Normal fluid and electrolytes physiology, its abnormalities and corrective modalities in adults and paediatrics alike. Also included acid base balance, types of intravenous fluids, categories of intravenous cannula sizes

1. ELECTROLYTES, & ACID – BASE BALANCE
IN SURGERY
BY
Dr. Ernest Osemudiamen Salami,
Department of Surgery,
Central Hospital,
Benin City.

2. OUTLINE
 Introduction
 Fluid, electrolytes & acid – base physiology including daily requirements
 Aetiology of fluid and electrolyte losses
 Management of fluid imbalances
 Fluid therapy including dehydration
 Water intoxication
 Management of electrolyte imbalances
 Hypokalaemia
 Hyperkalaemia
 Hyponatraemia
 Hypernatraemia
 Management of acid – base imbalances
 Metabolic acidosis
 Metabolic alkalois
 Respiratory acidosis
 Respiratory alkalosis
 Some technicalities in IV fluid and electrolytes therapy
 Types and examples of iv fluids
 Infusion giving sets, drop rates, & cannula sizes
 Complications of IV fluid therapy
 Conclusion
 References

3. INTRODUCTION
 Fluids are an integral component of the human body,
notably so as they constitute a part of the internal
milléu and play a major role in homeostasis.
 Electrolytes are important for a myriad of functions
such as energy metabolism, neurvous transmission,
muscular activories.
 Patients who may not be able to take feeds orally either
because of disease, e.g. peritonitis, or because of an
operation, e.g. intestinal resection, usually require
parenteral fluid and electrolytes therapy, as well as
energy which is included in this presentation.
 To help do this, a good understanding of the daily
exchanges of water and electrolytes is essential.

4. FLUID, ELECTROLYTES & ACID – BASE
PHYSIOLOGY
FLUID
TOTAL BODY WATER
 The total body water (T.B.W) of the adult male
is about 60% of body weight.
 In general, T.B.W. depends on
 Age: TBW reduces with increasing age
 Sex: TBW is less in females, about 50% of body
weight
 BMI: TBW is lower in the obese individual

5. The body water is distributed in two
compartments:
1. Intracellular - 40% of body weight.
2. Extracellular - 20% of body weight.
 Intravascular (plasma) - 4%.
 Extravascular
 Transcellular - l %
 Interstitial- 15 %.

6. FLUID REQUIREMENTS
 The body loses water physiologically through;
 Insensible loss (expired air and skin),
 Urine
 Faeces
And gains it from;
 Food
 Liquids
 Endogenous metabolism of carbohydrate, protein and
fat.

7.  An adult (surgical patient) usually requires
maintenance fluid of 3L daily.
 Analysis of how this is arrived at will be discussed
later

8. PAEDIATRICS DAILY FLUID REQUIREMENTS
 Children, when compared to adults have greater fluid
requirements; reasons being:
 The relative immaturity of their kidneys and hence, inability to
concentrate urine effectively
 They have a greater surface area to weight ratio
 A higher metabolic rate needed for growth will demand for more
fluid
 Their respiratory rates are higher, therefore, there is increased
insensible water loss.
 A paediatric patient’s daily fluid requirement is arrived only by
calculation, based on the body weight.
 Details of this are described in latter part of the presentation.

9. ELECTROLYTES
 Intracellular ions:
 Potassium is the most important cation in the cells,
about 140mmol/L.
 The concentrations of magnesium and sodium are 15 and
8mmol/L respectively.
 Phosphates, 26mmol/L and proteins, 9mmol/L
are the most important anions.
 Extracellular ions:
 Sodium is the most important cation 135-
145mmol/L.
 Other cations are potassium 3.6-5.2, calcium 2.1-2.6mmol/L and
magnesium 0.7-0.9mmol/L.
 Chloride 95-105mmol/L and bicarbonate 24-
29mmol/L are the main anions.

