fluid management in surgical patient

1. Fluid management

3. plasma interstitial intracellular
Cations
Na 140 146 12
K 4 4 150
Ca 5 3 10
Mg 2 1 7
Anions
Cl 103 104 3
HCO 24 27 10
SO4 1 1 -
HPO4 2 2 116
Protein 16 5 40

5. • Potassium ~50 - 60 meq (1meq/kg/day)
• Magnesium – 8-20 meq
• Sodium – ~100-120 meq (2meq/kg/day)
Fluid requirements
per day
Fluid
requirements per
hour
First 10kg 100 ml/kg 4 ml/kg
Second 10kg 50 ml/kg 2 ml/kg
Subsequent kgs 20 ml/kg 1 ml/kg
Adults ~ 1.5ml/kg per hour

7. Maintenace fluids in post operative
patients.
• 1st post op day – only 5% D
• 2nd post op day – add Na+
• 3rd post op day – add K+
Daily requirements = Normal maintenance + Abnormal losses
+ Pre-existing deficits

8. Secretions
Sodium
(mmol/L)
Potassium(m
mol/L)
Chloride
(mmol/L)
Bicarbonate
(mmol/L)
Salivary 50 20 40 50
Gastric 50 15 120 20
Duodenal 140 5 80 -
Biliary 140 10 100 40
Pancreatic 140 10 80 80
Jejuno-ileal 130 20 105 30
Faeces 80 10 100 25
Diarrhoea 100 30 50 60
Approximate electrolyte concentrations

9. • On going GI loss
• CORRECT WITH 0.9% NS and 20 meq K+
(1g=13 mEq)

10. • What will be the maintainance IV fluid order
for a 70 kg man. POD1. Ng=500ml.