This document discusses intravenous fluid therapy. It describes the distribution of fluids in the body, with 3L of the 5L vascular volume being plasma. Intravenous fluid therapy consists of crystalloids and colloids. Crystalloids contain sodium as the major particle and include normal saline, Hartmann's solution, D5W, and others. Crystalloids are inexpensive and used for volume expansion, maintenance infusions, and electrolyte imbalance correction. Colloids contain particles that exert oncotic pressure, either naturally like albumin or synthetically like gelatin and hydroxyethyl starches. A daily maintenance fluid regimen typically consists of a combination of 5% dextrose solution and Ringer's lactate or normal saline.

1. Intravenous Fluids
Management
Dr. Muhammad Zakaullah Dogar
Resident Surgeon

2. Distribution of fluids within body
Vascular volume is 5L and in it 3L is Plasma

3. Intravenous Fluids Therapy
Consists of:
• Crystalloids
• Colloids
• Combination of both

4. CRYSTALLOIDS
• Are the solutions that contain SODIUM as the major particle.
• With or without glucose
• These include
• Sodium Chloride 0.9% (Normal Saline)
• Hartmann’s Solution (Ringer Lactate)
• D5W
• 0.45%NaCl
• D5RL
• D5/0.45%NaCl
Na

5. Composition of Common CRYSTALLOIDS Fluids
Solution Osmolarity mOsml
Extracellular Fluid 280-310
RL, NS Isotonic Crystalloids
0.45%NaCl, D5W Hypotonic Solution
D5/0.45NaCl, D5LR Hypertonic Saline Solution

6. Crystalloids are inexpensive and used for:
1. Volume Expansion
2. Maintenance infusions
3. Correction of Electrolyte imbalance

7. COLLOIDS
• Solutions contain the particles that expert an Oncotic Pressure.
• May occur:
• Naturally ( Albumin)
• Synthetic ( Gelatin, hydroxyethyl starches HES)
e.g, Gelofusine, Haaemacel, Hetastarch

8. Fig A. Distribution of different fluids in body fluids compartments
30-60 minutes after rapid intravenous infusion of 1000ml.

9. Assessing losses in Surgical Patients

10. Maintenance Fluids requirements
• Are calculated from an estimation of insensible and obligatory losses.
2500
Pyrexia 200ml/day
Sweating 1Litre/hour

11. Maintenance Fluids requirements
• 30-40 ml/kg gives an estimate of daily requirements.
• 4/2/1 Formula
Example: What is the maintenance fluid requirement for a 70-kg man?
Answer: 40+20+50110ml/hr
110 x 24 2640ml in day

12. Daily requirements of Electrolytes

14. Daily maintenance fluids
A typical daily maintenance fluid regimen would consist of combination
of:
• 5% Dextrose solution (2/3rd) with
• Ringer lactate/ Normal Saline (1/3rd), to a volume of 2 liters
A 40kg small elderly patient 500ml of saline and 1.5 liters of 5% dextrose.
A 80kg large young patient 1 liter of saline and 2 liters of 5 % dextrose.