10. ELECTROLYTE REQUIREMENTS
 Sodium and potassium are lost in sweat, urine and
faeces and are replaced from food.
 Daily requirements
 Sodium: 130mmol/L
 Potassium: 50mmol/L
 As mentioned earlier, the surgical patient who requires
parenteral therapy is not likely to pass faeces,
 Hence, the daily loss of sodium and potassium from
faeces (10mmol/L daily respectively) is subtracted from
the total daily losses of 140mmol/L for sodium and
60mmol/L for potassium.

11. ENERGY REQUIREMENTS
 The body's store of glycogen is small - 400g - and
provides only about 1600kcals of energy.
 This is used up in the first day of starvation after
which 75 – 90% of the energy is provided by the
combustion of fat and the rest by protein.
 If 100-150g of exogenous glucose (i.e.. 1674-
2508J) is provided, gluconeogenesis is reduced to
a minimum and acidosis prevented.

12.  The surgical patient should therefore be given at
least 2L of 5% dextrose daily for energy.
 Sorbitol, which can be infused in concentrations of
up to 30% peripherally, will provide more energy.
 Glucose 5g/kg/day is advisable to provide more
exogenous energy if IV therapy is prolonged.

13.  In summary, the fluid, electrolyte and energy needs
of the surgical patient per day include:
 Water 3Litres
 Sodium 130mmol/L
 Potassium 50mmol/L
 Carbohydrate 100g
These are provided by:
 1Litre of Ringer's lactate (Na+ 130, K+ 4, Ca2+ 4, Cl-
111 and HCO3
-, 27 mmol/L).
 2Litres of 5% dextrose.
 3g of potassium chloride.

14. ACID – BASE PHYSIOLOGY
 pH, potential hydrogen, is a scale representing the
relative acidity or alkalinity of a solution, in which a
value of 7.0 is neutral, below 7.0 is acidic and
above 7.0 is basic or alkaline
 pH reflects the relative concentration of hydrogen
ion H+ to base ions like HCO3
-, and OH- in the
system
 The normal pH of body fluids is maintained
between 7.3 and 7.5

15.  Acidosis is accumulation of H+ ions in the
extracellular fluid resulting in a fall of pH below
7.36; it could be of metabolic or respiratory origin
 Alkalosis is accumulation of base in the
extracellular fluid resulting in an elevation of pH
above 7.44; it could be of metabolic or respiratory
origin
 The body has a buffer system that keeps the
concentration of H+ relatively constant; this
includes;

16.  Intracellular H+ buffers these are proteins and
phosphates
 H+ buffers in blood – HCO3
-, and haemoglobin
 The lungs – by excreting H+ as H2O and CO2 control H+
levels and thereby the pH
 The kidneys – by retaining or excreting HCO3
- also
control H+ levels and thereby the pH

17. AETIOLOGY OF FLUID &
ELECTROLYTE LOSSES
 Apart from the physiologic loss of fluid and
electrolytes from the body as earlier pointed out,
there are also pathologic losses.
 The pathological losses listed out below are on a
general note as there are other causes specific to
individual fluid, electrolyte and acid – base
imbalances.
 These will be stated when considering the specific
derangements.

18.  Preoperative losses
 Revealed losses
 Vomiting
 Diarrhoea
 Fistulal losses e.g ECF
 Burns
 Haemorrhage
 Infection
 Concealed losses
 Peritonitis
 Pancreatitis
 Intramuscular haemorrhage
 Intestinal obstruction (3rd space loss)

19. NB:
*** 3rd Space Loss
is defined as pooling of fluid above normal in any part
of the extracellular compartment, or abnormal
collection in any space in the body outside the
intracellular or extracellular compartments

20.  Intraoperative losses
 Primary haemorrhage
 Bowel losses e.g. via NGT drainage during surgery
 Postoperative losses
 Nil per os
 Bowel losses e.g via NGT drainage
 Via drains e.g abdominal wound drain
 Postoperative fever
 Postoperative diarrhoea e.g. after colectomy
 Post-prostatectomy

21. MANAGEMENT OF FLUID
IMBALANCES
 Fluid imbalances can either be a deficiency or an
excess.
 Deficiencies in fluid imbalance can either be due to
physiologic losses or pathologic losses. These are
discussed subsequently under the broad heading
“Fluid Therapy”
 Excess fluid in the body is called “Water
Intoxication” and this is discussed later as well.

