
D. In a patient with right ventricular dysfunction, a
CVP of 10 mm hg should be considered
elevated.
38. • A. CVP measurements must be evaluated in
context of the clinical setting. Factors such as
underlying cardiopulmonary disease, patient
position, and anatomy can affect the values. A
CVP of <5 mm Hg can be normal in a healthy
patient without signs of hypovolemia. For surgical
cases during which large fluid shifts are expected,
placement of a CVP monitor may be indicated.
Patients with compromised right ventricular
function generally have high CVPs, and thus, a
CVP of 10 mm Hg should be considered normal to
low depending on the degree of dysfunction.
39. 3. In healthy patients, the lactate in lactated
ringer solution:
1. Causes lactic acidosis.
2. Is converted to bicarbonate by the liver.
3. Is rapidly bound by albumin.
4. Causes a hyperchloremic metabolic acidosis.
40. B. In healthy patients the lactate in lactated
Ringers solution is rapidly converted to
bicarbonate by the liver and does not cause a
lactic acidosis. Administration of a large
volume of normal saline can cause a
hyperchloremic metabolic acidosis. Lactate is
not bound by albumin.
41. 4. All of the following fluids are generally
considered to be isotonic except:
1. Lactated ringer solution
2. Normal saline
3. D5 normal saline
4. D5+1/4normal saline
42. • C. An intravenous solution’s effect on fluid movement
depends in part on its tonicity. This term is sometimes
used interchangeably with osmolarity, although they
are subtly different. Osmolarity is the number of
osmoles or moles of solute per liter of solution.
Tonicity is the effective osmolality and is equal to the
sum of the concentrations of the solutes which have
the capacity to exert an osmotic force across the
membrane. A solution is isotonic if its tonicity falls
within (or near) the normal range for blood serum—
from 275 to 295 mOsm/kg. A hypotonic solution has
lower osmolarity (<250), and a hypertonic solution has
higher osmolarity (>350).
43. 5. All of the following statements regarding
dextran solution are true except:
A. Dextran 40 may improve blood flow through
microcirculation.
B. Dextrans may have antiplatelet effect.
C. Large volume infusion of dextrans have been
associated with renal failure.
D. Dextran 40 is better volume expander.
44. D. While dextran 40 has a molecular weight
of 40,000, dextran 70 has a molecular weight
of 70,000, and therefore, the latter is broken
down more slowly, lasts longer, and is a better
volume expander. Dextran 40 appears to
improve blood flow through the
microcirculation, and all dextrans may have
antiplatelet effects. Infusion of large volume
of dextran (>20 mL/kg/day) has been
associated with renal failure.
45. 6. Which of the following statement is true regarding fluid
loss:
A. Substantial evaporative losses can be associated with
large wounds & are directly proportionated with
surface area exposed.
B. Internal redistribution of fluids ,”third spacing” cannot
cause massive fluid shifts.
C. Traumatised inflammed or infected tissues can only
sequester minimal amount of fluid in interstitial space
D. Cellular dysfunction as a result of hypoxia usually
produces a decrease in intracellular fluid volume
46. A. Substantial evaporative losses can be
associated with large wounds and are directly
proportionate to the surface area exposed.
Third spacing can cause massive fluid shifts,
and traumatized, inflamed, or infected tissue
can sequester large amounts of fluid. Cellular
dysfunction as a result of hypoxia usually
produces an increase in intracellular
fluid volume.
47. 7. All of the following are advantages of
crystalloid solution except:
A. Nontoxic
B. Reaction free
C. Relatively inexpensive
D. Ability to remain in intravascular space
48. D. Advantages of crystalloid solutions are that they
are nontoxic, reaction-free, and inexpensive.
Colloid solutions are composed of large-
molecular-weight substances that remain in the
intravascular space longer than crystalloids, and
typically, the initial volume of distribution is
equivalent to the plasma volume. The synthetic
colloids and processed albumin have minimal or
no risks of infection. Colloids are more expensive
than crystalloids, but have fewer risks than blood
products.
49. 8. Administration of large volumes of saline can
lead to:
A. Metabolic acidosis
B. Hyperchloremic induced nongap metabolic
acidosis
C. Anion gap metabolic lactic acidosis
D. None of the above.
50. B.Normal saline (0.9% NaCl) is slightly
hypertonic and contains more chloride than
extracellular fluid. Administration of large
volumes of normal saline solution can lead to
a hyperchloremic non–anion gap metabolic
acidosis. Administration of large amounts of
lactated Ringer solution may result in a
metabolic alkalosis because of increased
bicarbonate production from the metabolism
of lactate.
