Dr. Lokesh GargMBBS MD.(Med.)SANTOSH HOSPITALYAMUNA NAGAR
Why to discuss fluid Therapy
Why patients need intravenous fluidtherapy ?Patient needs IV fluid therapy forMaintenance ( to supply daily needs ) ,Repla...
Planning and preparing prescription ofintravenous fluids
Step 1 : Assessment
Step 2:Calculation of volume of intravenous fluids
Step 3 :Selection of intravenous fluids
Step 4 :Determine rate of fluid administration
How much fluid to give ?
Assessment of volume statusMild dehydration: up to 5% total body water (2 to 3L in 70kg man)Normal mental state, dry mucou...
Which fluid to give ?Intravenous fluids to be infused in a given patient is selected on the basis ofComposition of IV flui...
Sodium concentration of variousintravenous fluidsIntravenous fluidsIsotonicsalineRingerslactate5% / 10%dextroseIsolyte-G I...
Potassium concentration of variousintravenous fluidsIntravenous fluidsRingerslactateIsolyte-GIsolyte-M Isolyte-Pk(mEq/L) 4...
Characteristics of intravenous fluidsCharacteristic Intravenous fluids Characteristic Intravenous fluidsMost physiological...
Selection of intravenousfluid in common clinicalproblems
Fluid therapy in hypovolemic shock :
Selection of intravenous solution for initialtreatment of hypovolemic shock
Avoid all isolytes
Isotonic saline is most preferred
Ringer’s lactate ( RL)
Colloids , albumin, blood productsmost effective agents
Fluid Therapy in Diarrhea
Fluid Therapy in DiarrheaPatients with severe dehydrationand shock need IV fluid therapyRL is most preferred IV fluid toco...
Fluid therapy in vomitingVomiting leads to hypokalemichyperchloremic metabolic alkalosis withdehydration.Most preferred IV...
Fluid therapy in initial phase of strokeAvoid 5% dextrose –• it is hypotonic fluid and increases brain edema• Leads hyperg...
Take Home messageClinical disorder Ideal initial fluid Clinical disorder Ideal initial fluidHypovolemic shock NS,RL Burns ...
Thank youQuestions ?
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Fluid therapy in medical disorders

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As diarrheal fluid is rich in sodium, bicarbonate and potassium diarrhea leads to hypokalemic hyperchloremic metabolic acidosis with dehydration. Mild dehydration: up to 5% total body water (2 to 3L in 70kg man) Normal mental state, dry mucous membranes, usually thirsty, blood pressure and heart rate normal, lower than normal urine output and skin turgor almost normal.
Moderate dehydration: 5-10% total body water (4 to 5 L in 70kg man) Disinterest in surrounding, can be drowsy, increased heart rate and respiratory rate, orthostatic hypotension, decreased skin turgor and reduced urine output
Severe dehydration: 10-15% total body water (7 to 8 L in 70kg man) Reduced conscious level, fast heart rate, low blood pressure, respiratory distress and oliguria/anuria

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Fluid therapy in medical disorders

  1. 1. Dr. Lokesh GargMBBS MD.(Med.)SANTOSH HOSPITALYAMUNA NAGAR
  2. 2. Why to discuss fluid Therapy
  3. 3. Why patients need intravenous fluidtherapy ?Patient needs IV fluid therapy forMaintenance ( to supply daily needs ) ,Replacement ( to replace deficit and on-going losses )Resuscitation ( to correct an IV or extracellular deficit )
  4. 4. Planning and preparing prescription ofintravenous fluids
  5. 5. Step 1 : Assessment
  6. 6. Step 2:Calculation of volume of intravenous fluids
  7. 7. Step 3 :Selection of intravenous fluids
  8. 8. Step 4 :Determine rate of fluid administration
  9. 9. How much fluid to give ?
  10. 10. Assessment of volume statusMild dehydration: up to 5% total body water (2 to 3L in 70kg man)Normal mental state, dry mucous membranes, usually thirsty, blood pressure and heart ratenormal, lower than normal urine output and skin turgor almost normal.Moderate dehydration: 5-10% total body water (4 to 5 L in 70kg man)Disinterest in surrounding, can be drowsy, increased heart rate and respiratory rate,orthostatic hypotension, decreased skin turgor and reduced urine outputSevere dehydration: 10-15% total body water (7 to 8 L in 70kg man)Reduced conscious level, fast heart rate, low blood pressure, respiratory distress andoliguria/anuria
  11. 11. Which fluid to give ?Intravenous fluids to be infused in a given patient is selected on the basis ofComposition of IV fluids .Underlying etiology and presence of electrolyte and acid-basedisorder.Selection of intravenous fluids (considering its composition)
  12. 12. Sodium concentration of variousintravenous fluidsIntravenous fluidsIsotonicsalineRingerslactate5% / 10%dextroseIsolyte-G Isolyte-M Isolyte-PNa (mq/L) 154 130.0 25 63 40 25
  13. 13. Potassium concentration of variousintravenous fluidsIntravenous fluidsRingerslactateIsolyte-GIsolyte-M Isolyte-Pk(mEq/L) 4.017.035.0 20.0KCl (15%)Amp20 mEq/10 ml
  14. 14. Characteristics of intravenous fluidsCharacteristic Intravenous fluids Characteristic Intravenous fluidsMost physiological RL Glucose free Saline, RLRich in sodium NS,DNS,RL Sodium free Dextrose solutionsRich in chloride NS,DNS,Iso-G Potassium free NS/DNS,dextrose solutionRich in potassium Iso-M,P and G Avoid in liver failure RL, Iso-G, 5% DCorrects acidosis RL, all isolyte Except Iso-G Avoid in renal failure NS, RL, all isolyteCorrects alkalosis Isolyte-G, NS Provides phosphorous Isolyte-M
  15. 15. Selection of intravenousfluid in common clinicalproblems
  16. 16. Fluid therapy in hypovolemic shock :
  17. 17. Selection of intravenous solution for initialtreatment of hypovolemic shock
  18. 18. Avoid all isolytes
  19. 19. Isotonic saline is most preferred
  20. 20. Ringer’s lactate ( RL)
  21. 21. Colloids , albumin, blood productsmost effective agents
  22. 22. Fluid Therapy in Diarrhea
  23. 23. Fluid Therapy in DiarrheaPatients with severe dehydrationand shock need IV fluid therapyRL is most preferred IV fluid tocorrect dehydration
  24. 24. Fluid therapy in vomitingVomiting leads to hypokalemichyperchloremic metabolic alkalosis withdehydration.Most preferred IV fluid to correct dehydrationdue to vomiting is isotonic saline (NS)
  25. 25. Fluid therapy in initial phase of strokeAvoid 5% dextrose –• it is hypotonic fluid and increases brain edema• Leads hyperglycemia and enhances brain injuryIsotonic saline (NS) is the ideal IV fluid
  26. 26. Take Home messageClinical disorder Ideal initial fluid Clinical disorder Ideal initial fluidHypovolemic shock NS,RL Burns Ringer’s lactateDiarrhea Ringer’s lactate Intraoperative Ringer’s lactateVomiting Isotonic saline Starvation deficit 5% dextroseDiabetic ketoacidosis Isotonic saline Hypokalemia Isolyte-M, KCl dripAdult maintenance Isolyte-M SIADH 3%NaCl + IV frusemidePost TURP NS, Avoid 5% D Stroke, neuro surg. NS. Avoid dextrose sol
  27. 27. Thank youQuestions ?
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