fluids

1. What Fluid?
Gerard Fennessy

2. The (fictional) normal 70kg white male?
• How much water?
• What else is does he contain?
• What else is in his blood?

3. Total water content?

4. 42 litres!
Fictional
70kg white
man

5. 42 litres!

6. What is your water volume OUTSIDE
the cells (extracellular volume)?

7. 15 litres

8. What is your blood volume?

9. 5-6 litres

10. What is your PLASMA volume?

11. 3 litres

12. 42 litres total
15 litres EC
3 litres plasma

15. Daily fluid requirement?
• How much?
• What type of fluid?

16. Intake

17. Output

18. Others
• “Third Space” losses
• Insensible losses

19. Electrolyte Content?

20. In the cell
Outside the cell

21. In the cells
Outside the cells

22. Our main concerns are…

23. The aim is to match input and output
(for water, Na+, K+)
Oral + IV
=
Urine + Vomiting/NG
+ Bleeding + Insensible

24. What fluid to use?

27. TASTE TEST

29. 5% Glucose
• Glucose – 50g
• Water – 1000ml
• “free water”

30. 42 litres total
14 litres EC
3 litres plasma

31. 5% Glucose
• Good for…
– High Na+
– Glucose infusion
• Bad for…
– Blood pressure

32. 4% Glucose + 1/5 N saline
• Glucose – 50g
• Na+ - 30mmol
• Water – 1000ml
• “free water”

33. 42 litres total
14 litres EC
3 litres plasma

34. 4% Glucose + 1/5 N saline
• Good for…
– High Na+
– Glucose infusion
• Bad for…
– Blood pressure

35. Normal Saline
• Contains (mmol):
• Na+ 150
• K+ 0
• Cl- 150
• Water 1000ml

36. 42 litres total
14 litres EC
3 litres plasma

37. Normal Saline
• Good for…
– Na+ replacement
– Water replacement
– Resuscitation
• Bad for…
– K+ replacement
– Other electrolytes
– Acidosis

38. Compound Sodium Lactate
(CSL, Hartmann’s Solution)
• Contains (mmol):
• Na+ 129
• K+ 5
• Cl- 109
• Ca2+ 2
• Lactate 29
• Water 1000ml

39. 42 litres total
14 litres EC
3 litres plasma

40. Compound Sodium Lactate
(CSL, Hartmann’s Solution)
• Good for…
– Na+ replacement
– Electrolyte balance
– Water replacement
– Resuscitation
• Caution with…
– Liver failure

42. …a word about potassium…
• Daily potassium requirement
– 100mmol
• It all depends
– Intake (IV or oral)
– Output (stoma, URINE, NG losses)

44. Potassium (mmol)
• Chlorvescent – 14
• Slow K – 8
• Normal Saline – 0
• CSL / Hartmann’s – 5
• CSL+KCl – 30
• Albumin, 5% Glc - 0

45. Compound Sodium Lactate + KCl
(Hartmann’s Solution + KCl)
• Contains (mmol):
• Na+ 129
• K+ 30
• Cl- 134
• Ca2+ 2
• Lactate 29
• Water 1000ml

46. 42 litres total
14 litres EC
3 litres plasma

47. Compound Sodium Lactate + KCl
(Hartmann’s Solution + KCl)
• Good for…
– Na+ replacement
– K+ replacement
– Electrolyte balance
– Water replacement
– Maintenance
• Caution with…
– Liver failure

48. Albumin 4%
• Contains
– Human albumin 20g
– Water 500ml
– Na+ 75
– Cl- 75
– Good for oedema
– Fluid resus

49. 42 litres total
14 litres EC
3 litres plasma

50. Albumin 20%
• Contains
– 20g albumin
– 100ml water
• Good for
– Resuscitation
– Oedema

51. OTHERS
• FFP
• Cryoprecipitate
• Red Blood Cells
• Platelets
• Starches (gelofusin, voluven)

52. 42 litres total
14 litres EC
3 litres plasma

53. What fluid? - Summary
• Type of fluid depends on the patient
• If they are bleeding give blood and blood
products
• Resuscitation

54. What fluid? Summary
Resuscitation Fluid
• Normal Saline
• CSL
• Albumin 4%

55. What fluid? Summary
Maintenance
• CSL or CSL+KCl
• Always add potassium UNLESS there is a good
reason not to.
• 4% + 1/5 NS a reasonable alternative