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Fluid & Electrolytes Management: Part I Component & composition of body fluid Mechanisms of fluid homeostasis Parenteral fluid therapy.

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Presentation on theme: "Fluid & Electrolytes Management: Part I Component & composition of body fluid Mechanisms of fluid homeostasis Parenteral fluid therapy."— Presentation transcript:

1 Fluid & Electrolytes Management: Part I Component & composition of body fluid Mechanisms of fluid homeostasis Parenteral fluid therapy

2 Body Fluid Compartments: ICF:55%~75% Intravascular  plasma X 50~70% lean body weight Extravascular  Interstitial fluid TBW ECF 3/4 1/4 Male (60%) > female (50%) Most concentrated in skeletal muscle TBW=0.6xBW ICF=0.4xBW ECF=0.2xBW 2/3 1/3

3 Composition of Body Fluids: Ca 2+ Mg 2+ K+K+ Na + Cl - PO 4 3- Organic anion HCO 3 - Protein CationsAnions ECF ICF Osmolarity = solute/(solute+solvent) Osmolarity = solute/(solute+solvent) Osmolality = solute/solvent (290~310mOsm/L) Osmolality = solute/solvent (290~310mOsm/L) Tonicity = effective osmolality Tonicity = effective osmolality Plasma osmolility = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma osmolility = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma tonicity = 2 x (Na) + (Glucose/18) Plasma tonicity = 2 x (Na) + (Glucose/18)

4 Regulation of Fluids: Hydrostatic pressure v.s. Oncotic pressure  Albumin is the major determining oncotic pressure

5 Regulation of Fluids: Renal sympathetic nerves Renin-angiotensin- aldosterone system Atrial natriuretic peptide (ANP)

6 Composition of GI Secretions: Source Volume (ml/24h) Na +* K+K+K+K+ Cl - HCO 3 - Salivary 1500 (500~2000)10 (2~10)26 (20~30)10 (8~18)30 Stomach 1500 (100~4000)60 (9~116)10 (0~32)130 (8~154)0 Duodenum 100~ Ileum (80~150)5 (2~8)104 (43~137)30 Colon Pancreas (113~185)5 (3~7)75 (54~95)115 Bile (131~164)5 (3~12)100 (89~180)35 * Average concentration: mmol/L

7 Signs of Hypovolemia: Diminished skin turgor Dry oral mucus membrane Oliguria - <500ml/day - normal: 0.5~1ml/kg/h Tachycardia Hypotension Hypoperfusion  cyanosis Altered mental status

8 Clinical Diagnosis of Hypovolemia: Thorough history taking: poor intake, GI bleeding…etc BUN : Creatinine > 20 : 1 - BUN↑: hyperalimentation, glucocorticoid therapy, UGI bleeding Increased specific gravity Increased hematocrit Electrolytes imbalance Acid-base disorder

9 Parenteral Fluid Therapy: Crystalloids: - contain Na as the main osmotically active particle - useful for volume expansion (mainly interstitial space) - for maintenance infusion - correction of electrolyte abnormality

10 Crystalloids: Isotonic crystalloids - Lactated Ringer’s, 0.9% NaCl - only 25% remain intravascularly Hypertonic saline solutions - 3% NaCl Hypotonic solutions - D5W, 0.45% NaCl - less than 10% remain intra- vascularly, inadequate for fluid resuscitation

11 Colloid Solutions: Contain high molecular weight substances  do not readily migrate across capillary walls Preparations - Albumin: 5%, 25% - Dextran - Gelifundol - Haes-steril 10%

12 SolutionsVolumes Na + K+K+K+K+ Ca 2+ Mg 2+ Cl - HCO 3 - DextrosemOsm/L ECF Lactated Ringer’s % NaCl % NaCl D5W D5/0.45% NaCl % NaCl % Hetastarch % Albumin 250, < % Albumin 20,50, < Common parenteral fluid therapy

13 The Influence of Colloid & Crystalloid on Blood Volume: 1000cc 500cc Lactated Ringers 5% Albumin 6% Hetastarch Whole blood Blood volume Infusion volume

14 Signs of Hypervolemia: Hypertension Polyuria Peripheral edema Wet lung Jugular vein engorgement Especially when hypo-albuminemia

15 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

16 Fluid Management: Goal: - to maintain urine output of 0.5~1.0mg/kg/h Rule: 100* *10 + 〔 (x-20)/10 〕 *20 = x Electrolytes require: - Na + : 1-2mmol/kg/day - K + : 0.5~1.0mmol/kg/day Avoid fluid overload, especially in malnutrition, heart failure and renal insufficiency patient

17 Fluid Management: For acute blood loss - Begin with 2-3L isotonic crystalloid to restore blood pressure and peripheral perfusion - Early use of colloid - Crystalloid + 5% albumin in a ratio of 4:1 - Blood transfusion - Large borne IV line

18 To be Continued !!!


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