22. FLUID THERAPY
MAINTENANCE FLUID THERAPY
 This is the IV fluid given to replace physiologic
losses in a patient who cannot take by mouth by
reason of disease or therapy.
 These physiological losses include urine, faeces
and insensible losses.
 It is the amount of fluid an individual needs in a 24-
hour period to maintain homeostasis.

23.  Maintenance fluid consists of; water, electrolytes
and glucose
 Water – to replace the physiologic water loss
 Electrolytes – to maintain plasma osmolality
 Glucose – to provide energy.
 Maintenance fluid alone is indicated in a surgical
patient who cannot take by mouth but does not
have any pathological losses e.g. vomiting,
intestinal obstruction, etc.

24.  IV fluid used for maintenance therapy in
children;
 4.3% dextrose in 0.18 saline
 8% dextrose in 0.18 saline (used when there is need to give
extra glucose e.g. in neonates, children not tolerating orally for
some time)
 5% dextrose in 0.45 saline
 5% dextrose in Ringers’ lactate (used only when there is
need to give some potassium)
 10% dextrose water (used only in the first day of life –
electrolytes not required at this age, glucose highly needed due
to tendency for hypoglycaemia)

25.  IV fluids used for maintenance therapy in adults
 Normal saline alternating with 5% dextrose water
 Ringers’ lactate alternating with 5% dextrose water
 5% dextrose saline alternating with 5% dextrose water

26.  Calculation of Maintenance fluid requirements;
 Based on weight (commonly used for paediatric
patients)
100ml/kg for the first 10kg OR 4ml/kg/hr
50ml/kg for the second 10kg OR 2ml/kg/hr
20ml/kg for the remaining kg OR 1ml/kg/hr
 Based on BSA
BSA = √
𝐰𝐞𝐢𝐠𝐡𝐭 𝐤𝐠 𝐱 𝐇𝐞𝐢𝐠𝐡𝐭(𝐜𝐦)
𝟑𝟔𝟎𝟎
Maintenance fluid (ml) = 1500 X BSA

27.  Based on empirical estimation (used in adults): This is
based on a volume to volume replacement of
physiological losses.
 In the tropics, usual fluid loss per day:
 Stool – 200ml
 Urine – 1,500ml
 Insensible loss – 1,700ml
 Total – 3,400ml
 Most patients hospitalized after surgery usually may not
lose fluid via faeces
(minus 200ml = 3,200ml)
 The normal metabolic breakdown of glucose by the
body releases 200ml of fluid.
C6H12O6 + 6O2 → 6CO2 + 6H2O
(minus 200ml = 3,000ml
 Net physiological loss per day = 3L

28.  Maintenance fluid percentages
 Giving a patient his normal maintenance is called 100%
maintenance.
 However, in certain conditions such as heart failure,
renal failure, pneumonia, meningitis, 100% maintenance
can be dangerous, hence it is reduced to 2/3
maintenance, 50% maintenance as the case may be.

