FLUID and BLOOD management

- Sensors of acute change in fluid volume

--> low and high pressure baroreceptors (mediated via inc sympathetic outflow)
--> renal vasoconstriction ------> reduced volume of filtrate, activates the RAAS -----> increased salt
and water retention, increased peripheral vascular resistance, increased cardiac output
--> in on going blood loss, delayed responses to restore plasma volume within 12-72 hrs, increase
hepatic plasma protein synthesis, and restore RBC levels by erythropoiesis w/in 4-8 weeks

- proportion of infused fluid will be lost as a result of capillary filtration

-low-pressure baroreceptor stimulation leads to decrease in pituitary ADH secretion allowing diuresis
- atrial stretch leads to ANP release ----> natriuresis
- may take several days for 20 ml/kg dose of isotonic salt solution to be fully excreted

CRYSTALLOIDS
- solutions of electrolytes in water
- balanced solutions: contains electrolytes found in plasma and a buffer (lactate or acetate)
- distributes freely throughout the ECF with only 20% remaining in the IV
- Lactate undergoes predominantly hepatic oxidation or gluconeogenesis
to yield HCO3 at a maximum rate of approximately 200mmol/h. Acetate is normally present in trace
quantities in the plasma (0.2 mM), because it is rapidly oxidized by liver, muscle, and heart to yield
HCO3 at a maximum turnover of 300 mmol/h, beyond which zero-order kinetics intervene