Fluids and electrolyte abnormalities sample
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The document covers various aspects of blood transfusion, including blood grouping, components, and potential complications associated with transfusions. It discusses electrolyte abnormalities, acid-base disorders, and the management of shock, along with features of enteral and parenteral nutrition. The text highlights important concepts such as anion gap calculations and the implications of transfusion reactions, providing critical insights for medical professionals.
Fluids and electrolyte abnormalities sample
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FLUIDS AND ELECTROLYTE ABNORMALITIES www.medpgnotes.com 1BLOOD TRANSFUSION CONTENTS BLOOD TRANSFUSION................................................................................................................................................... 4 BLOOD GROUPING.................................................................................................................................................... 4 BLOOD COMPONENTS .............................................................................................................................................. 4 BLOOD TRANSFUSION............................................................................................................................................... 5 COMPLICATIONS OF BLOOD TRANSFUSION ............................................................................................................. 5 ELECTROLYTE ABNORMALITIES..................................................................................................................................... 6 ANION GAP ............................................................................................................................................................... 6 GENERAL FEATURES OF ACID BASE DISORDERS ....................................................................................................... 6 INTERPRETATION OF ABG VALUES............................................................................................................................ 7 METABOLIC ACIDOSIS ............................................................................................................................................... 7 METABOLIC ALKALOSIS............................................................................................................................................. 8 RESPIRATORY ACIDOSIS ............................................................................................................................................ 8 RESPIRATORY ALKALOSIS .......................................................................................................................................... 9 ENTERAL NUTRITION..................................................................................................................................................... 9 TOTAL PARENTERAL NUTRITION................................................................................................................................... 9 FEATURES OF TPN ..................................................................................................................................................... 9 COMPLICATIONS OF TPN ........................................................................................................................................ 10 SHOCK ......................................................................................................................................................................... 10 GENERAL FEATURES OF SHOCK............................................................................................................................... 10 ANAPHYLACTIC SHOCK............................................................................................................................................ 10 HYPOVOLEMIC SHOCK ............................................................................................................................................ 11 SEPTIC SHOCK ......................................................................................................................................................... 11 CARDIOGENIC SHOCK.............................................................................................................................................. 12 NEUROGENIC SHOCK .............................................................................................................................................. 12 HEMORRHAGIC SHOCK ........................................................................................................................................... 12 MANAGEMENT OF SHOCK ...................................................................................................................................... 12 ELECTROLYTE IMBALANCE .......................................................................................................................................... 13 GENERAL FEATURES OF ELECTROLYTE IMBALANCE ............................................................................................... 13 INTRAVENOUS FLUIDS ............................................................................................................................................ 13 WATER .................................................................................................................................................................... 13 SODIUM .................................................................................................................................................................. 14 HYPERNATREMIA .................................................................................................................................................... 14
- 3. FLUIDS AND ELECTROLYTE ABNORMALITIES www.medpgnotes.com 2BLOOD TRANSFUSION HYPONATREMIA...................................................................................................................................................... 14 POTASSIUM............................................................................................................................................................. 15 HYPERKALEMIA ....................................................................................................................................................... 15 HYPOKALEMIA......................................................................................................................................................... 16 MAGNESIUM........................................................................................................................................................... 16 HYPERMAGNESEMIA............................................................................................................................................... 16 HYPOMAGNESEMIA................................................................................................................................................ 17 PHOSPHATE............................................................................................................................................................. 17
- 4. FLUIDS AND ELECTROLYTE ABNORMALITIES www.medpgnotes.com 3BLOOD TRANSFUSION KEY TO THIS DOCUMENT Text in normal font – Must read point. Asked in any previous medical entrance examinations Text in bold font – Point from Harrison’s text book of internal medicine 18th edition Text in italic font – Can be read if you are thorough with above two.
