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Surgery 6th year, Tutorial (Dr. AbdulWahid)

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College of Medicine, Sulaymaniyah
College of Medicine, Sulaymaniyah

Oct. 26th, 2011

Health & MedicineBusinessTechnology
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Fluid & Electrolytes Management ,[object Object],[object Object],[object Object],[object Object]
Fluid and electrolyte balance is an extremely complicated thing.
 
Solutes – dissolved particles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Composition of Body Fluids: ,[object Object],[object Object],[object Object],[object Object],[object Object],Ca 2+ Mg 2+ K + Na + Cl - PO 4 3- Organic anion HCO 3 - Protein 0 50 50 100 150 100 150 Cations Anions ECF ICF
 
 
Regulation of Fluids: ,[object Object],[object Object],[object Object],[object Object]
 
GI secretions Volume (ml) per day ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Composition of GI Secretions: * Average concentration: mmol/L 0 40 30 60 100-9000 Colon 115 75 (54~95) 5 (3~7) 140 (113~185) 100-800 Pancreas 35 100 (89~180) 5 (3~12) 145 (131~164) 50-800 Bile 30 104 (43~137) 5 (2~8) 140 (80~150) 3000 Ileum 0 80 5 140 100~2000 Duodenum 0 130 (8~154) 10 (0~32) 60 (9~116) 1500 (100~4000) Stomach 30 10 (8~18) 26 (20~30) 10 (2~10) 1500 (500~2000) Salivary HCO 3 - Cl - K + Na +* Volume (ml/24h) Source
 
[object Object],[object Object]
[object Object],[object Object]
Saline Solutions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dextrose solutions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colloid solutions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fluid & electrolyte balance ,[object Object],[object Object],[object Object],[object Object]
Volume Deficit-Clinical Types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Replacement of losses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parenteral Fluid Therapy: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Crystalloids: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Colloid Solutions: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Common parenteral fluid therapy D5W 310 154 154 500 6% Hetastarch 330 130-160 <2.5 130-160 250,500 5% Albumin 273 28 109 3 4 130 Lactated Ringer’s 308 154 154 0.9% NaCl 154 77 77 0.45% NaCl 406 278 77 77 D5/0.45% NaCl 1026 513 513 3% NaCl 280-310 27 103 5 4 142 ECF 330 130-160 <2.5 130-160 20,50,100 25% Albumin mOsm/L Dextrose HCO 3 - Cl - Mg 2+ Ca 2+ K + Na + Volumes Solutions
The Influence of Colloid & Crystalloid on Blood Volume: 1000cc 500cc 500cc 500cc 200 600 1000 Lactated Ringers 5% Albumin 6% Hetastarch Whole blood Blood volume Infusion volume
Example of IVF order ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Your fluid chart should look something like this. (I have written it out twice as I was unconvinced of my first attempt)
Maintenance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fluid Management: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fluid Management: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 

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Surgery 6th year, Tutorial (Dr. AbdulWahid)

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  • 2. Fluid and electrolyte balance is an extremely complicated thing.
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  • 17. Composition of GI Secretions: * Average concentration: mmol/L 0 40 30 60 100-9000 Colon 115 75 (54~95) 5 (3~7) 140 (113~185) 100-800 Pancreas 35 100 (89~180) 5 (3~12) 145 (131~164) 50-800 Bile 30 104 (43~137) 5 (2~8) 140 (80~150) 3000 Ileum 0 80 5 140 100~2000 Duodenum 0 130 (8~154) 10 (0~32) 60 (9~116) 1500 (100~4000) Stomach 30 10 (8~18) 26 (20~30) 10 (2~10) 1500 (500~2000) Salivary HCO 3 - Cl - K + Na +* Volume (ml/24h) Source
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  • 30. Common parenteral fluid therapy D5W 310 154 154 500 6% Hetastarch 330 130-160 <2.5 130-160 250,500 5% Albumin 273 28 109 3 4 130 Lactated Ringer’s 308 154 154 0.9% NaCl 154 77 77 0.45% NaCl 406 278 77 77 D5/0.45% NaCl 1026 513 513 3% NaCl 280-310 27 103 5 4 142 ECF 330 130-160 <2.5 130-160 20,50,100 25% Albumin mOsm/L Dextrose HCO 3 - Cl - Mg 2+ Ca 2+ K + Na + Volumes Solutions
  • 31. The Influence of Colloid & Crystalloid on Blood Volume: 1000cc 500cc 500cc 500cc 200 600 1000 Lactated Ringers 5% Albumin 6% Hetastarch Whole blood Blood volume Infusion volume
  • 32.
  • 33. Your fluid chart should look something like this. (I have written it out twice as I was unconvinced of my first attempt)
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Editor's Notes

  1. Fluid deficits may occur across all compartments, or may occur in any one of them: Water loss (dehydration) depletes all compartments equally. This leads to hypernatremic dehydration. Common examples include diabetes insipidus, osmotic diuresis (e.g. uncontrolled hyperglycemia), osmotic diarrheas. A tendency towards hypernatremia is usually followed by intense thirst and rapid restoration of the fluid deficit. However, when access to free water is restricted (demented or ventilated patients), hypernatremic dehydration develops. 2. Salt and water loss (isotonic loss) may lead to depletion of extracellular fluid. Examples include burns, ascites, secretory diarrheas (cholera), diuretic therapy and third spacing. 3. Intravascular fluid loss is seen with acute hemorrhage