Fluid and Electrolyte
Management in Surgical
        Patient
     Dr.Kiti Siriwatana
Total body water

•   Infant=80
•   Male=65
•   Female=55
•   Thin>Fat
Body fluid compartment
• ICF=40%
• ECF=20%
 – Intravascular fluid(plasma) =5%
 – Interstitial fluid =15%
Total body water

   ICF
   Intravascular fluid
   Interstitial fluid
PO4-
                 38
        2
        2
        8
HCO3-         28
             24
                                  ...
160
140
120
100
 80
                                               Serum
 60
                                             ...
Osmolality

• Homeostatic machanism by kidney
• Serum Osmolality
=(Na+x2)+(BUN/2.8)+(Glucose/18)
• Fluid movement:Osmolali...
ADH
Aldosterone
Fluid
• Crystalloid
  – Maintenance type fluid:Hypotonic solution
  – Replacement type fluid:Isotonic solution
  – Special...
Example of crystalloid
• D5W:Dilutional hyponatremia
• NSS:Normal saline:Isotonic saline
• Lactated Ringer’s solution
  (L...
Na+         K+       Ca++         Mg++       Cl-           HCO3        Glucose

ECF             142        4            5 ...
Crystalloid VS Colloid

• Crystalloid:2-3 Blood loss
• Colloid: ~1:1 Blood loss
• Blood replacement: for Oxygen
  carrier
Fluid and Electrolyte
           therapy

• Fluid:Quatity:volume

• Electrolyte:Quality:composition
Replacement for what?

•   Daily requirement:Fluid maintenance
•   Fluid deficit:Already loss
•   Third space loss from su...
Daily requirement:Fluid
         maintenance
• Sensible loss:kidney and GI
  – Urine:800-1200 cc/day
• Insensible loss:ski...
Daily requirement:Fluid
      maintenance 1
• Holliday and Segar
• น้ําหนัก 10 Kg แรก          = 100 cc/Kg
•             1...
Daily requirement:Fluid
         maintenance 2
• Fluid maintenance           in 1 Hr.
• น้ําหนัก 10 Kg แรก           = 4 c...
Daily requirement:Fluid
      maintenance 3

• For NPO pt. before surgery
• 5% D/N/2 rate 1.5-2 cc/kg/hr
Daily requirement:Fluid
       maintenance
• Composition and concentration
• Sodium requirement:
  – Adult:2-3 mEq/kg/day=...
Na+         K+       Ca++         Mg++       Cl-           HCO3        Glucose

ECF             142        4            5 ...
Daily requirement:Fluid
       maintenance

• 5% D/N/2 1000 cc.+ Water 1000 cc.

• 5%D/N/2 2000 cc.

• 5% D/NSS 1000 cc.+ ...
Fluid deficit,already loss
• Volume deficit assesment from
  history taking and physical
  examination
• Mild dehydration:...
STAGE              0-5%                 5-10%          10-15%
                   Dehydration          Dehydration    Dehyd...
อาการ                  Deficit (% body wt.)
Early      Thirst                        2%
Moderate                          ...
Fluid deficit,already loss
• Composition assesment:Fluid loss
  from what?
• Vomitting?
• Diarrhea?
• NG-tube?
• T-tube?
Na+        K+        Cl         HCO3

Stomach          10        26         10      30

Duodenum     140            5     ...
Na+         K+       Ca++         Mg++       Cl-           HCO3        Glucose

ECF             142        4            5 ...
Fluid deficit,already loss

•   Diarrhea จะเลือกใช N/2+KCl 30 mEq/l
•   Vomiting จะเลือกใช N/2+KCl 10 mEq/l
•   NG tube ...
Third space loss

• Volume:
  –   Major surgery:8 cc/kg/hr
  –   Moderate surgery:6 cc/kg/hr
  –   Minor surgery:4 cc/kg/h...
Blood loss therapy
• Acceptable blood loss (ABL)
• (Hct -30) x ปริมาณเลือดในรางกาย x 3/100
• < 1/3 ABL—LRS,ARS 2-3:1 of b...
Fluid therapy during the
        operation
• Maintenance
• Preoperative deficit
  – ½ in first hour
  – ¼ in second hour
 ...
Fluid and electrolyte
         abnormality

• Volume disturbance
• Concentration disturbance:Sodium
• Composition disturba...
Volume disturbance

• Volume excess

• Volume deficit (dehydration)
Concentration
         disturbance
• Hyponatremia (Water intoxication)
 -Water shift to icf:cell swelling esp.brain


• Hy...
Composition disturbance
• Hypokalemia
  – กลามเนือออนแรง,ทองอืด,หัวใจเตนไมเปนจังหวะ
            ้
• Hyperkalemia
  –...
The End
Upcoming SlideShare
Loading in...5
×

