1. FLUID AND ELECTROLYTE BALANCE
Prof. ÖZCAN GÖKÇE, MD
Director of the Department of General Surgery
Yeditepe University Hospital

2. Chemical and biologic activities of fluid
Total particle count in per unit volume of solution (mmol/L)
Electrically active particles in per unit volume of solution (mEql/L)
Osmotically active particles in per unit volume of solution (mO/L)

3. Osmolality
is a measure of the osmoles of solute per kilogram of solvent (osmol/kg)
The osmole (Osm or osmol) is a non-SI unit of measurement
that defines the number of moles of a chemical compound
that contribute to a solution's osmotic pressure.
Osmolarity is the measure of solute concentration (osmol/L)

5. Every increase 100 mg/dl glucose  1,6-3 meq/L Na+ decrease

6. Henderson-Hasselbach equation

8. pCO2= 37-42 mm Hg HCO3- = 22-28 meq/L
pH=7.34-7,44

21. P50
it is common to use the concept of P50 to describe the affinity of a given hemoglobin for oxygen.
The P50 is the PO2 at which the hemoglobin becomes 50% saturated with oxygen.
As the P50 decreases, oxygen affinity increases and visa versa.
Normal adult Hemoglobin A has a P50 of 26.5 mm Hg while
Fetal Hemoglobin F has a P50 of 20 mm Hg and
sickle cell anemia Hemoglobin S has a P50 of 34 mm Hg.

24. B C A
A<B<C
(a – v) O2

26. Anionic gap
Measured cathions = Na,K
Measured anions= HCO3- , Cl-

27. Anionic gap = Unmeasured anions-Unmeasured cathions
Na+K + Unmeasured cathions = HCO3- + Cl- + Unmeasured anions
Anionic gap = Na+K - ( HCO3- + Cl- )
Anionic gap = ( )
Anionic gap = 12 Meq/L
Correcred anionic gap = Actual anionic gap - {2,5(4,5-Albumin)}

34. FLUID REPLACEMENT

35. PRACTICAL ISSUES 1
Protein intake increases urea(Urine) and causes osmotic diuresis.
1gr protein needs 7 ml water

36. PRACTICAL ISSUES 2 Treatment of Hypernatremia
%5 dextroz, CVP and control of electrolytes

37. PRACTICAL ISSUES 3 Treatment of Hyponatremia 135 - Na mEq/lt = A
A*0,5*Body weight = B
%3 NaCl……518 mEq/lt
B*1000 = C C/2….in 2 hours
C/2….in other 6 hours

38. PRACTICAL ISSUES 4 Treatment of Acidosis 15-CO2 mEq/lt = A
A*0,3*Body weight = B
B*1000 = C (1/6 M Lactate) C/2….in 2 hours
C/2….in other 6 hours
B*1000 = C (1/6 M NaHCO3)
178

39. PRACTICAL ISSUES 5 Treatment of Hypopotasemia 3,5 - K mEq/lt = A
A*0,2*Body weight = B
B is not given more than 40mEq/hour
40mEq/liter
Blood K should be measured every 2 hs
K solutions contains 1 mEq/cc

40. PRACTICAL ISSUES 6 Daily Na requirement is 2-4 mEq/kg
Daily K requirement is Na/2 mEq/kg

41. THE END