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FLUIDS AND ELECTROLYTES D E L P R A D O M. D.. FLUID COMPOSITION Total Body Water: 60% Body Weight Intracellular 40% Body Weight Extracellular 20% Body.

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Presentation on theme: "FLUIDS AND ELECTROLYTES D E L P R A D O M. D.. FLUID COMPOSITION Total Body Water: 60% Body Weight Intracellular 40% Body Weight Extracellular 20% Body."— Presentation transcript:

1 FLUIDS AND ELECTROLYTES D E L P R A D O M. D.

2 FLUID COMPOSITION Total Body Water: 60% Body Weight Intracellular 40% Body Weight Extracellular 20% Body Weight Interstitial: 15% Body Weight Intravascular: 5 % Body Weight

3 INTRACELLULAR AND EXTRACELLULAR FLUID COMPOSITION Intracellular (mEq/L) Extracellular (mEq/L) Na+20133-145 K+1503-5 Cl--98-110 HCO3-1020-25 PO4 3-110-1155 Protein7510

4 Maintenance Requirements Holiday-Segar Method –Estimates caloric expenditure in fixed weight categories; it assumes that for each 100 calories metabolized, 100ml of water will be required.

5 HOLIDAY-SEGAR METHOD Water Body WeightmL/kg/dayml/kg/hr First 10kg10024 hr/day4 Second 10kg5024 hr/day2 Each additional kg. 2024 hr/day1

6 BODY SURFACE AREA METHOD Mosteller’s Formula Surface area (m2): –Square root (Height (cm) x Weight (kg)/ 3600)

7 STANDARD VALUES FOR USE IN BODY SURFACE AREA METHOD H201500 mL/m2/24 hr Na+30-50 mEq/m2/24 hr K+20-40 mEq/m2/24 hr

8 BSA TFR: Insensible water loss + urine output IWL: 400-600 ml/m2/day x BSA Urine: 600-1000 ml/m2/day x BSA

9 CONDITIONS THAT ALTER MAINTENANCE FLUID Fever: 12% for each C >37.5 C or 7ml/kg for each 0.5C > 37.5C Room temp: >31 C 30% per degree rise Hypermetabolism –Major surgery –Burns 20-30% 20% increase per 1% area burn

10 CONDITIONS THAT ALTER MAINTENANCE FLUID Less required Hypothermia High Humidity Oliguria/Edema Sedated/Paralyzed 12% for each C <37.5 30% Case to case/ 30% 40%

11 DEFICIT THERAPY Fluid Deficit (L) – pre-illness weight (kg) - illness weight (kg) % Dehydration –(pre-illness weight - illness weight)/pre-illness weight x 100%

12 PERCENTAGE OF DEFICIT FROM EXTRACELLULAR AND INTRACELLULAR COMPARTMENTS Duration of Illness Deficit from ECF (%) Deficit from ICF (%) <3 days8020 >3days6040

13 CLINICAL OBSERVATION IN DEHYRATION OLDER CHILD 3% (30mL/kg)6% (60mL/kg)9% (90mL/kg) INFANT Examination5% (50mL/kg)10% (100mL/kg) 15% (150mL/kg) DehydrationMildModerateSevere Skin TurgorNormalTentingNone Skin (Touch)NormalDryClammy Buccal Mucosa MoistDryParched/ Cracked

14 CLINICAL OBSERVATION IN DEHYDRATION EyesNormalDeep SetSunken TearsPresentReducedNone FontanelleFlatSoftSunken CNSConsolableIrritableLethargic/ Obtunded Pulse rateNormalSlightly increased Increased Pulse qualityNormalweakFeeble/ Impalpable Capullary refilNormal2 sec> 3sec Urine OutputNormalDecreasedAnuric

15 LUDANS METHOD MildModerateSevere <15kg < 2y/o 50cc/kg100150 > 15kg > 2 y/o 306090 D5 0.3NaCl 6-8 hrs 1st hr 1/4 PLRS Next 5-7 hr 3/4 D5LRS 1st hr PLRS Next 5-7 hr 2/3 D5 0.3 NSS

16 COMPOSITION OF FREQUENTLY USED PARENTERAL FLUIDS LIQUIDCHO g/100mL Protein g/100mL Cal /L Na+ mEq/L K+ mEq/L Cl- mEq/L HCO3 mEq/L Ca+2 mEq/L mOs m/L D5W5-170-----252 NS (0.9% NaCl) ---154- --308 D5 0.35-17051- --- LRS0-10-0- 340 1474155.5-4 D5 IMB5-170252022--- D5 NM5-170401340--- D5 NR5-170140598---

17 ELECTROLYTE COMPOSITION OF VARIOUS BODY FLUIDS FluidNa+ (mEq/L)K+ (mEq/L)Cl- (mEq/L) Gastric20-805-20100-150 Pancreatic120-1405-1590-120 Small Bowel100-1405-1590-130 Bile120-1405-1580-120 Ileostomy45-1353-1520-115 Diarrhea10-9010-8010-110 Burns1405110 Sweat10-303-1010-35

18 ANION GAP (Na + K) - (Cl + HCO3) N.V. : 8-16 mg/dL

19 SODIUM DEFICIT mEq Na deficit : – (desired - actual) x TBW – TBW = 0.6 x BW (kg) Initial goal : 120 mEq/L subsequent 130mEq/L in 24 hrs Correct up to 12 mEq/L/day

20 HYPERNATREMIA (Plasma Na - 140) / 140 x TBW Correct up to 10-15 mmol/L/day

21 HYPOKALEMIA mmol K deficit : –(desired-actual) x 0.3 x wt.kg. Deficit : Wt. (kg) x 50 x Estimated % deficit


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