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Fluid and Electrolyte Changes in
Major Surgery
- Fall in intravascular volume
- Causes
- loss of fluid by haemorrhage / burns
- interstitial squestration
- oedema
- systemic hormonal responses
- restricted oral intake
- stimulates sympathetic activity
- maintains blood pressure
- boosts cardiac output
- increased peripheral resistance
- increased turnover of carbohydrates, protein, lipids
- falling renal perfusion
- activates renin-angiotensin-aldosterone system
- increases renal sodium and water reabsorption
- ADH secretion
- Reduced cardiac output and peripheral perfusion
- Causes
- hypovolaemia
- depressed myocardial contractility
- anaesthetic agents
- other drugs
- sepsis
- pulmonary embolism
- myocardial infarction
- Pain
- ↑ catecholamine / ACTH secretion
- Stress
- ↑ sympathetic function / hypothalamic activity
- Sepsis
- Inflammation
- cytokines / humoral factors
- Excess Heat Loss
- Secondary Effects on Blood
- Starvation
- ↑ susceptibility to infection
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