Fluid Therapy Essentials

UNIT:6.3
FLUID THERAPY
2/28/2021
JONES H.M- MBA/DMS 1

MRS C. S. HAMWEETE
RN, BscN.
2/28/2021

 Fluid, electrolyte , and acid base balances within the
body are necessary to maintain health and function in
all body systems. These balances are maintained by
the intake and output of water and electrolytes and
regulation by the Renal and pulmonary systems.
Imbalances may result from factors like altered fluid
intake, or prolonged episodes of vomiting or diarrhea.
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 Solute- is a substance that dissolves in a solvent.
 There are many solutes, for example:
 Plasma proteins (eg. albumin, globulins, fibrinogen)
 Ions (sodium chloride, magnesium, calcium,
bicarbonates)
 Food molecules (eg. glucose, amino-acids), waste
products as urea
 Solvent- is a substance capable of dissolving a
solute.
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 Electrolyte- are charged particles (ions) that are
dissolved in body fluids.
 E.g potassium, calcium, magnesium, sodium etc.
 Osmolarity-measure of total solute concentration
per liter of solution.
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 Isotonic solution-fluid with the same osmolarity
as the interior of the cell.
 Hypotonic -solutions where solutes are less
concentrated than the interior of cell.
 Hypertonic -solutions where solutes are more
concentrated than the interior of cell.
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 Water is a major component of our body’s make
up. 60% of an adult male’s body weight is water
while 50% of an adult female weight is water. 70
to 80% of a baby’s weight is water.
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Body fluids are distributed into two distinct
compartments, that is intracellular fluids
and extracellular fluids.
Intracellular fluid comprises of fluid within
body cells. In adults approx. 40% of body
weight is ICF.
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Extracellular fluid is all the fluid outside a cell.
It is divided into smaller compartments :
interstitial fluid( lymph), intravascular fluid( blood
plasma) and transcellular fluids( CSF, pleural,
peritoneal, and synovial fluids).
Extracellular fluid makes up 20% of the body
weight.
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 Transport of nutrients and electrolytes to cells
 Dissolving and carrying waste products away
from the cell
 Regulation of body temperature
 Acts as a medium for food digestion
 Lubricates joints and membranes.
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ELECTROLYTES
2/28/2021

Plasma
(mmol/L)
Interstitial
fluid (mmol/L)
Intracellular
fluid (mmol/L)
Na+ 142 144 10
K+ 4 4 160
Ca2+ 2.5 2.5 1.5
Mg2+ 1.0 0.5 13
2/28/2021

Cl- 102 114 2
HCO3
- 26 30 8
PO4
2- 1.0 1.0 57
SO4
2- 0.5 0.5 10
Organic acid 3 4 3
Protein 16 0 55
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 Distribute body water between fluid compartments
 Regulate acid-base balance
 Maintain body fluid volume and osmolarity
 Promote neuromuscular irritability
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Body fluids are regulated by fluid intake,
hormonal control and fluid output.
Fluid intake is regulated primarily through thirst
mechanism. The thirst control center is found in
the hypothalamus in the brain.
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 Average intake for an adult=2200-2700mls
of fluids per day.
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Antidiuretic hormone (ADH) is released in
response to blood osmolarity. It works directly on
the renal tubules making them more permeable to
water thereby causing more water to return to the
systemic circulation.
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 Output occurs through four organs of water loss,
kidneys, skin , lungs and gastrointestinal tract.
 Kidneys produces and excretes between 1200-
1500mls of urine per day.
 Skin loses water through sweat.
On average 500-600mls of fluids is lost through
the skin.
 Lungs expires on average 400mls of water per
day
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 Maintenance ( to supply daily needs).
 Maintenance therapy is usually undertaken when the
individual is not expected to eat or drink normally for a
longer time (eg, perioperatively or patient on a ventilator)
 Resuscitation ( to correct an IV or extracellular
deficit ). Correction of existing abnormalities in
volume status or serum electrolytes (as in
hypovolemic shock).
 Replacement ( to replace deficit and on-going
losses ). E.g Diarrhoea or vomiting.
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 History taking. The history will reveal any
risk factor that may cause disturbance of
fluid and electrolyte balance.
 Physical assessment . You look out for
signs of fluid deficit and fluid excess .
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 Sunken eyes.
 Cold clummy skin.
 Loss of skin turgor.
 Dry mucus membranes.
 Weak pulse.
 Low Blood pressure.
 Oliguria or anuria.
 Decreased body temperature.
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 The fluids used in clinical practice are usefully
classified into colloids, crystalloids and blood
products.
1.Colloid
Solutions that contain large molecules that don't
pass the cell membranes.
When infused, they remain in the intravascular
compartment and expand the intravascular volume.
They draw fluid from extravascular spaces via their
higher oncotic pressure
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2.Crystalloid
Solutions that contain small molecules that flow easily
across the cell membranes, allowing for transfer from the
bloodstream into the cells and body tissues.
This will increase fluid volume in both the interstitial and
intravascular spaces (Extracellular)
It is subdivided into:
* Isotonic
* Hypotonic
* Hypertonic
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 A solution is considered isotonic When the concentration
of the particles (solutes) is similar to that of plasma, So it doesn't
move into cells and remains within the extracellular
compartment thus increasing intravascular volume.
Types of isotonic solutions include:
 0.9% sodium chloride (0.9% NaCl)
 lactated Ringer's solution
 5% dextrose in water (D5W)
 Ringer's solution
2/28/2021