29. DEHYDRATION & DEFICIT FLUID
THERAPY
 Deficit fluid therapy is fluid given to correct for
pathologic fluid losses such as vomiting, diarrhoea,
3rd space loss in ntestinal obstruction, etc.
 To administer this type of fluid therapy, the level of
deficit is first asssessed by;
 Checking for the clinical features (symptoms and signs)
of dehydration
 Evaluating the cardiovascular haemodynamics
 Assessing the neurological status

30.  The clinical features of dehydration include:
 A history of pathological fluid loss
 Symptoms such as
 Reduced urinary output
 Thirst
 Physical signs such as
 Sunken eyes
 Buccal mucosa dryness
 Loss of skin turgor.
 The cardiovascular haemodynamics examined
include:
 Capillary refill
 Pulse rate
 Blood pressure

31.  The neurologic status could be any of the following:
 Alert and well oriented
 Restlessness
 Lethargy
 Confusion
 Coma
 From assessment of these three parameters, fluid deficit
could be
 Mild dehydration
 Moderate dehydration
 Severe dehydration
 Hypovolaemic shock

32. MILD DEHYDRATION
 Here, the patient has lost about 5% of body weight
as fluid which amounts to 50ml/kg deficit
 1 kg of body weight lost = 1000ml
 5% of body weight lost =
5% x 1000ml
1kg
= 50ml/kg
 There are features suggestive of pathologic fluid
loss in the history but no physical signs of
dehydration
 Assessment of cardiovascular haemodynamics and
neurologic status are normal

33.  Correction = Maintenance fluid + 50ml/kg deficit,
given over 24hrs.
 The fluid used is the routine maintenance fluid.
 The total fluid is divided into two parts; first half is given
over 8hrs and the second over 16hrs

34. MODERATE DEHYDRATION
 The fluid lost here is 7.5-10% of body weight and this amounts
to 75-100ml/kg
 The patient has some signs of dehydration like sunken eyes,
loss of skin turgor
 There is mild tachycardia with normal mental state or just
restlessness.
 Correction = Maintenance fluid + 75-100ml/kg deficit, given
over 24hrs
 The fluid used is the routine maintenance fluid. Normal
saline/Ringer’s lactate could be added to the fluid regimen
 The total fluid is divided into two parts. First half is given over
8hrs and the remainder over 16hrs

35. SEVERE DEHYDRATION
 The fluid lost here is 10-15% of body weight and
this amounts to 100-150ml/g
 In addition to signs of dehydration, there is marked
tachycardia and altered mental state.
 There may or may not be hypotension.

36.  Correction = Maintenance fluid + 100-150ml/kg
deficit, given over 24hrs
 Here, it is important to use plasma expanders such as
normal saline as part of the fluid regimen
 This is because the intravascular volume needs to be
expanded as severe dehydration is the beginning of
hypovolaemic shock.
 The total fluid is divided into two parts. First half is given
over 8hrs and the remainder over 16hrs .
 Note however, that severe dehydration could be treated
as hypovolaemic shock.

37. HYPOVOLAEMIC SHOCK
 Here, the patient has lost up to 15-20% of body
weight.
 The clinical features include;
 Cold clammy extremities
 Fast and thready pulse
 Hypotension or unrecordable blood pressure
 Altered mental status – lethargy or coma
 Reduced urinary output

38.  Treatment;
 Give anti-shock at 20ml/kg over 30-60mins using an
isotonic fluid (normal saline or Ringer’s lactate)
 Continuous monitoring of vital signs
 The bolus anti-shock fluid can be repeated if the vital
signs are still compromised
 When out of shock, continue with severe dehydration
fluid regimen.
 However, ensure to subtract the antishock given earlier
from the total fluid.
 Give the remaining fluid over 24hrs, i.e. half over 8hrs
and the second half over the next 16hrs

39. FLUID THERAPY FOR ONGOING
LOSSES
 This is done for patients on admission who continue
to have pathologic losses after the initial deficit
therapy.
 The aim is to correct the pathologic losses that are
still ongoing.
 A nurse usually documents the volume of these
ongoing losses which are then corrected volume
for volume using isotonic fluid e.g. normal saline.

