Fluid and electrolyte
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al hussein teaching hospital : Objectives: How much fluid ? What type of fluid ? Rate and regime ?
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Fluid and electrolyte
- 1. By Ph. Ali Salman Fluid and electrolyte
- 3. Objectives: How much fluid ?01 What type of fluid ?02 Rate and regime ?03 Special cases ?04
- 4. How much fluid I should give? Like burn patients Patient may need a lot of fluid Like patient with fever Patient may need some what above normal maintenance For all patient that could not get required fluid orally! Routine maintenance ! Like HF patients, renal failure with anuria Fluid restricted patients
- 5. FLUID USES Resuscitation vomiting Mild hyponatremia volume overload Resuscitation burn injuries Diarrhea Trauma Surgical metabolic acidosis lactic acidosis liver disease renal impairment provide calories free water renal failure cerebral edema Resuscitation early postoperative hypokalemia intracellular Dehydration: Hypernatremia Diabetic ketoacidosis Hyperosmolar hyperg lycemic increased ICP liver disease trauma or burns 0.9% NS RL GW 5% Hypo tonic severe Hyponatremia cerebral edema volume overload pulmonary edema Hyper tonic
- 7. Resuscitation Sever 1-2 liters then assess Mild 50-100mL/h greater than estimated fluid losses. Depends on severity of dehydration
- 8. 1 TEXT Routine Maintenance When patient couldn’t get his required fluid orally.
- 9. Guidelines : Routine maintenance If patients need IV fluids for routine maintenance alone, restrict the initial prescription to: 25–30 ml/kg/day of water and approximately 1 mmol/kg/day of potassium, sodium and chloride and approximately 50–100 g/day of glucose to limit starvation ketosis.
- 10. Needs: Water = 2 liters Na+ & CL- = 70mmole equivalent to content of 1 NS 0.9% OR 2 NS 0.45% K+ = the amount should to the nearest fluid content. Sever caution of adding KCl to fluid bag!!!! (density dif.) Glu: 50- 100 g/ day equal content of 1- 2liters of GW 5% OR GS 5%/ 0.9%. Example of adult (70kg) MEANS :: This can be achieved using 0.18% Saline in 4% glucose with 20mmol potassium on day one (use caution if total fluid prescription exceeds 2.5 litres per day as this prescription may increase the risk of hyponatraemia).
- 11. regimen 16 h fluid regimen24h fluid regimen
- 12. Fever ? 40% 37% For each Centigrade above normal body temp. Add 100-150 cc of fluid per day.
- 14. Burns: Use calculator ! 4 * Weight * Percent%
- 16. Pancreatitis 5-10 Fluid replacement — We provide aggressive hydration at a rate of 5 to 10 mL/kg per hour of isotonic crystalloid solution (eg, normal saline or lactated Ringer's solution) to all patients with acute pancreatitis, unless cardiovascular, renal, or other related comorbid factors preclude aggressive fluid replacement. Duration: 24-48h Goal: Adequate fluid replacement can be assessed by an improvement in vital signs (goal heart rate <120 beats/minute, mean arterial pressure between 65 to 85 mmHg), urine output (>0.5 to 1 cc/kg/hour) and reduction in hematocrit (goal 35 to 44 percent) and BUN over 24 hours, particularly if they were high at the onset
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- 19. CI TO Albumin Sever anemia Heart failure Use ACEI 24H PRE
- 20. Thank You
Editor's Notes
- D5W is not good for patients with renal failure or cardiac problems since it could cause fluid overload. - patients at risk for intracranial pressure should not receive D5W since it could increase cerebral edema - D5W shouldn't be used in isolation to treat fluid volume deficit because it dilutes plasma electrolyte concentrations - Never mix dextrose with blood as it causes blood to hemolyze. - Not used for resuscitation, because the solution won't remain in the intravascular space. - Not used in the early postoperative period, because the body's reaction to the surgical stress may cause an increase in antidiuretic hormone secretion