51. 9. All of the following contains potassium
except:
A. Lactated ringer solution
B. Plasmalyte
C. Hespan
D. Packed RBCs
52. C. Hespan is colloid containing starch and saline.
All of the other options contain potassium.
Many patients with hyperkalemia, including
patients with renal failure, routinely receive
normal saline because it contains no
potassium.
53. 10. All are true for normal saline except :
A. Osmolarity higher than plasma.
B. Osmolality similar to plasma.
C. Isotonic to plasma.
D. Slightly alkaline.
54. 11. Maximum tolerated amount of blood loss
without any hemodynamic alteration:
A. 20%
B. 25%
C. 30%
D. 35%
55. 12. Parkland fluid resuscitation is for:
A. Burns
B. Trauma
C. Sepsis
D. Organ failure
56. 13. Triple H therapy for cerebral vasospasm after
subarachnoid hemorrhage include:
A. Hypoxia , Hypervolemia, hemodilution
B. Hypervolemia, hemodilution, hypertension.
C. Hypocarbia, hemodilution, hypertension.
D. Hypervolemia, hypercarbia, hypotension.
57. 14. Upper GI losses to be replaced with:
A. Lactated ringer solution.
B. Normal saline.
C. Normal saline with K+ supplementation.
D. D5+ ½ NS
58. Dehydration occurs as a result of water loss, reduced total body
Cl−content, and alkalosis
caused by proton loss, with raised serum HCO3.The
initial renal response is formation of urine with low Cl−
and high HCO3− content. However, progressive dehydration
leads to increased aldosterone secretion, aimed at
retaining Na+ and water. Na+ is retained at the expense
of K+ and H+ ions, leading to hypokalemia, and worsening
metabolic alkalosis with a paradoxically acid urine.
The alkalosis also reduces the circulating ionized fraction
of Ca2+.
59. 15.Maintenance requirements in postoperative
period include all except:
A. 1500-2500 ml in 24 hrs or 1 to 1.2 ml/kg/hr
B. 50–100 meq sodium
C. 40-80 meq potassium
D. 60 meq calcium
60. 16. The following ion concentrations are
corrects:
A. 0.9% saline= sodium 131 mmol/L
B. Albumin 4.5% =calcium 2mmol/L
C. Hartmann’s solution = 154 mmol/L
D. gelofuscine = calcium 5.1 mmol/L
E. Dextrose 4% Saline 0.18% = sodium 30
mmol/L
61. 17. Concerning the use of hydroxylethyl starch as an
intravenous fluid:
A. Glomerular filteration is the major route of
elimination
B. About 48% of the total dose is deposited in the
reticuloendothelial system.
C. Large volumes may alter coagulation by lowering
factor X concentration.
D. Incidence of allergic reactions is similar to that of the
gelatins
E. Serum amylase concentrations may be elevated .
62. 18. Perioperative fluids:
A. Should not be given orally within 4 hrs of anaesthesia.
B. Need to replace unmeasured losses of up to 5
mlkg−1 hr−1 during abdominal surgery.
C. Are a frequent cause of left ventricular failure and
pulmonary oedema.
D. Should be restricted in the first 24 hrs post-op due to
inappropriate ADH secretion.
E. Should be included in day of surgery fluid balance.
63. 19. What regulates water homeostasis
A. Thirst
B. Arginine vasopressin
C. Kidneys
D. All of the above
64. 19. What regulates water homeostasis:
A. Thirst [ Fluid homeostasis depends on proper water intake
(regulated by thirst mechanism) and on urinary excretion of
free water (regulated by AVP).]
B. Arginine vasopressin
C. Kidneys
D. All of the above [ The serum sodium concentration and thus
serum osmolality are controlled by water homeostasis.
Water homeostasis is mediated by thirst, arginine
vasopressin, and the kidneys. Abnormal water balance
manifests as an abnormality in the serum sodium
concentration (hypernatremia or hyponatremia).
65. 20. ECF volume contraction results in
A. Hypotension
B. Stimulation of baroreceptors
C. Stimulation of sympathetic nervous system
D. Stimulation of renin secretion
E. All of the above.
66. ECF volume contraction results in
A. Hypotension [ Clinically ECF volume contraction manifest as a
decreased plasma volume and hypotension. Hypotension is due to
decreased venous return (preload) and diminished cardiac
output.]
B. Stimulation of baroreceptors [ Hypotension stimulates barorecept
ors inthe carotid sinus and aortic arch.].
C. Stimulation of sympathetic nervous system[ Hypotension activates
the sympathetic nervous system and the renin-angiotensin
system.]
D. Stimulation of renin secretion
E. All of the above T [ The net effect is to maintain mean arterial
pressure and cerebral and coronary perfusion. In contrast to this
cardiovascular response, the renal response attempts to restore
the ECF volume.