This document discusses fluid management and discusses several key points: 1) It outlines the typical water content of the human body which can vary from 45-75% depending on factors like age, gender, and body type. 2) It describes the importance of fluid for homeostasis, transport mechanisms, metabolic reactions, tissue texture, and temperature regulation. 3) It discusses fluid disturbances like hypovolemia which is a common issue for surgical patients and can be caused by factors like bleeding, vomiting, diarrhea, or burns. 4) It provides guidance on fluid resuscitation versus maintenance volumes and outlines some special fluids that can be used in certain clinical situations.

1. Fluid management
Dr Shambhavi sharma
1st year resident
Department of Surgery
PAHS

2. Introduction
• Body is formed with solids & fluids.
• In human body water content is 45-75% of
body weight.

3. TBW varies with age, gender and body habitus
adult males= 60-65% of body weight, average
= 60%
 adult female= 45-50% of body weight,
average = 50%
 infant = 80% of body weight
 Obese patients have less TBW per Kg than
lean body adult.

5. Importance
• In homeostasis
• In transport Mechanism
• In metabolic reactions
• In maintenance of tissue texture
• In temperature regulation

6. Composition
Organic inorganic
• Glucose oxygen
• Amino acids electrolytes
• Protein
• Lipid
• Fats
• Hormones
• enzymes

7. Composition

9. Fluid disturbances
Hypovolemia ( volume depletion)
• ECF volume deficit is most common
fluid loss in surgical patients, and
aggravated by General Anesthesia.

10. Causes
Non hemorrhagic:
GI losses from vomiting
Nasogastric suction
 Diarrhoea
Fistular drainage
Stomas
Diuresis
Soft-tissue injuries and infections
Inflammation
Intestinal obstruction
Burn

11. Hemorrhagic:
Chest: aortic disruption, pulmonary
parenchyma trauma,pulmonary vascular
injury, hemoptysis
Abdomen/pelvis/peritoneum:
GI hemorrhage( varices/ulcers),solid organ
injuries,vascular( trauma ,rupture)
fractures (pelvic,long bones)
Gynaecological causes
External bleeding from tissue skin

12. assessment
History :
• Thorough history taking: poor intake, GI
bleeding, trauma, excessive vomiting,
symptoms of underlying disease

13. • Signs
 Diminished skin turgor
 Dry oral mucus membrane
 Dry axilla
 Oliguria - <500ml/day (normal: 0.5~1ml/kg/h)
 Flat neck veins
Tachycardia
Orthostatic Hypotension
 Hypoperfusion
cyanosis (hypothermia)
 Sunken eye
 Altered mental status

14. Monitoring fluid balance
 vital signs, including the development of fever
 serum and urine electrolytes
 Serum and urine osmolarity,
 BUN, creatinine and GFR
 Central venous pressure

15. • ABG: lactic acidosis
• Strict Inputs & Outputs on patients by
accurately measuring each source of input (ex:
IV fluid and medication volumes, oral intake
calculations) and output sources (urine,
stool/ostomy [emesis/diarrhea volume], and
drains [ex: NGT, chest tube]).

16. Resuscitation versus Maintenance
Volume
• Volume resuscitation : restoration of cardiac
output through the use of intravenous solutions
with an osmolarity that will allow it to remain
within the circulating volume and not be lost
quickly into the intracellular or interstitial space
• Maintenance fluid : restoration of the daily needs
of the entire system for normal homeostatic
function in order to maintain a euvolemic state.

20. colloids

22. Crystalloids or colloids…???
• Crystalloids – recommended as the initial fluid of
choice in resuscitating patients from hemorrhagic
shock
Svensen C, Ponzer S… Volume kinetics of Ringer solution
after surgery for hip fracture. Canadian journal of
anesthesia 1999 ; 46 : 133 – 141
• • COCHRANE Collaboration in critically ill patients – “
No evidence from RCT that resuscitation with colloids
reduces the risk of death, compared with crystalloids in
patients with trauma or burns after surgery” Roberts I,
Alderson P, Bunn F et al : Colloids versus crystalloids for
fluid resuscitation in critically ill patients.. Cochrane
Database Syst Rev(4) : CD 000567, 2004

24. Special fluids
• Inj KCl 10 ml amp – 20mEq
• 25%D (25 ml amp or 100 ml infusion bottle)–
in hypoglycemic shock
• Inj. Sodium bicarbonate (25 ml amp. 22.5mEq
Na+ & 22.5mEq HCO3-) dose = 10-15 mEq/L :
in metabolic acidosis
• Mannitol 10% & 20% : osmotic diuretic

25. Hypervolemia
• Iatrogenic or Secondary to renal insufficiency, cirrhosis, or
CHF.
Signs
• CNS: none
• CVS: elevated JVP, venous distension – pulmonary edema,
S3,
• Respiratory : shortness of breath even in rest.
• GI: edema of bowel
• Tissue: pitting edema – anasarca, ascites, weight

26. Clinical Diagnosis
• Electrolytes imbalance
• Decreased specific gravity
• Decreased hematocrit
• Cholesterol
• Liver enzymes: Bilirubin
• Creatinin clearance

27. Management of Hypervolemia
• Prevention is the best way
Guide fluid therapy with CVP level or
pulmonary wedge pressure
• Diuretics
• Increase oncotic pressure: FFP or albumin
infusion (may followed by diuretics)
• Dialysis

28. Fluid therapy in surgical patients
• paramount to the care of the surgical patient.
• Changes in both fluid volume and electrolyte
composition occur preoperatively,
intraoperatively, and post operatively,
• in response to trauma and sepsis.

29. Fluid resuscitation amount
• 20 ml/kg body weight bolus
• Until till no signs and symptoms of
dehydration
• For burn patients:
Parkland formula: 4ml/kg/burn surface area

30. Normal needs for a 70 kg man/day
water 2000ml
urine 1500ml
sodium 2-4 g
potassium 100 meq

31. Maintenance fluid: ½ normal saline
with 5% dextrose
rate: (40 + weight per kg )per hour
Water 2760ml
Dextrose 132g
Sodium 11.8g (203 meq)
Potassium 1.9 g (53 meq)

32. Calculation of maintenance fluid

33. preoperative
No fluids required for routine elective surgeries

40. references
• Sabiston Textbook of Surgery, 20th Edition
• Bailey & Love's Short Practice of Surgery,
27th Edition,Norman Williams, P Ronan
O'Connell, Andrew McCaskie
• World J Crit Care Med. 2015 Aug 4; 4(3): 192–
201.Published online 2015 Aug
4. doi: [10.5492/wjccm.v4.i3.192]

41. • Thank you