40. WATER INTOXICATION
 This is a condition where there is retention of large
volumes of water – 67ml/kg/day
 Common causes
 Excess administration of 5% dextrose
 Excess secretion of ADH –SIADH
 It is common in the presence of hypoproteinaemia,
congestive cardiac failure, renal or liver disease
 Features
 Oedema
 Symptoms of raised ICP: headache, vomiting,
drowsiness, confusion, convulsions,

41.  Added breath sounds, crepitations
 Prolonged post-operative paralytic ileus
 Central Venous Pressure >15cm of H2O
 Low serum Na+
 Treatment
 Water restriction,
 the infusion in question is stopped
 Loop diuretic (IV Frusemide) is given
 Rarely hypertonic saline is given

42. MANAGEMENT OF ELECTROLYTE
IMBALANCES
HYPOKALAEMIA
 This is a clinical condition in which serum potassium is <
3.5mmol/L
 Causes include;
 Upper GI losses e.g,
 GOO e.g. pyloric stenosis
 High jejunal obstruction
 Prolonged NGT placement
 Ileostomy
 Duodenal fistula
 Lower GI losses e.g.
 Diarrhoea
 Low intestinal obstruction

43.  Medications
 Diuretics therapy
 Insulin therapy
 Beta agonists
 Others
 Peritonitis
 Alkalosis
 Diabetes mellitus
 Parenteral nutririon with inadequate K+ replacement
 Prolonged administration of K+ free parenteral fluids
 Liver failure
 Primary hyperaldosteronism (Conn’s disease)

44.  Clinical features – failure of normal contractility of
skeletal, smooth and cardiac musculature;
 Muscle weakness
 Flaccid paralysis eith diminished or absent tendon
reflexes
 Paralytic ileus
 Slurred speech
 Lethargy
 ECG features
 Prolonged PR interval
 Flattened or inverted T-wave
 Prominent U-waves
 Cardiac arrest @ systole may occur
 Metabolic alkalosis

45.  Treatment
 K+ level of 3-3.4mmol/L
 Food supplements e.g. bananas, canned foods, citrus foods,
milk, meat soups, honey, etc.
 Effervescent tablets of KCl e.g. Slow K; if food supplements
are not effective
 K+ level of 2.4 -2.9mmol/L – IV KCl is required.
 Correction = Potassium deficit + Potassium maintenance
 Deficit = (Expected – Observed) x Body weight x 0.6
 Maintenance = 1-2mmol/L
 Expected is usually taken as 3.5-4mmol/L

46.  Correct slowly over 24hrs using IV KCl added in 5% D/S or
N/S
 Usually given slowly 6hourly, alternating with rest periods of
KCl-free infusion
 IV KCl correction must not exceed 40mmol per 1L of infusion.
 Total KCl given in a day must not exceed 120mmol
 Ensure patient is making urine before giving KCl
 Ideally, correction should be done under ECG monitoring.

47. HYPERKALAEMIA
 This is a clinical condition in which serum potassium is
>5.5mmol/L
 Common causes include;
 Renal failure
 Acidosis, hypoxia, ischaemia
 Features
 Diarrhoea,
 Colicky abdominal pain
 ECG features include
 Flattened P waves
 Tall peaked T waves
 Widened QRS complex
 When K > 6.5 mmol/L, cardiac arrest (Ventricular Fibrillation) can
occur

48.  Treatment
 Withhold exogenously administered K+
 Treat the cause
 Give IV calcium gluconate 10%, 10ml slow push under ECG
monitoring to suppress the myocardial effects of K+
temporarily
 Give IV NaHCO3 to suppress the myocardial effects of the
acidosis associated with hyperkalaemia
 IV insulin and dextrose infusion help to drive K+ + into the
cells
 IV salbutamol can also be used to drive K+ into the cells
 Give ion exchange resins e.g. resonium, kayexalate, per os,
or per rectum.
 Do dialysis in extreme of cases.

