Basic Concepts of Fluid and Electrolyte Therapy

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Table 13: Simple acid-base disorders Primary change Compensation Effect on pH Metabolic acidosis HCO – 3 Pco 2 pH Metabolic alkalosis HCO – 3 Pco 2 pH Respiratory acidosis Pco 2 HCO – 3 pH Respiratory alkalosis Pco 2 HCO – 3 pH Causes of simple acid-base disorders The cause of an acid-base disorder is often apparent from the clinical presentation. Metabolic acidosis is best considered as associated with a high anion gap (Table 14) or a normal anion gap (Table 15). Table 14: Causes of a metabolic acidosis with a high anion gap Ketoacidosis diabetes Lactic acidosis tissue hypoxia liver failure metformin Drug toxicity ethylene glycol methanol salicylate Kidney disease chronic kidney disease acute kidney injury 66
Table 15: Causes of metabolic acidosis (hyperchloraemic) with a normal anion gap Gastrointestinal HCO 3 – loss diarrhoea fistulae Renal HCO 3 – loss renal tubular acidosis acetazolamide Infusion of 0.9% saline Metabolic acidosis with a high anion gap - can be caused by four broad categories of disorders including ketoacidosis, lactic acidosis, poisonings or advanced acute or chronic kidney disease. Ketosis occurs when there is a lack of insulin or glucose depletion. To compensate fatty acids are oxidised to produce energy which results in the production of ketoacids as a by-product. Severe diabetic ketoacidosis occurs secondary to insulin deficiency (Chapter 10) Ketosis may also occur with prolonged starvation or in alcoholics Lactic acidosis is subdivided into Type A lactic acidosis - secondary to insufficient oxygen delivery to the tissues hypovolaemic shock cardiogenic shock septic shock Type B lactic acidosis – impaired gluconeogenesis causing inability to clear lactate liver failure metformin 67
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Dileep N. Lobo Andrew J. P. Lewingt
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Basic Concepts of Fluid and Electro
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Foreword This book, ‘Basic Concep
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Table of Contents 1. Normal Physiol
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ever, contains large anions such as
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Oral intake 1.5-2 L Saliva 1.5 L Ga
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Table 2: Normal maintenance require
Page 16 and 17: Kidney: this is the main organ for
Page 18 and 19: Conversely, if the intake of Na + i
Page 20 and 21: volume at all costs. It also explai
Page 22 and 23: Conclusion Appropriate fluid therap
Page 24 and 25: Intravascular fluid volume - the to
Page 26 and 27: Colloid - a fluid consisting of mic
Page 28 and 29: Base excess - Base excess is define
Page 30 and 31: Parameter Urine output Significance
Page 32 and 33: Figure 5: Example of a vital signs
Page 34 and 35: Fluid balance charts These provide
Page 36 and 37: Osmolality In the presence of AKI,
Page 38 and 39: Chloride Despite the fact that seru
Page 41 and 42: 4. Properties of Intravenous Crysta
Page 43 and 44: 6-12 h. The colloid should be metab
Page 45 and 46: Table 8: Advantages and disadvantag
Page 47: Plasma- Sterofundin 0.18% Plasma-Ly
Page 50 and 51: 50 Patients receiving artificial nu
Page 52 and 53: Once resuscitation has been achieve
Page 54 and 55: (3) The answer to this question is
Page 57 and 58: 6. Methods of Fluid Administration
Page 59 and 60: Central Modern single or multi lume
Page 61 and 62: 7. Acid-Base Balance Introduction M
Page 63 and 64: vide a simple description of the mo
Page 65: change in Pco 2 = respiratory proce
Page 69 and 70: Renal HCO 3 - loss results from re
Page 71: Mixed acid-base disorders These are
Page 74 and 75: Urine output should be interpreted
Page 76 and 77: assess clinical response to fluid i
Page 78 and 79: Oliguria following surgery 48 h and
Page 80 and 81: Definition AKI is a result of a rap
Page 82 and 83: AKI is most commonly secondary to a
Page 84 and 85: History Examination Investigations
Page 86 and 87: Management Prevention Any patient a
Page 88 and 89: if no clinical response and no pulm
Page 90 and 91: acidosis pH 7.2-7.4 - there is ver
Page 92 and 93: Referral to nephrologist NOT all p
Page 94 and 95: Follow up Acute kidney injury is a
Page 96 and 97: DKA and HONK represent the two extr
Page 98 and 99: Fluids and insulin In the absence
Page 100 and 101: Surgery in the patient with diabete
Page 102 and 103: 10 mmol/l/day. In the differential
Page 104 and 105: portionately more water is lost tha
Page 106 and 107: Hypokalaemia: a fall in serum conce
Page 108 and 109: Four common aspects of Ca 2+ disord
Page 110 and 111: Treatment depends on severity and c
Page 112 and 113: 112
Page 114 and 115: Hypophosphataemia
Page 116 and 117:
116
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Prolonged periods of preoperative f
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position to postoperative parotitis
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13. *Chowdhury AH, Lobo DN. Fluids
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42. Hussein H, Lewington A, Kanagas
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67. *Michell AR. Diuresis and diarr
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94. *Stewart PA. Modern quantitativ
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colloids 7, 26, 41, 42, 43 44, 45,
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intravascular compartment 20, 41, 4
Page 134 and 135:
Stewart approach 63, 71 sympathetic
Page 136:
Dileep N. Lobo Andrew J. P. Lewingt
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