Fluid

Management
PROFF. AMER ALKHUZAIE
 Isotonic hyperto hypoto
volume nic nic

ICF

PLASMA5
40%
%
na+
K+ I.S
Cl-
Protins-
Mg++
Phosphate- 15%na+
Proteins- Cl-
Osmolaity:is the power to bring water to solute side
applied by osmotically active particles

In healthy pt osmolarity of ECF &ICF

are equal even the solutes are different
no of osmotically active patricles in fluid
=osmolarity
osmotic pressure :pressure applied by
solute to prevent water movement from
hypo osmolar to hyperosmolar side
Osmolality

any change to osmolality water move from

hypo to hyper osmolar side till equilibrium
isotonic fluid =if we add nacl to pure water till
osmolarity =300mos/l
but if we add half amount of nacl the osmolarity
will decrease this called hypotonic and if we
add more nacl this lead to increase osmolarity
more than 300mos/l this called hypertonic fluid
obese male has less water
young female also capillary membrane
permeable to na +and cl-
always fluid follow solute which are cations
and anions while cell membrane does not allow
solute to pass
in many diseases we loose Na replace it by
NACL.the amount of water present in any
compartement is proportionate to number of
osmotically active particles
How do I know someone needs
fluid?
 Physical
Exam– HR, BP, Mucous
membranes, UOP, Orthostatics,
Sensorium
 Labevaluation– Hct, pH, urine
specific gravity, Sodium (urine and
serum), chloride, BUN/Cr
 Invasive testing– a-line, CVP, Swan
types

Crystalloid
Colloid
Blood products
 Crystalloid
D5W
LR
NaCl
Plasmalyte

Hyper, iso, hypotonic

Salts
Maintenance v. replacement
Colloid

Starches – penta, heta

Albumin – Heated 60C for 10h,
not infectious
Blood – later secret slides

Oncotically active
Long T1/2
Periop Fluid Mx

How much volume do I

start with?
How much do I loose?
How much do I give
back?
 How should I get started?
 4,2,1rule 4cc/kg/h for first 10 kg…2cc/kg/h for
second 10 kg 1 cc/kg/h for each kg above 20 rough
maintenance less than 10kg =100ml/kg/24
 10 -20 kg=1000+50ml/kg for each kg above 10
 More than 20kg =1500+20ml/kg for each over 20
 Deficit=the amount of fluids pt. needs to become
rehydrated can be calculated as : %dehydration x body
wt x 10
 Losses– secretions, blood, third spacing, urine, sweating,
evaporation, other…
 Stress of operation
 Blood Transfusion
ABO system
Rh system
Typing
Screening
Cross Matching
Time
What’s in blood anyway?

Whole blood
RBCs
FFP
Platelets
Cryo

Complications
Hemolytic reactions– acute, delayed
Nonhemolytic reactions – Febrile,
urticarial, anaphylactic, TRALI, Graft v.
host, post transfusion purpura,
immunosuppression
Infections – HIV, Hep a-z, CMV,
parasites and bacteria
 Massive Transfusions
Rapid infusers
Coagulopathy
Citrate tox
Hypothermia
Acid/base balance
Potassium
 Since blood has risk…
Autologous transfusion
Blood salvage and reinfusion
Normovolemic hemodilution
Donor directed transfusion
Always keep an eye on your
patient your patient is yours not
the patient of others and don’t
loose yours my best
whishes
amer- alkhuzaie