 A- 0.9% sodium chloride (Normal Saline)
 Simply salt water that contains only water, sodium
(154 mEq/L), and chloride (154 mEq/L).
 It's called "normal saline solution" because the
percentage of sodium chloride in the solution is
similar to the concentration of sodium and chloride
in the intravascular space.
2/28/2021

When to be given?
1- to treat low extracellular fluid, as in fluid volume deficit from
- Hemorrhage - Severe vomiting or diarrhea - Heavy drainage from
GI suction, or wounds
2- Shock
3- Mild hyponatremia
4- Metabolic acidosis (such as diabetic ketoacidosis)
5- It’s the fluid of choice for resuscitation efforts.
6- it's the only fluid used with administration of blood products.
2/28/2021

 B- Ringer's lactate or Hartmann solution.
o is the most physiologically adaptable fluid because
its electrolyte content is most closely related to the
composition of the body's blood serum and
plasma.
o Another choice for first-line fluid resuscitation for
certain patients, such as those with burn injuries.
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When to be used?
 To replace GI tract fluid losses ( Diarrhea or
vomiting )
 Fistula drainage
 Fluid losses due to burns and trauma
 Patients experiencing acute blood loss or
hypovolemia due to third-space fluid shifts.
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 Note: Both 0.9% sodium chloride and LR may be
used in many clinical situations, but patients
requiring electrolyte replacement (such as surgical
or burn patients) will benefit more from an
infusion of LR.
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 D- Dextrose 5% in water
It is considered an isotonic solution, but when the dextrose is
metabolized, the solution actually becomes hypotonic and
causes fluid to shift into cells.
How does it work?
 D5W provides free water that pass through membrane
pores to both intracellular and extracellular spaces. Its
smaller size allows the molecules to pass more freely
between compartments, thus expanding both
compartments simultaneously.
2/28/2021

 It provides 170 calories per liter, but it doesn't replace
electrolytes.
 The supplied calories doesn't provide enough nutrition for
prolonged use. But still can be added to provide some
calories while the patient is NPO.
2/28/2021

 Compared with intracellular fluid (as well as compared
with isotonic solutions), hypotonic solutions have a
lower concentration of solutes (electrolytes). And
osmolality less than 250 mOsm/L .
 Hypotonic crystalloid solutions lowers the serum
osmolality within the vascular space, causing fluid to
shift from the intravascular space to both the
intracellular and interstitial spaces.
 These solutions will hydrate cells, although their use
may deplete fluid within the circulatory system.
2/28/2021

