FLUID THERAPY
RESUSCITATION MAINTENANCE
Crystalloid
Colloid
ELECTROLYTES
NUTRITION
Electrolyte composition
mEq/L
Na+ K+ Ca2+ Mg2+ ClHCO3HPO42SO42Organic acid
Protein
Ion Distribution
ANION Suitable solution
containing K+ Mg+ and HPO4Cl-, HCO3- Prot. High Na+ and ClCl- HCO3-
Deficit .
Dehydration
* thirst * urine output hypotonic electrolytes
Hypovolemia
headache nausea syncope isotonic electrolytes
5% Dextrose N/2-D5
Hypotonic -Fluid has fewer solutes than plasma Water, 1/2 N/S (0.45% NaCl), and D5W (5% dextrose in water) after the sugar is used up
Hypertonic-Fluid has more solutes than plasma 5 % Dextrose in Normal Saline (D5 N/S), 3% saline solution, D5 in RL.
Isotonic Dehydration
Most Common form of Dehydration
Hypertonic Dehydration
Second most common type of dehydration.
Occurs when water loss from ECF is greater than solute loss
hyperventilation, pure water loss with high fevers, and watery diarrhea.
Diabetic Ketoacidosis and Diabetes Insipidus Iatrogenic Causes prolonged NPO, excessive hypertonic fluids, sodium bicarbonate, or tube feedings with inadequate water
Hypotonic Dehydration
Relatively Uncommon - Loss of more solute
(usually sodium) than water. Hypotonic Dehydration causes fluid to shift from the blood stream into the cells, leading to decreased vascular volume and eventual shock
Increased cellular swelling -causes increased intracrainial pressure - H/A and Confusion.
Isotonic infusion
Ringers acetate Ringers lactate Normal saline
Replace acute/ abnormal loss
increases ECF
ICF
ISF 800 ml
Plasma 200 ml
Hypotonic infusion
5% dextrose
ICF
660 ml
ISF
255 ml
Plasma
85 ml
Fluid Therapy
Replacement Maintenance Repair deficit
BACIC PRINCIPLES
Replace
Abnormal loss: GIT, 3rd space, Ongoing loss, septic and Hypovolemic shock IWL + urine Acid base, electrolyte imbalances
Maintain Repair
FLUID SELECTION
Replace : RA, RL, NS
Maintain: N/2 + D (adult) + K+ 20 mEq
Maintenance
IWL + urine Adults/children : 4:2:1 eg 60 kg 4 x 10 + 2 x 10 + 1 x 40 = 100ml/hr
Requirements
Fever Restless/delirium Warm ambient temperature Hyperventilation
Requirements
Hypothermia High humidity Oliguria/anuria Reduced consciousness Retention/oedema Increased intracranial pressure
Electrolyte solutions
Plasma
Isotonic solutions 308 273 Hypotonic solutions
290
278 278
290
D5
KAEN 3B*
* KAEN 3B : contains 50 mmol Na+, 20 mmol K+, 50 mmol Cl-, 20 mmol lactate, 27 g dextrose per L.
Relationship between serum K+ serum and TBK at various levels of deficit and excess
10 86serum K+ (meq/L) 4 2-900 -600 -300 0 +300 K+ deficit (meq) K+ excess (meq)
4.5
4.0
4.0
3.5
3.5
3.0
3.0
2.5
2.5
2.0
100 mEq
200 mEq
3.2
Acidosis
cell ECF
3.0
2.5
2.0
1.5
DCC
Cell
ECF
Tubulus distal
3 K+ H+ 2 Na +
3 K+ H+ 2 Na +
H+ K+
3 K+
3 K+
H+ 2 Na +
H+ 2 Na +
K+ H+ Urin
Urine
H +
acid urine
K + low urine K+
KCl bolus
Conclusion
Maintenance fluid therapy : normal loss (IWL + Urine) Suitable in hypertonic dehydration Minimized risk of potassium depletion in cases of prolonged inadequate oral intake Ready for use product associated with less risk of contamination Can be combined with amino acids