49. HYPONATRAEMIA
 This is a clinical condition in which plasma sodium drops
below 135mmol/L.
 It is the most common disturbance seen in surgical
practice
 Common causes
 GIT losses – vomiting, diarrhoea, fistula
 Peritonitis
 Addison's disease – adrenocortical insufficiency
 Frusemide diuretic use
 Excess IVF 5% dextrose in water
 Transurethral resection of the prostate (TURP)
 Cardiac failure, Cirrhosis
 Syndrome of inappropriate ADH secretion

50.  Features
 At Na+ of 120-130mmol/L, patient is usually asymptomatic
 At Na+ of 110-120mmol/L, there is confusion, contraction of
ECF space, oliguria, hypovolaemia dry skin, loss of turgor,
sunken eyeballs
 At Na of < 110mmol/L, convulsions and even coma might
occur
 Treatment
 Treat the cause
 Give daily fluid requirement as IVF Normal saline, rarely
hypertonic saline is given
 Water retention is treated by fluid restriction
 When Na is <120mmol/L or the condition is symptomatic
correct for sodium deficit as shown below

51.  Correction for sodium deficit
 Correction = Sodium deficit + Sodium maintenance
 Deficit = (Expected – Observed) x Body weight x 0.6
 Maintenance is 2-3mmol/kg
 Expected is put at 120mmol
 Corrected over 24hrs using hypertonic saline or normal
saline infusion

52. HYPERNATRAEMIA
 This is a clinical condition in which serum sodium is
> 145mmol
 Common causes include;
 Dehydration
 Iatrogenic – excess IVF Normal saline
 Primary hyperaldosteronism (Conn's syndrome)
 Features
 Similar to water depletion
 When serum Na+ > 160mmol/L, it causes hypernatraemic
encephalopathy
 Treatment
 Slow I.V. replacement with hypotonic saline solution e.g. 4.3%
dextrose in 0.18 saline infusion

53. MANAGEMENT OF ACID – BASE
IMBALANCES
METABOLIC ACIDOSIS
 It occurs due to retention or production of acids or loss of
HCO3
-
 Causes include;
 Lactic acidosis; as in shock
 Ketoacidosis; as in complicated diabetes
 Excess HCO3
-; loss; as in intestinal obstruction
 Renal failure, Uraemia
 Drugs, Aspirin poisoning
 Starvation
 Alcohol intoxication
 The most common cause of severe metabolic acidosis in surgical
patients is acute circulatory failure with accumulation of lactic
acid.

54.  Blood gas picture
 pH <7.36
 PaCO2 <4.7 kPa
 HCO3
- < 18 mmol/L
 Base excess <-5 mmol/L
 Treatment
 Directed towards correcting the underlying cause
 Reserve HCO3 therapy for severe metabolic acidosis; in
this correct HCO3, deficit using IV sodium bicarbonate
as shown below
 Frequent measurements of HCO3, and blood pH are the
best guides of therapy

55.  Correction for HCO3, deficit
 Correction = HCO3 deficit + HCO3 maintenance
 Deficit = (Expected – Observed) x weight x 0.3
 Maintenance: 2-3mmol/kg
 The total is divided into 3 portions; one-third is given as
slow IV push over 10 mins and the rest added in the
maintenance infusion over 24 hrs

56. METABOLIC ALKALOSIS
 Results from the loss of fixed acids or gain of HCO3;
 It is aggravated by any existing K+ deficit
 Respiratory compensation is usually small
 Compensation is generally through the renal
mechanisms
 Causes
 Any condition predisposing to H+ loss e.g. nasogastric
suction, vomiting
 Excess alkali (NaHCO3) ingestion
 Any condition predisposing to hypokalaemia
 Diuretics
 Excess citrate

57.  Blood gas picture
 pH> 7.44
 PaCO2 > 6.0 kPa
 HCO3 > 32 mmol/L
 Base excess > +5 mmol/L
 Treatment
 Treat underlying cause
 Isotonic sodium chloride infusion
 Correction of hypokalaemia if present

