Maintenance & Replacement Fluid Therapy

2. obligatory water intake or generation
obligatory water output
Fluid input and output should be equal.

3. Volume depletion result from :
Gastrointestinal losses, including vomiting, diarrhea, bleeding, and external drainage
Renal losses, including the effects of diuretics, osmotic diuresis, salt-wasting
nephropathies, and hypoaldosteronism
Skin losses, including sweat, burns, and other dermatological conditions
Third-space sequestration, including intestinal obstruction, crush injury, fracture, and acute
pancreatitis.

4. Clinical manifestation of fluid loss
• Symptoms related to fluid and symptoms related to electrolytes
disturbances.
• Symptoms related to fluid :
Easy fatigability, Thirst , Muscle Cramps and Postural Dizziness.
More severe fluid loss can lead to abdominal pain, chest pain, or
lethargy and confusion

5. • Symptoms related to electrolyte
Muscle weakness due to hypokalemia or hyperkalemia
Polyuria and polydipsia due to severe hypokalemia
Tachypnea due to acidosis
Neuromuscular irritability and confusion due to metabolic alkalosis
Lethargy, confusion, seizures, and coma due to hyponatremia or
hypernatremia

6. Fluid imbalance

7. 1. Maintenance replaces the ongoing losses of water and electrolytes
urine, sweat, respiration, and
stool
2. Replacement corrects any existing water and electrolyte deficits
Gastrointestinal, Urinary, or Skin losses, Bleeding,
and Third-space sequestration

8. 1.Maintenance Fluid Therapy
(Water + Electrolytes)
In the presence of normal or near-normal kidney function, maintenance fluid therapy is
usually undertaken when the patient is not expected to be able to eat or drink normally
for a prolonged period of time (eg, perioperatively or on a ventilator).
Goal
one to two weeks

9. best estimate of water balance
does not provide any information on volume status
Weighing the patient daily best means for estimating net gain or loss of fluid
clinical signs edema
reduced skin turgor, fall in blood pressure
1.Maintenance Fluid Therapy
(Water + Electrolytes)

10. less than one liter of electrolyte
(sodium and potassium)-free water as maintenance fluid
1. Increased water intake fever, sweating, burns, tachypnea, surgical drains, polyuria, or
ongoing significant gastrointestinal losses.
1. Decreased water intake oliguric renal failure, the use of
humidified air, edematous states, and hypothyroidism.
1.Maintenance Fluid Therapy
(Water + Electrolytes)

11. 1.Maintenance Fluid Therapy
(Water + Electrolytes)

12. 2 liters per day of one-half isotonic saline in 5 % dextrose
to which 20 mEq of Potassium Chloride is added per liter.
400 kilocalories
1.Maintenance Fluid Therapy
(Water + Electrolytes)

13. Electrolytes
The original solution can be continued unless one of the following occurs:
If the serum Na starts to fall, a more concentrated solution should be given (eg, isotonic saline in
5 % dextrose)
If the serum Na starts to rise due, for example, to increased insensible losses from high fever, a
more dilute solution should be given (eg, one-quarter isotonic saline in 5 % dextrose)
If the serum K starts to fall, more K should be added and, should it rise above normal, K should be
eliminated.
In patients with normal or near-normal renal function, hyperkalemia is a rare problem.
1.Maintenance Fluid Therapy
(Water + Electrolytes)

14. 2.Replacement Fluid Therapy
(Water Deficit)

15. blood pressure jugular venous pressure urine Na concentration urine
output the hematocrit
below 15 mEq/L
2.Replacement Fluid Therapy
(Water Deficit)

16. at least 1 to 2 liters of
isotonic fluids
eg, low blood pressure, low urine output, and/or
impaired mental status
2.Replacement Fluid Therapy
(Rate of Replacement)

17. must be greater than the
rate of continued fluid losses equal to the urine output plus estimated insensible losses
(usually 30 to 50 mL/hour) plus any other fluid losses
50 to 100 mL/hour greater than estimated fluid losses
2.Replacement Fluid Therapy
(Rate of Replacement)

18. isotonic or one-half isotonic saline
 Hypotonic solutions
 Isotonic or hypertonic saline
 Isotonic saline and/or blood
 Potassium or bicarbonate
2.Replacement Fluid Therapy
(Choice of replacement fluid)