 Body is formed with solids & fluids.

 In human body water content is 45-75% of body weight.

 Importance :
1. In homeostasis
2. In transport Mechanism
3. In metabolic reactions
4. In maintenance of tissue texture
5. In temperature regulation
 TBW varies with age, gender and body habitus .
 In adult males= 60-65% of body weight, average = 60%
 In adult female=45-50% of body weight, average = 50%
 In infant = 80% of body weight
 Obese patients have less TBW per Kg than lean body adult.
Body compartment fluid
1= Intracellular fluid (ICF)= 70% TBW or 30%(F) - 40% (M) BW

2= Extracellular fluid (ECF) = 30%TBW or 20% BW

 Interstitial fluid = 7.5% of body weight ( 15%)

 Intravascular fluid or plasma volume = 4% of body weight ( 5%)

 Transcellular fluid = 3.5 % of body weight

 Organic Inorganic

Glucose Oxygen
Amino acids electrolytes
Proteins
Fatty acid
Lipid
Hormones
Enzymes
 Osmolarity :
 It is fluid’s capability to create osmotic pressure.
 It is concentration of osmotically active substances in
solution.

Osmolality :
 It is no. of particles / L of solution.

Tonicity : Cell in a Cell in a

hypertonic hypotonic
 Way of expressing effective osmolarity.
solution solution

Same effective osmolarity as body fluid Greater effective osmolarity than body less effective osmolarity than body fluid
 Cell Membrane
Cell Membrane

Urea
H2O Na+= 10
ICF
H2O
Interstitial
Na+
K+

glucose

Cell membrane is freely permeable to H20 but Na and K are pumped across
this membrane to maintain a gradient!
Water Gain route Average Minimum Maximum
Daily vol. (ml) (ml) (ml)
sensible Oral fluids 800 - 1500 0 1500/h
Solid food 500 – 700 0 1500

insensible Water of 250 125 800

oxidation
Water of 0 0 500
solution

Water loss route average Minimum Maximum

Daily vol. (ml) (ml) (ml)
sensible Urine 800 - 1500 500 1400 / h
Intestine 0 – 250 0 2500 / h
sweat 0 0 4000 / h
insensible Lungs 400
600 1500
Skin 500 - 1000
Daily fluid replacement = 700 + urine output

Excess water loss

1. fever : 100 ml / degree fever / day
2. Tracheostomy (unhumidified air) : >1.5 L /
day
11
Salt intake & output
 Daily salt intake varies 3-5 gm as NaCl

 Kidneys excretes excess salt: can vary from < 1 to > 200
mEq/day

 Volume and composition of various types of gastrointestinal

secretions

 Gastrointestinal losses usually are isotonic or slightly hypotonic

 Should replace by isotonic salt solution

 Volume Changes : Hypovolemia
Hypervolemia

 Concentration Changes : Hyponatremia

Hypernatremia

 Composition Changes : Acid/Base Balance

Potassium Abnormalities
Hypovolemia
Hypervolemia
Hypovolemia
 ECF volume deficit is most common fluid loss in surgical
patients, and aggravated by General Anesthesia.

 Most common causes of ECF volume deficit are: GI losses

from vomiting, nasogastric suction, diarrhoea, and fistular
drainage

 Other common causes: soft-tissue injuries and infections,

peritonitis, obstruction and burns.
Signs Clinical Diagnosis
• Thorough history taking: poor
 Diminished skin turgor
 Dry oral mucus membrane intake, GI bleeding…etc
 Dry axilla • glucocorticoid therapy
 Oliguria
• BUN : Creatinine > 20 : 1
- <500ml/day (normal: 0.5~1ml/kg/h)
 Flat neck veins • Increased specific gravity
 Tachycardia
• Increased hematocrit
 Orthostatic Hypotension
 Hypoperfusion  cyanosis • Electrolytes imbalance
(hypothermia)
• Acid-base disorder
 Sunken eye
 Altered mental status
 Hypervolemia
 Iatrogenic or Secondary to renal insufficiency, cirrhosis, or CHF.

