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Maintenance fluid calculation: 4/2/1 rule

o 4 cc/kg/hr for first 10 kg
o 2cc/kg/hr for second 10 kg
o 1cc/kg/hr for rest
o Example: 80kg patient gets 120 cc/hr
Postop pts get NS and 20mEq KCl
o Pts need 1.8 mEq/kg/d of Na and 0.5 mEq/kg/d of K
Peds fluid resuscitation at 10cc/kg bolus of NS
o Before surgery, UOP should be > 2cc/kg/hr
o CO2 should be less than 30
Myoglobinuria increase pH to 6.5-7.5 by adding bicarb
Calculating volume deficit
o Volume expansion for anesthesia = 6 cc/kg
o NPO deficit = maintenance fluid x hrs of NPO
o OR maintenance fluid = Maintenance fluid x hrs of OR time
o From blood loss = EBL x 3
o 3
space = 5 cc/kg/hr
Normal saline admin decrease Na by 0.03 mEq/L
Calculating water deficit = (current Na/140-1) x 0.6(body weight)
Decrease Na by 0.5-1 mEq/L/hr and no more than 12 mEq/L/24 hr
1L D5W in 100 kg patient decrease Na by 2.5 mEq/L
Repleting Ca
o In renal failure or hypoparathyroidism (no functioning PTH), use calcitrio
b/c it doesnt need to be metabolized to be active
o Use calcium gluconate in IV to replete faster
o Monitor serum calcium TID after repleting


Recent MI, severe heart failure, arrhythmias a/w increased risk of perioperative MI
If MI occurs, stop procedure, give aspirin, beta block to keep HR 50-60 bpm, no
heparin, cards consult
To prevent MI, d/c smoking, control blood glucose, continue statins and beta
blockers up to start of an operation
Suspect MI order troponins, EKG, BMP, start beta blocker to keep HR 50-60 bpm,
aspirin, start PPI, oxygen, IV morphine, sublingual nitroglycerin

Atelectasis on CXR blurring of diaphragms