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Fluid Therapy in Emergency Setting

Hadiki Habib

Emergency Unit
Ciptomangunkusumo General Hospital
TARGET AUDIENCE

GENERAL PRACTITIONER
IV Fluid Therapy is similar with drug therapy

1. Dose Response Relationship


2. Side Effect

Individualized fluid therapy


FLUID THERAPY DILLEMMA
Fluid overload
Tissue Oedema
Electrolite Derangement

Tissue Hypoperfusion
Electrolite Derangement
FLUID THERAPY = DRUG THERAPY
Indication (Based on etiology and phase of fluid
therapy)
Contraindication (based on etiology and comorbidities)
Type of fluid therapy
Rate of fluid administration
Dose
Monitoring
Indication
IV fluid fundamental reason is to sustain an
effective circulating intravascular volume
Volume depleted because of
Hemorrhage
Vomitting
Diarrhea
Capillary leak
Relative hypovolemia (e.g sepsis)
Life saving
Indication
Adequate blood
Adequate O delivery
Balance of Blood gas
and electrolite

Hoste EA, et al. Four phases of intravenous fluid therapy : a conceptual models. BJA. 2014
Indication

Hoste EA, et al. Four phases of intravenous fluid therapy : a conceptual models. BJA. 2014
Type of Fluid Therapy
Kristaloid
Isotonic
Hypotonic
Hypertonic
Colloid
VERSUS

Bai SJ, Lee JW, Lee K. Fluid therapy : classification and characteristics of intrevenous fluid. J Korean Med Assoc. 2010
Common Isotonic Crystalloid Composition

Bai SJ, Lee JW, Lee K. Fluid therapy : classification and characteristics of intrevenous fluid. J Korean Med Assoc. 2010
In Hypovolemic shock, colloid is equal with crystalloid
Chloride restriction strategy
Normal saline has more chloride than balance
salt solution
Large volume infusion increase risk of
hyperchloremic metabolic acidosis and
hypernatremia

Lira A, Pinsky MR. Choices in fluid type and volume during resuscitation : impact on
patient outcomes. Annals of intensive care.2014
Rate of fluid administration

Hoste EA, et al. Four phases of intravenous fluid therapy : a conceptual models. BJA. 2014
Rate of fluid administration
Doses
Based on clinical observation (observational
medicine)
Treat and evaluate
Based on prediction
Mild dehydration (5% total body water loss)
Moderate dehydration (5-10% total body water
loss)
Severe dehydration ( > 10% total body water loss)
MONITORING
Parameter observasi klinis
Pemantauan target
Kesadaran GCS meningkat
Frekuensi nadi Menurun
Isi nadi Isi cukup dan akral hangat
Frekuensi nafas Kussmaul teratasi
Produksi urin > 0.5 ml/kgbb/jam
Tekanan darah Sistole meningkat, MAP target 65 mmHg
Vena cava inferior Collapsibilitas < 50%
Tekanan vena sentral Meningkat 8-12 cmH2O
Darah rutin Hemokonsentrasi teratasi
Analisis gas darah Asidosis metabolik atau alkalosis
metabolik teratasi
Kreatinin Nilai kreatinin turun