Signs Clinical Diagnosis

• Electrolytes imbalance
• CNS: none
• Decreased specific gravity
• CVS: elevated JVP, venous
• Decreased hematocrit
distension – pulmonary edema, S3,
• Cholesterol
• Respiratory : shortness of breath even
• Liver enzymes
in rest.
• Bilirubin
• GI: edema of bowel
• Creatinin clearance
• Tissue: pitting edema – anasarca,
ascites, weight gain
Management of
Hypervolemia:
 Prevention is the best way
 Guide fluid therapy with CVP level or
pulmonary wedge pressure
 Diuretics
 Increase oncotic pressure: FFP or
albumin infusion (may followed by
diuretics)
 Dialysis
Hyponatremia <135 mEq/l.
Hypernatremia > 145 mEq/l.
Hyponatremia

 Na+ is the most abundant positive ion of ECF compartment

and is critical in determining the ECF and ICF osmolality.

 Normal amount 135-145 mEq/l.

Signs & symptoms

 Sign & symptoms : <120 mEq/l.
• CNS: confusion, lethargy, stupor,
headache, seizure, coma

• GI: nausea, vomiting

• Skeletal system : muscle twiches

Etiology & treatment of hyponatremia
 Hypernatremia

>145 mEq/l.
• Asymptomatic
• Symptomatic (Na>160 meq/L)
CNS manifestations : due to
dehydration of brain cells
Body system Signs & symptoms
Central nervous system Restlessness, lethargy, ataxia, irritability, tonic
spasms, delirium, seizures, coma

Musculoskeletal Weakness
Cardiovascular Tachycardia, hypotension, syncope
Tissue Dry sticky mucous membranes, red swollen tongue,
decreased saliva and tears
Renal Oliguria
Metabolic Fever
Etiology & treatment
of hypernatremia

Aggressive correction :
central pontine
myelinolysis
Potassium Abnormalities
 Normal daily dietary intake of K+ is approx. 50 to 100 mEq/day,
& The normal range of serum potassium: 3.5-5.1 meq/L.

 Majority of K+ is excreted in the urine (0-700 meq/day).

 98% of the potassium in the body is located in ICF at 150 mEq/L

and it is the major cation of intracellular water.

 Intracellular K+ is released into the extracellular space in

response to severe injury or surgical stress, acidosis, and the
catabolic state.

 K+ has an important role in the regulation of acid-base balance.

 Hypokalemia
Serum K+ < 3.5 mEq /L
Etiology :
 Inadequate intake
 Dietary, potassium-free intravenous fluids, potassium-deficient
 Total parenteral nutrition
 Excessive potassium excretion
 Hyperaldosteronism
 Medications
 Gastrointestinal losses
 Direct loss of potassium from gastrointestinal fluid (diarrhea), (gastric fluid,
either as vomiting or high nasogastric output)
 Renal loss of potassium
 Intracellular-shift (metabolic alkalosis or insulin therapy)
 Potassium decrease by 0.3 meq/L for every 0.1 increase in pH above normal
Body system Signs & symptoms
Gastrointestinal Paralytic Ileus, constipation

Neuromuscular Decreased reflexes, fatigue, weakness, paralysis,

rhabdomyolysis, hyporeflexia
Cardiovascular U-waves
T-wave flattening
ST-segment changes
Arrhythmias
Tissue Dry sticky mucous membranes, red swollen tongue,
decreased saliva and tears
Renal Polyuria & polydypsia

Treatment :
 KCl 10 mEq/L/hr IV - pripherally
 KC1 20 mEq/L/hr IV - centrally
 Hyperkalemia
Serum K+ > 5.1 mEq /L

Etiology :

1. Increased intake : Potassium supplementation & Blood transfusions

2. Endogenous load/destruction: hemolysis, rhabdomyolysis, cruch injury,

gastrointestinal hemorrhage

3. Increased release : Acidosis

4. Rapid rise of extracellure osmolality (hyperglycemia or mannitol) : Impaired

excretion of potassium & Renal insufficiency/failure.

Body system Signs & symptoms
Gastrointestinal Nausea/vomiting ,colic diarrhea

Neuromuscular weakness, paralysis, respiratory failure

Cardiovascular Arrhythmia, arrest
ECG changes Peaked T waves (early change)
Flattened P wave
Prolonged PR interval (first-degree block)
Widened QRS complex
Sine wave formation
Ventricular fibrillation

Treatment of hyperkalemia
Thank you