 TYPES OF HYPOTONIC FLUIDS
 0.45% sodium chloride (0.45% NaCl), 0.33% sodium
chloride, 0.2% sodium chloride, and 2.5% dextrose in water
 Hypotonic fluids are used to treat patients with
conditions causing intracellular dehydration, when fluid
needs to be shifted into the cell , such as:
1. Hypernatremia
2. Hyperosmolar hyperglycemic state.
2/28/2021

 Hypertonic solutions are those that have a higher
tonicity or solute concentration. Hypertonic fluids
have an osmolarity of 375 mOsm/L or higher.
 The osmotic pressure gradient draws water out of
the intracellular space, increasing extracellular fluid
volume, so they are used as volume expanders.
2/28/2021

Some examples and Indications:
1- 3% sodium chloride (3% NaCl):
 May be prescribed for patients in critical situations of
severe hyponatremia.
 Patients with cerebral edema may benefit from an infusion
of hypertonic sodium chloride
2- 5% Dextrose with normal saline (D5NS): which replaces
sodium, chloride and some calories.
2/28/2021

How do they work?
 They expand the intravascular volume by drawing fluid
from the interstitial spaces into the intravascular
compartment through their higher oncotic pressure.
 They have the same effect as hypertonic crystalloids
solutions but they require administration of less total
volume and have a longer duration of action because
the molecules remain within the intravascular space
longer.
 Their effect can last for several days if capillary wall
linings are intact and working properly.
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Examples: 5% albumin (Human albumin solution).
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• Fluid balance is essential in determining
hydration, and ideally fluid intake should be
equal to fluid output.
• A fluid balance chart is a tool devised to
monitor fluid balance .
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 Actual or potential dehydration
 Commencing IV fluid
 Routine post op management
 Acutely ill patients.
 Fluid restriction
 Cardiac failure
 Acute renal failure
2/28/2021

 Goal of fluid therapy is to provide the right amount
of the right fluid at the right time.
 Drops /minute= Total volume to be infused X
drops per/min ( drop factor) on a giving set over
the Total time for infusion in minute.
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Drops /minute= Total volume to be infused X drop factor
Total time for infusion in minutes
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What is a drop factor?
Drop factor is the number of drops in one milliliter used in IV
fluid administration (also called drip factor). A number of
different drop factors are available but the Commonest are:
1- 10 drops/ml (blood set)
2- 15 drops / ml (regular set)
3- 60 drops / ml (microdrop set)
2/28/2021

CLASS EXERCISE
1500 ml IV Saline is ordered over 12 hours. Using a
drop factor of 15 drops / ml, how many drops per
minute need to be delivered?
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• A fluid balance chart is a tool devised to monitor
fluid intake and output.
 Fluid balance chart is essential in determining
level of hydration.
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 In maintaining of a fluid balance chart you
record all fluid intake and output in a period of
24hours.
 Intake includes all liquids taken by mouth (e.g.
ice cream, soup, juice, and water), through NG
tube, and , IV fluids.
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 Output includes fluid loss through urine,
diarrhoea, vomitus, gastric suction, and
drainage from postsurgical wounds (for
surgical patients).
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 The process whereby fluids are lost through
sweating, breathing and so on.
 New fluid balance charts will have an averaged
amount stencilled into the output
 Insensible loss is added to the patients output
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 The health care provider must sign to say
he/she has started the chart
 Record the amount of fluid ordered, the period
of time it is supposed to run and the Rate of flow
calculated.
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 Complete the total intake
 Complete the output
 Add in the insensible loss
 Add the output & insensible loss together
 Subtract the output from the intake to enable the
final amount in the balance box
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 The health care provider completing the chart
and working out the balance has to sign for
completion at the end of the 24 hour period.
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Total
Intake
(a)
Total Output Balance
(a-d)
Output (b) Insensible
(c)
Both b & c
(d)
1863 1235 600 1835 28ml
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 Signs of fluid volume overload and the effects of
fluid overload on the body systems.
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THE END
2/28/2021

Fluid Therapy Essentials

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