INSENSIBLE

TOTAL LOSSES
SENSIBLE

EXTRACELLULAR
PLASMA INTERSTITIAL TOTAL BODY
WATER. 78-86%

INTRACELLULAR
 VOLUME EXPANSION VOLUME CONTRACTION

Low sympathetic High sympathetic

activity activity
Increased ANP, Low ANP, BNP
BNP
Low ADH- High ADH-
Vasopressin Vasopressin
Low Renin, High Renin,
Angiotensin, Angiotensin,
Aldosterone Aldosterone

INCREASED SODIUM INCREASED SODIUM

AND WATER AND WATER
EXCRETION EXCRETION
 STEROIDS
PLACENTA

AMNIOTIC
FLUID

FLUIDS
GIVEN TO
MOM

GA AND
WEIGHT
INSENSIBLE LOSSES
SENSIBLE LOSSES
 INSENSIBLE LOSSES

+
SENSIBLE LOSSES

+
FLUID REQUIRED FOR GROWTH

=
Total daily fluid
requirement
 Na+

Ca+
K+

Mg+
H+

Membrane
excitability
 Half Normal ClNa 3%
Saline Saline 510
77 meq/L 154 meq/L meq/L

HYPOTONIC ISOTONIC HYPERTONIC

 Edema
Excess Water
Kidney
function
Hyponatremia Low sodium
Diuretics
Sodium loss
Kidney loss
 Skin losses

Low Water

Kidney losses

Hypernatremia Sodium intake

GI losses

Combined

Polyuric ATN
 Half Normal D5W
Saline Saline 500
77 meq/L 154 meq/L ml
500 ml 500 ml

250 ml free water 0 ml free water 500 ml free water