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

2. FLUID COMPOSITION Total Body Water: Intracellular Extracellular
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+ 20 K+
150
3-5
Cl- -
98-110
HCO3- 10
20-25
PO4 3- 5
Protein 75

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 Weight mL/kg/day ml/kg/hr First 10kg
100
24 hr/day 4
Second 10kg 50 2
Each additional kg. 20 1

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
1500 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: ml/m2/day x BSA
Urine: 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) % Dehydration
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 days 80 20
>3days 60 40

13. CLINICAL OBSERVATION IN DEHYRATION
OLDER CHILD
3% (30mL/kg)
6% (60mL/kg)
9% (90mL/kg)
INFANT
Examination
5% (50mL/kg)
10%
(100mL/kg)
15%
(150mL/kg)
Dehydration
Mild
Moderate
Severe
Skin Turgor
Normal
Tenting
None
Skin (Touch)
Dry
Clammy
Buccal Mucosa
Moist
Parched/
Cracked

14. CLINICAL OBSERVATION IN DEHYDRATION
Eyes
Normal
Deep Set
Sunken
Tears
Present
Reduced
None
Fontanelle
Flat
Soft
CNS
Consolable
Irritable
Lethargic/ Obtunded
Pulse rate
Slightly increased
Increased
Pulse quality
weak
Feeble/ Impalpable
Capullary refil
2 sec
> 3sec
Urine Output
Decreased
Anuric

15. LUDANS METHOD Mild Moderate Severe <15kg < 2y/o 50cc/kg 100 15030 60 90
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
LIQUID
CHO
g/100mL
Protein
Cal/L
Na+
mEq/L K+
Cl-
HCO3
Ca+2
mOsm/L
D5W 5 -
170
252
NS (0.9% NaCl)
154
308
D5 0.3 51
LRS
0-10
0-340
147 4
155.5
D5 IMB 25 20 22
D5 NM 40 13
D5 NR
140 98

17. ELECTROLYTE COMPOSITION OF VARIOUS BODY FLUIDS
Na+ (mEq/L)
K+ (mEq/L)
Cl- (mEq/L)
Gastric
20-80
5-20
Pancreatic
5-15
90-120
Small Bowel
90-130
Bile
80-120
Ileostomy
45-135
3-15
20-115
Diarrhea
10-90
10-80
10-110
Burns
140 5
110
Sweat
10-30
3-10
10-35

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

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