European Diploma in Anaesthesia and intensive care ‘EDAIC’ MCQ and answer. FREE UPLOADS BY WWW.TARGETEDAIC.COM (100)

The section, European Diploma in Anaesthesia and intensive care ‘EDAIC’ MCQ and answer, covers a different topic each day with the intent that candidates can prepare one small topic each day, making steady progress in their exam preparation.

Question: Use of normal saline exclusively as the intraoperative fluid

1. Causes hyperchloraemic metabolic alkalosis
2. Causes a significant rise in plasma osmolarity
3. The excess sodium can cause a reduction in GFR by activation of RAS
4. Each litre infused contains more than the recommended daily dietary intake of sodium
5. The rise in chloride ions is compensated by a fall in bicarbonate ions

Answers:

1. 1. False
   2. False
   3. False
   4. True
   5. True

• The routine use of 0.9% saline is not recommended during routine surgery principally because of the risk of developing hyperchloraemic metabolic acidosis
  • NS has a sodium concentration of  154 mmol/L  vs 140 mmol/L in plasma, and chloride of 154 mmol/L vs  100 mmol/L in plasma (hyperosmotic when compared to plasma
  • The excess chloride provides a disproportionate rise in strong anions reducing the bicarbonate
    concentration as predicted by the Stewart equation
• Abdominal discomfort may be occasionally experienced and there is some research evidence that saline reduces gastrointestinal perfusion compared to balanced solutions.
• Hyperchloraemia produces an increase in renal eicosanoid release leading to renal vasoconstriction and reduced glomerular filtration rate.
• With a calculated osmolality of 308 mOsm/kg, saline is slightly hyperosmolar compared to plasma but this is probably not clinically significant.
• The measured osmolality using a micro-osmometer is 286 mOsm/kg, implying that saline is not fully ionised at 0.9% concentration.
• The GDA for dietary salt is 6 g per day for an adult, so a litre of saline with 9 g/L is 1½ times the GDA.

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‘European Diploma in Anaesthesia and Intensive Care MCQs’ covers a different topic each day with the intent that candidates can prepare one small topic each day, making steady progress in their exam preparation.