Download presentation

Presentation is loading. Please wait.

Published bySincere Moger Modified over 3 years ago

1
Fluid & electrolytes for 4th year studies; revision. Paddy Gibson Renal unit, RIE

2
What to do …. This presentation is based on a fluid and electrolytes lecture for 4th year students; in the absence of a speaker, it now has speakers notes ( click on view ), which should help you. If confused, reach for a textbook. Good luck.

3
Objectives: zRevision of fluid compartments zOsmotic/oncotic pressure / osmolality zFluid shifts in disease zPrescribing fluids

4
We are approximately two- thirds water

5
Fluid shifts / intakes Intracellular 30 litres Interstitial 9 litres IV 3 litres Kidneys Guts Lungs Skin Extracellular fluid - 12 litres

6
Osmotic / oncotic pressure Na + PP IntracellularInterstitialIntravascular

7
Calculation of osmolality zDifficult: measure & add all active osmoles zEasy = [ sodium x 2 ] + urea + glucose zNormal = 280 - 290 mosm / kg

8
The role of ADH: zADH = urinary concentration zADH = secreted in response to osmo; = secreted in response to vol; zADH acts on DCT / CD to reabsorb water zActs via V2 receptors & aquaporin 2 zActs only on WATER

9
Fluid shifts in disease zFluid loss: yGI: diarrhoea, vomiting, etc. yrenal: diuresis yvascular: haemorrhage yskin: burns zFluid gain: yIatrogenic: yHeart / liver / kidney failure:

10
Prescribing fluids: zCrystalloids: y0.9% saline - not normal ! y5% dextrose y0.18% saline + 0.45% dextrose yOthers zColloids: yblood yplasma / albumin ysynthetics

11
The rules of fluid replacement: zReplace blood with blood zReplace plasma with colloid zResuscitate with colloid zReplace ECF depletion with saline zRehydrate with dextrose

12
Crystalloids & colloids 30 litres 9 litres3 litres 2 litres of blood

13
Crystalloids & colloids 30 litres 9 litres5 litres

14
Crystalloids & colloids 30 litres 9 litres3 litres 2 litres of colloid

15
Crystalloids & colloids 30 litres 9 litres5 litres

16
Crystalloids & colloids 29 litres 8 litres7 litres

17
Crystalloids & colloids 30 litres 9 litres3 litres 2 litres of 0.9% saline

18
Crystalloids & colloids 30 litres 9 litres5 litres

19
Crystalloids & colloids 29 litres 10.5 litres4.5 litres

20
Crystalloids & colloids 30 litres 9 litres3 litres 2 litres of 5% dextrose

21
Crystalloids & colloids 31 litres 9.7 litres3.3 litres

22
How much fluid to give ? zWhat is your starting point ? yEuvolaemia ?( normal ) yHypovolaemia ?( dry ) yHypervolaemia ? ( wet ) zWhat are the expected losses ? zWhat are the expected gains ?

23
Signs of hypo / hypervolaemia: Signs of … Volume depletion Volume overload Postural hypotension Hypertension Tachycardia Absence of JVP @ 45 o Raised JVP / gallop rhythm Decreased skin turgor Oedema Dry mucosae Pleural effusions Supine hypotension Pulmonary oedema Oliguria Ascites Organ failure

24
What are the expected losses ? zMeasurable: yurine ( measure hourly if necessary ) yGI ( stool, stoma, drains, tubes ) zInsensible: ysweat yexhaled

25
What are the potential gains ? zOral intake: yfluids ynutritional supplements ybowel preparations zIV intake: ycolloids & crystalloids yfeeds ydrugs

26
Examples: zWhat follows is a series of simple - and some more complex fluid-balance problems for you zAnswers are in the speakers notes.

27
Case 1: zA 62 year old man is 2 days post-colectomy. He is euvolaemic, and is allowed to drink 500ml. His urine output is 63 ml/hour: 1. How much IV fluid does he need today ? 2. What type of IV fluid does he need ?

28
Case 2: z3 days after her admission, a 43 year old woman with diabetic ketoacidosis has a blood pressure of 88/46 mmHg & pulse of 110 bpm. Her charts show that her urine output over the last 3 days was 26.5 litres, whilst her total intake was 18 litres: 1. How much fluid does she need to regain a normal BP ? 2. What fluids would you use ?

29
Case 3: zAn 85 year old man receives IV fluids for 3 days following a stroke; he is not allowed to eat. He has ankle oedema and a JVP of +5 cms; his charts reveal a total input of 9 l and a urine output of 6 litres over these 3 days. 1. How much excess fluid does he carry ? 2. What would you do with his IV fluids ?

30
Case 4: z5 days after a liver transplant, a 48 year old man has a pyrexia of 40.8 o C. His charts for the last 24 hours reveal: zurine output:2.7 litres zdrain output:525 ml znasogastric output:1.475 litres zblood transfusion:2 units (350 ml each) zIV crystalloid:2.5 litres zoral fluids:500 ml

31
Case 4 cont: zOn examination he is tachycardic; his supine BP is OK, but you cant sit him up to check his erect BP. His serum [ Na+ ] is 140 mmol/l. zHow much IV fluid does he need ? zWhat fluid would you use ?

Similar presentations

OK

Fluid Management. The 60-40-20 rule: 60% total body weight is water 40% of total body weight is intracellular fluids 20% of body weight is extracellular.

Fluid Management. The 60-40-20 rule: 60% total body weight is water 40% of total body weight is intracellular fluids 20% of body weight is extracellular.

© 2017 SlidePlayer.com Inc.

All rights reserved.

Ads by Google

Ppt on eddy current probe Ppt on rabindranath tagore and his works Ppt on maintaining good health Ppt on earthquake in hindi Ppt on trial and error dvd Ppt on physical features of india for class 9th Ppt on ip addresses class a b c Ppt on life cycle of a frog 7 segment led display ppt online Bible ppt on how to treat mothers