F&E, Blood product Module 4 PP

Electrolytes & Blood Products

• Fluids and electrolytes are crucial for maintaining health and function.
• Blood products and transfusions are used to treat various medical conditions.

Electrolytes & Minerals

• Sodium (Na+) is primarily found in extracellular fluid (ECF).
• Normal levels range from 135-145 mEq/L.
• Sodium maintains water balance, osmotic pressure, nerve impulse conduction, and muscle contraction.

Sodium

• Sodium is obtained through diet and intravenous fluids.
• Homeostasis is regulated by the kidneys, which reabsorb most filtered sodium.
• The Renin-Angiotensin-Aldosterone System (RAAS), Antidiuretic Hormone (ADH), and Sympathetic Nervous System (SNS) manage blood pressure and intravascular volume.
• Other hormones and peptides influence sodium excretion and regulation.

Sodium Alterations

• Hyponatremia occurs due to various causes resulting in low sodium levels.
• Causes can be hypervolemic (e.g., heart failure, cirrhosis) or hypovolemic (e.g., diarrhea, vomiting).
• Other causes include salt wasting (e.g., intracranial injury) or euvolemic (e.g., adrenal insufficiency).
• Symptoms include nausea, vomiting, muscle cramps.
• Treatment depends on the underlying cause.
• Hypernatremia is characterized by elevated sodium levels.
• Causes include water loss (e.g., fever, sweating, osmotic diuresis).
• Other causes can be nephrogenic or central diabetes insipidus or excessive sodium administration.
• Symptoms include dehydration or fluid excess, cellular death.
• Treatment depends on the underlying cause.

Potassium

• Most potassium is found inside cells (intracellular).
• Normal levels range from 3.5-5.2 mEq/L.
• Potassium is vital for cell membrane excitability (nerves, muscles, heart).
• It also impacts kidney function, vasodilation, thrombus inhibition, and osmotic pressure.
• Kidney function, hormones like aldosterone, glucocorticoids, catecholamines, and arginine vasopressin play a role in potassium homeostasis.

Potassium Alterations

• Hypokalemia occurs due to various factors like diuretics, beta agonists, insulin, antibiotics, catecholamines or GI losses (e.g., laxatives, bowel preparation).
• Symptoms include muscle weakness, cramps, rhabdomyolysis, ileus, nausea/vomiting, and dysrhythmias.
• Treatment focuses on determining the cause and potassium replacement.
• Hyperkalemia is potentially life-threatening stemming from potassium redistribution, or inhibition of secretion.
• Causes include aldosterone antagonists, beta antagonists, NSAIDs, chemotherapy.
• Symptoms include widened QRS complex, cardiac conduction block, paresthesias, and muscle weakness.
• Treatment aims to rapidly restore potassium balance.

Magnesium

• Magnesium (Mg) is mainly found inside cells (intracellular).
• Normal levels range from 1.7-2.4 mg/dL.
• Magnesium contributes to various cellular functions, including protein synthesis, neuromuscular function, and antiarrhythmic effects.
• It also promotes vasodilation, BBB stabilization, and reduction in anesthetic requirements.
• Kidney function is a key regulator.

Calcium

• Most calcium is found in the skeleton.
• Normal ionized calcium levels range from 2 - 2.5 mEq/L.
• Normal levels range from 8.5 - 10.5 mg/dL.
• The body regulates calcium through vitamin D, parathyroid hormone (PTH), and calcitonin. These regulate intestinal absorption, renal reabsorption, and bone turnover.

Calcium Alterations

• Hypocalcemia occurs in diverse conditions, including low albumin level, vitamin D deficiency, hypoparathyroidism, pancreatitis, chronic renal failure, and citrate binding.
• Symptoms include neuromuscular problems, seizures, and dysrhythmias.
• Hypercalcemia results from conditions such as hyperparathyroidism, parathyroid adenoma, malignancies.
• Treatment aims to enhance renal calcium excretion with fluids, corticosteroids, biophosphonates, calcitonin.
• Emergency treatments require hemodialysis for severe cases.

Phosphate

• Phosphate primarily resides celluarly (intracellular).
• Normal levels range from 3-4.5 mg/dL.
• Phosphate is essential for energy metabolism (influencing ATP production), intracellular signaling, and immune/coagulation system function.
• Regulation involves an interplay between vitamin D, parathyroid hormone, and renal reabsorption.

Body Fluid Compartments

• Total body water accounts for 55-60% of total body mass in healthy individuals.
• About two-thirds are intracellular fluid (ICF) and one third are extracellular fluid (ECF).
• ECF can be further divided into interstitial fluid and plasma.

Intraoperative Fluid Management

• Intraoperative fluid management strategies are specific.
• Volume responsiveness is crucial.
• Appropriate choice of fluids depends upon individual patient conditions and circumstances.

Blood Physiology & Transfusion

• Blood components include cells (red blood cells, white blood cells, and platelets) and plasma.
• The composition of blood varies.
• Sources of blood cells are the bone marrow, liver, and spleen.

Blood Storage and Transfusion

• Proper storage is essential for blood products to maintain their quality until use.
• A variety of situations may call for transfusions and their related risks.
• Monitoring for adverse reactions and complications is essential.