Fluid%20and%20 Electrolyte%20 Management%20in%20 Surgical%20 Patient

2,511

Published on

Published in: Technology, Business
1 Comment
2 Likes
Statistics
Notes
  • This is great. Loved it.

    http://www.kidsbathroomsets.org/
    http://www.kidsbathroomsets.org/BathAccessoriesForKids.php
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total Views
2,511
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
95
Comments
1
Likes
2
Embeds 0
No embeds

No notes for slide

Fluid%20and%20 Electrolyte%20 Management%20in%20 Surgical%20 Patient

  1. 1. Fluid and Electrolyte Management in Surgical Patient Dr.Kiti Siriwatana
  2. 2. Total body water • Infant=80 • Male=65 • Female=55 • Thin>Fat
  3. 3. Body fluid compartment • ICF=40% • ECF=20% – Intravascular fluid(plasma) =5% – Interstitial fluid =15%
  4. 4. Total body water ICF Intravascular fluid Interstitial fluid
  5. 5. PO4- 38 2 2 8 HCO3- 28 24 ICF Cl- 2 113 ISF 103 Serum 160 K+ 4 4 10 Na+ 145 140
  6. 6. 160 140 120 100 80 Serum 60 ISF 40 20 ICF ICF 0 Na+ Serum K+ Cl- HCO3- PO4-
  7. 7. Osmolality • Homeostatic machanism by kidney • Serum Osmolality =(Na+x2)+(BUN/2.8)+(Glucose/18) • Fluid movement:Osmolality • Electrolyte movement:Active transport
  8. 8. ADH
  9. 9. Aldosterone
  10. 10. Fluid • Crystalloid – Maintenance type fluid:Hypotonic solution – Replacement type fluid:Isotonic solution – Special type fluid:Hypertonic solution • Colloid – Albumin – Gelatin(Haemaccel) – Starch(H.E.S.)
  11. 11. Example of crystalloid • D5W:Dilutional hyponatremia • NSS:Normal saline:Isotonic saline • Lactated Ringer’s solution (LRS):Physiologic solution – Liver-Lactate to bicarbonate and energy • Acetated Ringer’s solution (ARS) – Acetate metabolite by muscle
  12. 12. Na+ K+ Ca++ Mg++ Cl- HCO3 Glucose ECF 142 4 5 3 103 27 120 5%D/W 0 0 0 0 0 0 50 0.9%NSS 154 0 0 0 154 0 0 5%D/N/2 77 0 0 0 77 0 50 5%D/N/3 51 0 0 0 51 0 50 5%D/N/5 31 0 0 0 31 0 50 3%NSS 513 0 0 0 513 0 0 LRL 130 4 3 0 109 28 0 ARL 130 4 2.7 0 108.7 28 0
  13. 13. Crystalloid VS Colloid • Crystalloid:2-3 Blood loss • Colloid: ~1:1 Blood loss • Blood replacement: for Oxygen carrier
  14. 14. Fluid and Electrolyte therapy • Fluid:Quatity:volume • Electrolyte:Quality:composition
  15. 15. Replacement for what? • Daily requirement:Fluid maintenance • Fluid deficit:Already loss • Third space loss from surgery • Fluid for blood replacement
  16. 16. Daily requirement:Fluid maintenance • Sensible loss:kidney and GI – Urine:800-1200 cc/day • Insensible loss:skin and lung – Skin:20-400 cc/day – Lung:400-600 cc/day – Insensible perspiration (cc)=B.W. (kg.)x15 • Total:1600-2000 cc/day • I/O record
  17. 17. Daily requirement:Fluid maintenance 1 • Holliday and Segar • น้ําหนัก 10 Kg แรก = 100 cc/Kg • 10-20 Kg ตอมา = 50 cc/Kg • >20 Kg = 20 cc/Kg • For 24 Hr. of fluid maintenance
  18. 18. Daily requirement:Fluid maintenance 2 • Fluid maintenance in 1 Hr. • น้ําหนัก 10 Kg แรก = 4 cc/Kg/Hr • 10-20 Kg ตอมา = 2 cc/Kg/Hr • >20 Kg = 1 cc/Kg/Hr • Rate = cc/Hr • Rate/4= drop/min
  19. 19. Daily requirement:Fluid maintenance 3 • For NPO pt. before surgery • 5% D/N/2 rate 1.5-2 cc/kg/hr
