Fluid Therapy

Dimas N. Sunarto
Dr. Chandra Irwanadi, SpPD-KGH, FINASIM
MATA KULIAH DASAR
PPDS ILMU PENYAKIT DALAM JANTUNG PARU
R. SIDANG D, PDNS, 7 JANUARI 2016
Body Fluids Distribution
Approx. 60% of average human body is fluids
Distributed into two:
1. Extracellular fluid (incl. plasma and transcellular)
2. Intracellular fluid
Body Fluids Distribution (cont.)
Fluid Movements
Daily Fluid Balance
Intake
1500 ml liquid intake
750 ml food
250 ml oxidative phosphorylation

Output
1500 ml urine
100 ml feces
900 ml insensible loss (skin, lungs)
Daily Fluid Balance (cont.)
Daily requirements increased in:
1. Fever
2. Breathlessness and tachypnea
3. Diarrhea and vomiting
4. Haemorrhage
5. Surgical drains, stoma and fistulae
6. Polyuria
7. Third space losses
8. SIRS capillary leak
Fluid Balances Mechanism
Kidney
Thirst
ADH
RAA system
GI & skin
Fluid Imbalances
HYPOVOLEMIA
Isotonic
Hypotonic
Hypertonic
HYPERVOLEMIA
Isotonic
Hypotonic
Hypertonic
Volume Status
History taking
Examination
Investigations
Stages of Fluid Loss
Stage 1 (< 15% or <750ml loss)
Stage 2 (15-30% or 750-1500ml)
Stage 3 (30-40% or 1500-2000ml)
Stage 4 (>40% or >2000ml)
Intravenous Fluid

1. Maintenance
o To provide daily fluid requirements

2. Resuscitation
o To replace intravascular volume
Type of IV fluids
1. Crystalloids

2. Colloids

3. Blood products
Crystalloids
Solution Type Uses
Isotonic Fluid loss Dehydration
D5 Hypernatraemia

Isotonic Shock Hyponatraemia Blood

0.9% NaCl transfusions Resuscitation Fluid
challenges
Diabetic Keto Acidosis (DKA)

Isotonic Dehydration
Lactated Ringers Burns
(Hartmanns) Lower GI fluid loss Acute blood
loss
Hypovolaemia due to third spacing
Hypotonic Water replacement DKA
0.45% NaCl Gastric fluid loss from NG or vomiting

Hypertonic Later in DKA

D5 NSx
Hypertonic Temporary treatment from shock if plasma
D5 NS expanders arent available Addisons crisis

Hypertonic Water replacement

D10 Conditions where req. nutrition with glucose
Colloids
Colloid Action/use
Albumin (Plasma protein) Keeps fluids in vessels
4% or 20% Maintains volume
Primarily used to replace protein and treat
shock
Dextran (Polysaccharide) Shifts fluids into vessels
40 or 70 Vascular expansion
Prolongs haemodynamic response when
given with HES
Hetastarch (HES) Shifts fluids into vessels
(synthetic starch) 6% or Vascular expansion
10%
Mannitol (alcohol sugar) Oliguric diuresis
5% or 10% Reduces cerebral oedema
Eliminates toxins
Resuscitation volumes
1. Based on the plasma sodium levels
Na2 x Vol2 = Na1 x Vol1
Fluid deficit = Vol1 Vol2
2. Using Daldiyono scoring (for acute diarrhea)
Fluid needed = score / 15 x 10% x BW (kg) x 1 L
3. Special considerations:
Acute hemorrhage Liver failure
Burns Pancreatitis
Diabetic ketoacidosis Oliguria
Heart failure Geriatric pt
Take home messages
1. Body fluid distributed in intracellular and extracellular
space
2. Fluid balance is regulated by various organ and
mechanism
3. Type and volumes of IV fluid replacement are depends
from volume status and the underlying conditions