58. RESPIRATORY ACIDOSIS
 Causes
 Hypoventilation
 Ventilation-perfusion mismatch
 Airway obstruction
 Hypermetabolism
 Blood gas picture
 pH<7.38
 PaCO2 <5.7 kPa
 HCO3 < 2mmol/L
 Base excess < -2 mmol/L
 Treatment: Treat underlying cause

59. RESPIRATORY ALKALOSIS
 Causes
 Hyperventilation
 Apprehension
 Hysteria
 CNS injury
 Rapid-rate mechanical ventilation
 Blood gas picture
 pH > 7.42
 PaCO2 >5.3 kPa
 Base excess > +2 mmol/L
 Treatment
 Treat underlying cause

60. SOME TECHNICALITIES IN INTRAVENOUS
FLUID/ELECTROLYTE ADMINISTRATION
TYPES & EXAMPLES OF IV FLUIDS
 CRYSTALLOIDS
 Normal saline
 Ringer’s lactate
 5% dextrose water
 4.3% dextrose in 0.18saline
 8% dextrose in 0.18saline
 10% dextrose water
 50% dextrose water
 5% dextrose in normal saline
 Darrow’s solution
 COLLOIDS
 Gelatine solutions e.g. haemacel, gelofuscin
 Etherified starch solutions e.g. hetastarch, pentastarch
 Dextrans e.g. dextran-70

61. INFUSION GIVING SETS, DROP RATES, &
CANNULAE SIZES
 IV fluids are delivered intravenously using a drip
giving set
 There is a standard giving set used for all age
groups apart from neonates and infants
 There is a special infusion set called Biurette giving
set (Soluset or Buretrol)
 Soluset is used mostly for neonates and young
infants, where you want to give a fixed volume and
prevent unnecessary fluid overload.

62.  Parts of a standard drip giving set
 Connector to drip (i.e. the infusion bottle-IV fluid container)
 Counting chamber-in which the drop rate is counted per
minute
 Infusion tube with Regulator attached - for setting the flow
rate
 Connector to cannula
 Parts of a Biurette Giving set (Soluset or Buretrol)
 Connector to drip
 Drip filling tube, to let in the infusion into the caliberated
chamber
 Calibrated fluid chamber, contains fixed volume for infusion

63.  Air-vent( on the upper part of the calibrated chamber);
allows atmospheric air drive the infusion-flow
 Injection port (on the upper part of the calibrated
chamber), for injecting drugs into the chamber
 One-way-valve (within the chamber); prevents entering
of air into the delivery tube once the chamber volume is
exhausted
 Counting chamber, attached to the lower side of the
chamber
 Drip infusion delivery tube with Regulator

64.  Another injection port attached to the delivery tube for giving
IV drugs to the patient
 Connector to cannula with a lock: this prevents dislodgement
from the cannula
 Calculation of infusion drop rate
 Drop rate =
Infusion volune x Giving set constant
Infusion duration in minutes (Hr x 60)
 Giving set constant is 20 for the standard type and 60 for
Soluset
 IV Cannulae sizes
 Yellow – 24G
 Blue – 22G
 Pink – 20G
 Green – 18G
 Grey – 16G
 White – 14G

65. COMPLICATIONS OF IV FLUID
THERAPY
 Complications related to the process
 Thrombophlebitis
 Local sepsis
 Air embolism
 Haematoma formation
 Complications from the IV fluid
 Septicaemia
 Fluid overload
 Complications arising from the patient
 Pyrogenic febrile reactions
 Anaphylactic reactions

66. CONCLUSION
 Fluid and electrolytes are ery important for the
sustenance and health of every surgical patient.
 Derangements could therefore be lethal.
 Knowledge of the management protocols which
include the clinical features, examination and
investigation findings is necessary for a proper
management of the surgical patient.

67. THANK YOU FOR LISTENING!

68. REFERENCES
 Principles and Practice of Surgery including Pathology
in the Tropics, Badoe, Jaja, Archampong
 SRB Manual of Surgery
 Clinical Surgery Tutorial Manual, E.O. Udefiagbon