FLUID

WATER SOURCES & LOSSES

sources
Exogenous 2 – 3 l per day
Endogenous ( metabolic water )350 ml/d

Losses
-Sensible urine & faeces
-Insensible sweat & resp
 water input = water output
 Types of Fluids

 Crystalloids.

Colloids.
 CRYSTALLOIDS

Aqueous solutions of low mol.wt. ions(salts)

With or without glucose.

Sodium is the major osmotically active

particle.

Crystalloid replacement shoud be 3 to 6 times

the volume of lost blood.
 CRYSTALLOIDS

Normal saline(NS).
Lactated Ringer’s solution(LR).
5% dextose in water (D5W).
Ringer’s acetate.
D5LR.
D5 NS.
D5 ½ NS.
Hypertonic saline(HS)3%.
 NORMAL SALINE

0.9% NaCl (isotonic) 308 mOsm/L.

Na 154 mEq/L. Cl 154 mEq/L.PH 5.7
Uses: Hyponatremia.
Brain injury
Large quantity--hyperchloremic
metabolic acidosis.

The predominant effect of volume resuscitation with

crystalloid fluids is to expand the interstitial fluid
volume rather than the plasma volume
 LACTATED RINGER LR

Osmolarity 273 mOsm/L

Na 130 Cl 109 mEq/L
K 4 Ca 3 mEq/L
Lactate 28 mEq/L
The most physiological solution.
Lactate is converted into HCO3 in the liver

Ringer Acetate
Acetate 28 mEq/L
Metabolism 2.5-4 times faster than lactate(in
muscles).
 GLUCOSE 5%

It functions as free water.

50 gm/L isotonic (253 mOsm/L).
Uses:
To maintain normoglycemia.
To correct hypernatremia.
To keep an IV line open for medication.
Not used for volume expantion… as the predominant
effect of volume resusscitation with gluc 5 % is to
expand the intracellular volume ( cellular oedema )
During surgery only given for patients at increased risk
of hypoglycemia(infants,insulin T).
Avoided in critically ill (it increases CO2 production and
aggravates ischemic brain injury).
 HYPERTONIC SALINE HS 3%

Osmolarity 1026 mOsm/L.

Na 513 Cl 513 mEq/L.
It expands plasma volume by the increase in
IV oncotic pressure(fluids move from IC
fluid).More effective than crystalloids.
Uses: Severe hyponatremia.
Early treatment of hypovol. shock.
Side effects:
hypernatremia,hyperchloremia,hypokalemia
and coag. Problems.
 COLLOIDS

Solutions containing high-molecular weight

substances such as proteins or large glucose
polymers.

Plasma expanders by:

volume of colloid.
increasing plasma oncotic pressure moving
fluids from IS to IV spaces.
 COLLOIDS X CRYSTALLOIDS

Colloids stay more in IV space (3-6 h.).

Crystalloids (20-30 m.).
Colloids 3 times potent than crystalloids.
Severe IV fluid deficits can be more
rapidly corrected using colloids.
Colloid resuscitation more expensive.
Rapid administration of large amounts of
crystalloids (>4-5L) is more frequently
associated with significant tissue edema.
 TYPES OF COLLOIDS

1. Blood derived: Human albumin.

2. Synthetic
* Starches.
* Gelatins.
*Dextrans.
 HUMAN ALBUMIN

5% (isotonic) and 25% (hypertonic) in NS.

Uses:
Abnormal protein loss. e.g peritonitis.
Severe burns.
Expensive.
No risk of viral infection.
Rare allergic reactions.
No effct on coagulation.
 STARCHES

Hetastarch 6% Pentastarch 10% in NS.

More effective than 5% albumin,gelatins and
dextrans.
Non antigenic;no effect on crossmatching.
Lower cost than albumin.
Cleared by the kidneys.
Disadvantages:
Coag.abnormalities if >1.5L.
Rare anaphylactic reactions.
Elevated serum amylase.
 GELATINS

Haemagel
Relatively cheap.
No effect on coagulation or on
crossmatching.
High incidence of allergic
reactions.
 DEXTRANS

Dextran 40 and 70 in NS or 5% dextrose.

Anti-thrombotic effects.
Dextran 70 is preferrd (12h.).
Dextran 40 improves blood flow in microcirculat.
Uses:
*plasma expander.
*To prevent thromboembolism (postop.).
* To improve blood flow to isch.limb (dextran
40).
 DEXTRANS

Disadvantages:
1- Bleeding tendency.
2- Interfere with biood grouping
and crossmatching.
3- Rare anaphylactic reactions.
4- Dextran 40 can precipitate in
renal tubules leading to RF.
Thank you for your attention