  20. 20. Daily requirement:Fluid maintenance • Composition and concentration • Sodium requirement: – Adult:2-3 mEq/kg/day=100-150 mEq – Child:4 mEq/kg/day • Potassium requirement: – Adult:1 mEq/kg/day=40-50 mEq – Child:2 mEq/kg/day • Glucose :125-150 g for prevent ketosis
  21. 21. Na+ K+ Ca++ Mg++ Cl- HCO3 Glucose ECF 142 4 5 3 103 27 120 5%D/W 0 0 0 0 0 0 50 0.9%NSS 154 0 0 0 154 0 0 5%D/N/2 77 0 0 0 77 0 50 5%D/N/3 51 0 0 0 51 0 50 5%D/N/5 31 0 0 0 31 0 50 3%NSS 513 0 0 0 513 0 0 LRL 130 4 3 0 109 28 0 ARL 130 4 2.7 0 108.7 28 0
  22. 22. Daily requirement:Fluid maintenance • 5% D/N/2 1000 cc.+ Water 1000 cc. • 5%D/N/2 2000 cc. • 5% D/NSS 1000 cc.+ Water 1000 cc.
  23. 23. Fluid deficit,already loss • Volume deficit assesment from history taking and physical examination • Mild dehydration:3% B.W. • Moderate dehydration:6% B.W. • Severe dehydration:9% B.W.
  24. 24. STAGE 0-5% 5-10% 10-15% Dehydration Dehydration Dehydration Appearance Freshful Restless Semicomatose Skinturgor Normal or slightly Eyes Normal or sunken Sunken Mucous membrane Dry red Very dry Very dry, cyanosis H.R. 130 160 % B.W. loss 2-5 % 5-10 % > 10 % Skin temperature Warmer Cold or warm Cold Fontanelle (in Normal Maybe sunken Sunken child)
  25. 25. อาการ Deficit (% body wt.) Early Thirst 2% Moderate 6% Marked thirst Dry mouth Oliguria Weakness Malaise Loss of skin turgor Mental change Severe 7-14 % Severe mental change Hallucination Gross weakness
  26. 26. Fluid deficit,already loss • Composition assesment:Fluid loss from what? • Vomitting? • Diarrhea? • NG-tube? • T-tube?
  27. 27. Na+ K+ Cl HCO3 Stomach 10 26 10 30 Duodenum 140 5 80 0 Diarrhia stools 120 25 90 45 Pancreas 140 5 75 115 Bile 145 5 100 35
  28. 28. Na+ K+ Ca++ Mg++ Cl- HCO3 Glucose ECF 142 4 5 3 103 27 120 5%D/W 0 0 0 0 0 0 50 0.9%NSS 154 0 0 0 154 0 0 5%D/N/2 77 0 0 0 77 0 50 5%D/N/3 51 0 0 0 51 0 50 5%D/N/5 31 0 0 0 31 0 50 3%NSS 513 0 0 0 513 0 0 LRL 130 4 3 0 109 28 0 ARL 130 4 2.7 0 108.7 28 0
  29. 29. Fluid deficit,already loss • Diarrhea จะเลือกใช N/2+KCl 30 mEq/l • Vomiting จะเลือกใช N/2+KCl 10 mEq/l • NG tube ใช N/2+KCl 10 mEq • T tube (ในการผาตัดทอน้ําดี) ใช LRL
  30. 30. Third space loss • Volume: – Major surgery:8 cc/kg/hr – Moderate surgery:6 cc/kg/hr – Minor surgery:4 cc/kg/hr – OMFS:2-4 cc/kg/hr • Composition:LRS,ARS
  31. 31. Blood loss therapy • Acceptable blood loss (ABL) • (Hct -30) x ปริมาณเลือดในรางกาย x 3/100 • < 1/3 ABL—LRS,ARS 2-3:1 of blood loss • >1/3 ABL--LRS,ARS 2-3:1 of blood loss or Albumin 1:1 of blood loss • = ABL---Packed red cell(PRC) 0.5:1 of blood loss
  32. 32. Fluid therapy during the operation • Maintenance • Preoperative deficit – ½ in first hour – ¼ in second hour – ¼ in third hour • Third space loss • Blood loss during the operation
  33. 33. Fluid and electrolyte abnormality • Volume disturbance • Concentration disturbance:Sodium • Composition disturbance:Others electrolyte
  34. 34. Volume disturbance • Volume excess • Volume deficit (dehydration)
  35. 35. Concentration disturbance • Hyponatremia (Water intoxication) -Water shift to icf:cell swelling esp.brain • Hypernatremia (Water deficit) – Dehydration
  36. 36. Composition disturbance • Hypokalemia – กลามเนือออนแรง,ทองอืด,หัวใจเตนไมเปนจังหวะ ้ • Hyperkalemia – คลื่นไส อาเจียน ปวดทอง ทองเสีย หัวใจเตนไมเปน จังหวะ
  37. 37. The End
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×