3. Importance of Body fluid
Management
• To make a decision about patients
management.
• Loss of more than 10% of total body
fluids can shut one’s vital systems
down!!!
• Can be life-saving in certain conditions.
4. Abdus Subhan, A 35 years Old day laborer
admitted in DMCH with severe abdominal pain
with a history of ingestion of NSAID
one day back. On examination he is
restless, his BP is unrecordable and
his pulse is 120 b/min. his abdomen is
tender and rigid. What may be the first
step of management?
5. WATER BALANCE
•Daily Turn over 2500ml
•Daily Water input:
–Ingested water: 1500mL
–Water content in food: 800mL
–Water from oxidation : 300ml
–TOTAL: 2500mL
11. Maintenance Requirements
IV fluid -2500ml/Day
- NS- 500ml
- 5% Da – 2000ml
Easy Tips!!!
1500ml for first 20kg then 2oml for rest
per kg/day.
Don’t forget to add 1mp k+ in each litre of
5% DA solution if patient is in NPO. (add
it after 24 hour of Surgery.)
12. Maintenance Pathological losses
ml for ml Replacement with Normal Saline
in case of
Vomiting
Diarrhoea
Fistula
in case of ileostomy fistula-
• Hartmann’s solution
• h2 receptor Blocker
• Somatostatin
13. Be careful about…
Vitals of the Body
Urine Output
Respiratory distress
Any Cardiac Insufficiency
15. IV FLUIDS
According to Osmolarity:
Colloid solution
Crystalloid solution
According to tonicity:
isotonic solution
Hypotonic solution
Hypertonic solution
16. Commonly available fluids
0.9% NaCL solution
5% DA
5% DNS
Hartmann’s solution
Cholera Saline
Ringer Lactate solution
17. Available Fluids at a glance
Na+
mEq/L
K+
mEq/
L
Cl-
mEq/L
HCO3
-
mEq/
L
Dextrose
gm/L
mOsm/
L
Ca++
mEq/
L
Lactat
e
mEq/
L
NS 154 154 286
5% DA 50 278
5% DNS 154 154 50 564
Ringers
Lactate
130 4 109 28 50 272
Hartman
Solution
133 5
111
3 4 29
18. Indication of Fluid adminstration
Three seperate aspects need to be
considered.
i. Mainetenance requirements
ii. Replacement of ongoing
pathological losses
iii. Repair of deficits
28. Case scenario…
Doyal munshi a 65 year muslim male
admitted in DMCH 1 week back with
the complain of inability to pass
stool and abdominal swelling for
3days. Now he is getting just IV
fluids as his nutritional suppliment.
Is it enough for him?
29. Importance of nutrition
Patients with severe malnutrition have
greater incidence of postoperative
complications such as
Pneumonia
Wound infection
Prolonged hospital stay
34. Total Parenteral Nutrition
Indication: :( Where Enteral feeding is
impossible)
Gut short: Volvulus with
infarction
Gut blocked: Anastomotic edema
Gut unable to cope: Radiation
enteritis
Gut fistulated: Crohn’s disease
35. TPN regimen (In a 55kg pt)
Nutrition Amount/daily
50% Dextrose 550ml
20% lipid Solution 550 ml
Amino Acid solution 1000ml
Free Water 400ml
Total volume 2500ml
Volume For Electrolytes 200ml
Trace element Solution 10ml/day
Extra Zinc 10ml/day
Multivit Infusion 10ml/day
Folic Acid 1mg/day
36. Follow up of TPN
Tube Dressing – 3 times in a week
S. Electrolytes and glucose daily until
pt is stable. If stable then 3 Times in
a week.
Zinc, Mg, Hb – weekly
weight monitoring - Daily
39. Case Scenario…
Mr. Jashim Uddin is admitted in
DMCH for last 1 month. He has
undergone several episode of
laparotomy. He has h/o fever fpr last
2 days. Suddenly a rush of fresh
blood started to come from his
ileostomy bag. To manage it Which
component of blood he need?
40. Indication of BT
Acute blood loss
Major surgical operations
Road traffic accident
Hematemesis & melena
perioperative anemia
Severe burn victims
DIC
Hematological disorders etc.
41. Blood components
Whole blood
Packed red cell
Fresh frozen plasma
Platelet concentrate
Cryoprecipitate
Factor VIII
Factor IX
45. Management of HTR…
STOP THE TRANSFUSION.
Maintain the urine output at a minimum of
75 to 100 ml/hour.
Alkalinize the urine
Determine platelet count, partial
thromboplastin time, and serum fibrinogen
level.
Return unused blood to blood bank for
repeat crossmatch.
Prevent hypotension to ensure adequate
renal blood flow.
46. “Its not merely a mercy to the
patient to maintain the proper
supplementation of nutrients. it’s
essential to save life. If I miss it
then it will be just Miss-
magement…”