- 5. FLUIDS AND ELECTROLYTE ABNORMALITIES www.medpgnotes.com 4BLOOD TRANSFUSION BLOOD TRANSFUSION BLOOD GROUPING Gene determining ABO blood group Chromosome 9p Universal blood group donor O negative ABO blood group antigen Found of RBC membrane, Glycoprotein in nature, Highly immunogenic ABO blood group system remains most important in clinical medicine because ABO antibodies are invariably present in plasma when person’s RBC lack the corresponding antigen Genotype of a person with blood group A should be AO Deoxysugar characteristic of blood group polysaccharide Fucose ABO antigen NOT seen in CSF Both parents A group Children A or O ABO incompatibility occurs when mothers blood group is O Bombay Blood Group Lack of other Blood Group Antigens (only H) Kell antigen on Chromosome X MC blood group in Indian people O Diagnosis of ABO incompatibility can NOT be made from CSF ABO antigen NOT found in CSF NOT true about blood grouping It is the method to conclusively fix paternity ABO incompatibility is NOT seen with Cryoprecipitate MC cause of incompatibility in pretransfusion screening Lewis system BLOOD COMPONENTS Blood product least likely to carry infectious disease Red blood cells Cryoprecipitate is stored at Minus 40 degrees Cryoprecipitate is rich source of VIII Cryoprecipitate is rich in Fibrinogen I, Factor VIII, Von willebrand factor Cryoprecipitate does NOT contain Antithrombin Cryoprecipitate does NOT contain Factor IX Cryoprecipitate does NOT contain Factor IX Cross matching NOT required for transfusion of Cryoprecipitate Which blood fraction is stored at -40*C Cryoprecipitate Shelf Life of CPD 28 days Blood stored in CPDA for 35 days Stored plasma is deficient in Factor 5 and 8 NOT true about FFP Used as volume expander In cholecystectomy, FFP is given Just before operation Uses of fresh frozen plasma Antithrombin III deficiency, massive transfusion bleeding diathesis, reversal of
- 6. FLUIDS AND ELECTROLYTE ABNORMALITIES www.medpgnotes.com 5BLOOD TRANSFUSION warfarin effect Volume of one unit of cryoprecipitate 10-15 ml Volume of one unit of packed RBC 300 ml Volume of one unit of platelet concentrate 50 ml One unit of platelet concentrate increases platelet count by 10,000 Maximum lifespan of transfused RBC 60 days RBC stored in blood bank Decreased 2,3 DPG, Decreased Na+, Decreased pH, Increased K+ Blood platelets in stored blood do not remain functional after 24 hours Stored blood Decrease in ATP, INCREASE in K+, decrease in Na+ IMP is added to stored blood to act as source of 2,3 DPG Platelets can be stored at 20-24*C for 5 days Refrigerated blood stored up to 48 hours before transfusion can destroy Treponema pallidum Irradiation of blood products Prevent donor white cells from proliferating in recipient’s body Cryoprotectant Dimethylsulfoxide BLOOD TRANSFUSION Reverse type of pre blood transfusion testing To detect isoagglutinin in recipient Best investigation done immediately to confirm non matched blood transfusion Direct coomb’s test Better indicator for need of blood transfusion Hematocrit Blood transfusion Antigen D determines Rh positivity, febrile reaction is due to HLA antigen Massive blood transfusion defines Whole blood volume One unit of fresh blood rises Hb% concentration by 1 gm% Rh negative individual who is transfused for first time with Rh positive blood is likely to developed Delayed transfusion reaction Test for non mismatched blood transfusion Antibodies in recipient serum Indication for calcium replacement after transfusion Blood given at faster rate, blood transfusion given to a patient suffering from liver disease, neonates requiring transfusion COMPLICATIONS OF BLOOD TRANSFUSION MC transfusion reaction Febrile Non hemolytic reaction
- 7. FLUIDS AND ELECTROLYTE ABNORMALITIES www.medpgnotes.com 6ELECTROLYTE ABNORMALITIES Acute hemolytic blood transfusion Complement mediated hemolysis Transfusion associated lung injury Within 6 hours of transfusion Most probable reason for transfusion associated hepatitis Chronic carriers negative for HbsAg Transfusion related acute lung injury is triggered by Anti HLA antibodies ABO transfusion reaction Type II reaction Mismatched blood transfusion in an anesthetic patient present as Hypotension and bleeding from wound site Intra operative mismatch blood transfusion Excessive bleeding, hypotension, bronchospasm, rash Massive blood transfusion results in Hyperkalemia, DIC, Hypothermia, Thrombocytopenia Complication likely to result after several units of blood transfusion Metabolic alkalosis Massive transfusion in previous healthy adult male can cause hemorrhage due to Dilutional thrombocytopenia NOT a complication of massive blood transfusion Hypokalemia NOT a complication of Massive blood transfusion Metabolic acidosis NOT a complication of Massive blood transfusion Hypokalemia, Hypercalcemia NOT a complication of blood transfusion Hypokalemia FALSE about anaphylactic blood transfusion Occurs in IgG deficient Treatment of transfusion siderosis Desferiprone Drug for Hemolytic transfusion reaction Steroids Transfusion transmitted virus HBV,HTLV I, CMV, Toxoplasma, Syphilis MC virus associated with Transfusion Hepatitis HCV Blood transfusion does NOT transmit Leukemia NOT transmitted via blood transfusion Dengue NOT transmitted by blood transfusion EBV Post transfusion infection is commonly due to HCV ELECTROLYTE ABNORMALITIES ANION GAP Anion gap {Na+ + K+} - {HCO3- + Cl-} Normal anion gap 12 - 16 mEq/L Anion gap is mostly due to Protein Urinary anion gap is an indication for excretion of NH4+ ion Increased anion gap Lactic acidosis, DKA, Cardiac failure Increased anion gap is NOT seen in Diarrhea NOT associated with increased anion gap Glue sniffing NOT a cause of Normal anion gap Aspirin overdose GENERAL FEATURES OF ACID BASE DISORDERS Acid base disorder pH is determined by PCO2 and HCO3-, metabolic acidosis is compensated by decreased PCO2, buffering may be intra and extracellular Important role in regulation of acid base balance in neonates Kidney