Book contents
- Frontmatter
- Contents
- List of Abbreviations
- Acknowledgements
- Abdominal Trauma: Investigations
- Accessing the Thorax
- Acid-Base
- Acute Renal Failure (see also table in ‘Low urine output’)
- Acute Respiratory Distress Syndrome (ARDS)
- Agitation and Sedation
- Airway Management
- Analgesia
- Aortic Dissection
- Atelectasis
- Blood Pressure Monitoring
- Blood Products
- Blood Transfusion
- Brainstem Death and Organ Donation
- Bronchiectasis
- Burns
- Calcium Balance
- Cardiac Assessment
- Cardiogenic Shock
- Central Line Insertion
- Chronic Renal Failure
- Coagulation Defects
- Disseminated Intravascular Coagulation (DIC)
- ECG I – Basic Concepts
- ECG II – Rate and Rhythm Disturbances
- Endotracheal Intubation
- Enteral Nutrition
- Extubation and Weaning
- Fat Embolism Syndrome
- Flail Chest
- Fluid Therapy
- Haemorrhagic Shock
- Head Injury I – Physiology
- Head Injury II – Pathophysiology
- Head Injury III – Principles of Management
- Inotropes and Circulatory Support
- ITU Admission Criteria
- Jugular Venous Pulse (JVP)
- Lactic Acidosis
- Low Urine Output State
- Magnesium Balance
- Mechanical Ventilatory Support
- Metabolic Acidosis (see also ‘Acid-base’ and and ‘Lactic acidosis’)
- Metabolic Alkalosis
- Nutrition: Basic Concepts (see also parenteral nutrition & TPN)
- Oxygen: Basic Physiology
- Oxygen Therapy
- Parenteral Nutrition (TPN)
- Pneumonia
- Pneumothorax
- Potassium Balance
- Pulmonary Artery Catheter (see also ‘Central line insertion’)
- Pulmonary Thromboembolism
- Pulse Oximetry
- Renal Replacement Therapy
- Respiratory Assessment
- Respiratory Failure (see also ‘Oxygen therapy’)
- Rhabdomyolysis
- Septic Shock and Multi-Organ Failure
- Sodium and Water Balance
- Spinal Injury
- Systemic Response to Trauma
- Tracheostomy
- Transfer of the Critically Ill
- Tube Thoracostomy (Chest Drain)
Fluid Therapy
- Frontmatter
- Contents
- List of Abbreviations
- Acknowledgements
- Abdominal Trauma: Investigations
- Accessing the Thorax
- Acid-Base
- Acute Renal Failure (see also table in ‘Low urine output’)
- Acute Respiratory Distress Syndrome (ARDS)
- Agitation and Sedation
- Airway Management
- Analgesia
- Aortic Dissection
- Atelectasis
- Blood Pressure Monitoring
- Blood Products
- Blood Transfusion
- Brainstem Death and Organ Donation
- Bronchiectasis
- Burns
- Calcium Balance
- Cardiac Assessment
- Cardiogenic Shock
- Central Line Insertion
- Chronic Renal Failure
- Coagulation Defects
- Disseminated Intravascular Coagulation (DIC)
- ECG I – Basic Concepts
- ECG II – Rate and Rhythm Disturbances
- Endotracheal Intubation
- Enteral Nutrition
- Extubation and Weaning
- Fat Embolism Syndrome
- Flail Chest
- Fluid Therapy
- Haemorrhagic Shock
- Head Injury I – Physiology
- Head Injury II – Pathophysiology
- Head Injury III – Principles of Management
- Inotropes and Circulatory Support
- ITU Admission Criteria
- Jugular Venous Pulse (JVP)
- Lactic Acidosis
- Low Urine Output State
- Magnesium Balance
- Mechanical Ventilatory Support
- Metabolic Acidosis (see also ‘Acid-base’ and and ‘Lactic acidosis’)
- Metabolic Alkalosis
- Nutrition: Basic Concepts (see also parenteral nutrition & TPN)
- Oxygen: Basic Physiology
- Oxygen Therapy
- Parenteral Nutrition (TPN)
- Pneumonia
- Pneumothorax
- Potassium Balance
- Pulmonary Artery Catheter (see also ‘Central line insertion’)
- Pulmonary Thromboembolism
- Pulse Oximetry
- Renal Replacement Therapy
- Respiratory Assessment
- Respiratory Failure (see also ‘Oxygen therapy’)
- Rhabdomyolysis
- Septic Shock and Multi-Organ Failure
- Sodium and Water Balance
- Spinal Injury
- Systemic Response to Trauma
- Tracheostomy
- Transfer of the Critically Ill
- Tube Thoracostomy (Chest Drain)
Summary
How do you assess clinically the state of hydration?
Examining the fluid chart for the input/output balance
Examining the patient specifically looking for the state of the tissues
Skin turgor
Dry mouth
Sunken eyes
Concentrated urine in the catheter
Possible tachycardia and hypotension
Measure the central venous pressure (CVP), and determine the response to a fluid challenge. If there is ‘underfilling’, the CVP will not increase in response to the challenge
What are the main fluid compartments of the body, and what are their volumes?
The fluid compartments are
Intracellular compartment: 28l
Extracellular compartment: 14l
Plasma: 3l
Interstitium: 10l
Transcellular: 1l
Therefore the total body water is 42l, which makes up ∼60% of the body weight of a 70 kg male and 55–60% for females.
How can the percentage fall of the extracellular fluid volume be calculated?
In the case of loss of extracellular fluid (ECF), the concentration of the plasma albumin increases depending on the amount of water lost during dehydration. The resulting rise in the albumin concentration can be used to calculate the % fall in the ECF volume.
where A1 initial albumin concentration; A2 = albumin concentration following loss of volume.
How can the percentage fall in the plasma volume be calculated?
In situations of loss of plasma, there is a loss of plasma protein, but not of blood. Thus, the haematocrit increases in proportion to the volume of plasma lost. Measurements of the haematocrit are therefore useful in calculating the % fall in the plasma volume.
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- Surgical Critical Care Vivas , pp. 114 - 118Publisher: Cambridge University PressPrint publication year: 2002