Surgery: fluids and electrolytes

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Surgery: fluids and electrolytes
2012-01-01 08:50:39
surgery rotation

surgery rotation
Show Answers:

  1. What percentage of body weight is fluid?
    • 60%
    • (40 intracellular, 20 extracellular)
  2. How many liters of blood are in a 70 kg man?
    5 (blood is approximately 7% of TBW)
  3. Water requirement per 24 hours?
    30-35 mL/kg
  4. Potassium requirement per 24 hours?
    1 mEq/kg
  5. Chloride requirement per 24 hours?
    1.5 mEq/kg
  6. Sodium requirement per 24 hours?
    1-2 mEq/kg
  7. When does third spacing occur post-operatively?
    On about the 3rd post-op day, fluid that moved into the extravascular space begins to move back into the intravascular space. Beware of fluid overload.
  8. What are classic signs of third-spacing?
    • Tachycardia
    • Decreased urine output
  9. Causes of metabolic acidosis
    • Loss of bicarb (diarrhea, ileus, fistula, high-output ileostomy, carbonic anhydrase inhibitors)
    • Gain of acid (ischemia, renal failure, ketoacidosis, necrosis)
  10. What causes hypokalemic hypochloremic alkalosis?
    NGT suction or loss of gastric acid (vomiting, NGT)
  11. Why does NGT suctioning cause hypokalemia?
    Loss of gastric HCl results in alkalosis. In response, H+ is driven out of the cells, into the interstitium, in exchange for K+. K+ is also lost in the kidneys, in exchange for Na+.
  12. What is paradoxic alkalotic aciduria?
    In severe vomiting, there is metabolic alkalosis due to loss of gastric acid, but there is also acidification of the urine, due to loss of H+ in exchange for Na, in an attempt to restore intravascular volume.
  13. What is the most significant cause of insensible fluid loss?
    • Respiration--500-700 mL are lost, per 24 hours
    • Respiratory fluid loss increases with fever and tachypnea