Slide Notes

2 Food taken in is
3 Digested and absorbed at GIT,
4 Transported to the circulation, and then to all cells for proper metabolism & function
5 All compartments - GIT, blood, cells - are at equal osmolality at 300 m osmole
6 By-products of digestion are excreted on the stools.
By-products of cellular metabolism are excreted in the urine and
To some degree – to the lungs and skin
7 In diarrhea:
8 Nutrients, water, electrolytes are lost in the GIT
9 The vascular compartment is contracted, the cells are dehydrated with loss of nutrients &
electrolytes, resulting in metabolic acidosis & cellular dysfunction
10 Mild diarrhea may be treated with ORS à
11 To be absorbed in the circulation to prevent à
12 Hypovolemia à
13 And re-perfuse the cells for their volume & metabolic need
14 Adequate oral rehydration normalizes all compartments of the body
15 In severe diarrheal dehydration à
16 There is rapid & severe hypovolemia & cellular dehydration compromising physiologic
function
17 Death can occur without the proper isotonic intravenous rehydration à
18 To re-expand the vascular compartment & re-establish proper cellular perfusion à
19 With the right volume in a relatively short time; with vital componets to attempt to correct
metabolic derangements à
20 For cellular survival in physiologic equilibration with all fluid compartments of the body.
This is how a patient will survive diarrheal dehydration, metabolic acidosis & electrolyte
imbalance
21 The next model is plasma leak syndrome: Example is dengue
22 Leaking capillaries deplete the circulatory volume needed for cellular perfusion
23 The lack of essential cellular blood supply causes derangement of cellular physiologic
functions: O2, energy (caloric), other elements, as supply for aerobic metabolism
24 Decreased blood volume results in hypotension, decreased renal perfusion & decreased
excretion of metabolites in an already compromised cellular perfusion
25 Such metabolic & circulatory compromise need immediate resuscitation with an isotonic
intravenous infusion with the proper duration, enough volume to re-expand the vascular
compartment, and alleviate metabolic acidosis, à
26 Re perfuse the renal system to re-establish excretion of cellular metabolites then urine
excretion
27 Blood volume & perfusion pressure are re-established
28 Oliguria and decreased renal excretion is alleviated
29 Proper volume, comprehensive isotonic infusions at the fastest tolerable rate will re-
establish physiologic cellular metabolism & blood pressure which spells recovery from
potential death
30 Analysis of fluids are tabulated as follows for better comprehension.
Note: NSS = 308 m Osm
Plasma = 300 m Osm
31 Another solution (LRS) has osmolality of 274
32 With the right volume infusion,
The right components that may alleviate metabolic derangement,
Timely rapid action à
33 Circulation & cellular perfusion may be better re-established
34 Urine output & vital signs improve signifying survival
35 Osmolality of the fluid is a little lower than cellular (300) m Osm, favors vascular perfusion
toward the cell. This may be the key to better survival
36 Try to appreciate the comparative tabulation
37 Some reminders on components for cellular survival
38 Reminder on hydration duration & frequency of assessment & volume recommendations
39-40 Will be discussed at the next level.