Fluids and Electrolytes

DR A LUBEGA
Outline

 Normal Body water

 Common IV fluids
 Normal losses and requirements
 Normal secretions
 Surgical concerns
 Specific electrolyte imbalances
Compartments of total body water
Normal body water
Common IV fluids
Normal loss & requirements

Vol(mls) Na+ (mmol) K+ (mmol)

Urine 2000 80-114 50- 60
Insensible loss 700 10-16 -
Faeces 300 0-10 10
Endogenous (300)
water
Total 2700-3000 80-114 60-70
Normal losses
Surgical losses

 Peri-operative requirements
 Vomiting
 Sepsis/fever
 Stoma/ drainage tube losses
 3rd space losses
 Bleeding
Peri-operative Requirements

 Maintenance fluid requirements since NPO+ ongoing insensible

losses
 Adults: approximately 1.5 ml/kg/hr
 “4-2-1 Rule”
 4 ml/kg/hr for the first 10 kg of body weight
 2 ml/kg/hr for the second 10 kg body weight
 1 ml/kg/hr subsequent kg body weight
 Extra fluid for fever, tracheotomy, denuded surfaces
 Electrolytes
 2-3 mmol/kg/day Na+
 1-3 mmol/kg/day K+
Peri-operative Requirements

 Other losses e.g. NGT suction, bowel prep

 Intra operative
 Third space losses
 blood loss
 Special additional losses
 Ascitic fluid
Vomiting
Vomiting cont’d

 Serious problem in
 GOO
 I/O

 Paradoxical aciduria
Sepsis/fever

 Increased vascular permeability in inflammation

 Hypotension of septic shock

 Increased insensible water loss in fever

 8-12 ml/kg
 Increased by 10% per degree above 37 0C
Stoma/ drainage tube losses
Third Space Losses

 Isotonic transfer of ECF from functional body fluid

compartments to non-functional compartments.

 Interstitial space,

 Lymphatic drainage exceeded

Third Space Losses

 Depends on
 Surgical site
 Duration of operation
 Amount of tissue trauma,
 Ambient room temperature,
 Room ventilation.
Replacing Third Space Losses

 Superficial surgical trauma: 1-2 ml/kg/hr

 Minimal Surgical Trauma: 3-4 ml/kg/hr

 head and neck, hernia, knee surgery
 Moderate Surgical Trauma: 5-6 ml/kg/hr
 abdomen/chest surgery
 Severe surgical trauma: 8-10 ml/kg/hr
 retroperitoneal surgery
Blood Loss

 Replace 3 cc of crystalloid solution per cc of blood loss

 crystalloid solutions leave the intravascular space

 When using blood products or colloids replace blood loss

volume per volume
Specific electrolyte imbalances

 Na+
 Hyponatremia
 Hypernatremia
 K+
 Hypokalemia
 Hyperkalemia
 Trace elements
 Ca2+, Mg + +
Hyponatremia
hypernatremia
Hypokalemia <3mmol/l
Hypokalemia causes

 Vomiting
 Gastric aspirate
 Fistulae
 Diarrhoea
 Ileus
 I/O
 K+ secreting villous adenoma
 Metabolic alkalosis
 Drugs-diuretic, adrenaline, insulin
Hyperkalemia >5.5 mmol/l
Hyperkalemia causes

 Massive blood transfusion

 Massive tissue damage e.g. ischemic bowel
 Rhabdomyolysis
 Metabolic acidosis
 Acute renal failure
 Durgs (ACE inhibitors, spironolactone, NSAIDS)
Hypocalcemia < 2.25 mmol/l
Hypocalcemia
Hypocalcemia- causes

 Hypoparatyroidism
 Thyroid/parathyroid surgery
 Vitamin D deficiency
 Hypoprotenemia
 malnutrition
 Severe inflammation e.g. burns
 Liver failure e.g. cirrhosis
 Nephrosis
Hypercalcemia >2.6 mmol/l
Hypercalcemia-causes
Case study

62 y/o male, 80 kg, for hemicolectomy

 NPO after 22:00 hrs, surgery at 0800 hrs,
 had bowel prep
 3 hr. procedure,
 500 cc blood loss

 What are his estimated intraoperative fluid requirements?

Case study

 Fluid deficit: 1.5 ml/kg/hr x 10 hrs = 1200 ml + 1000 ml for

bowel prep = 2200 ml total deficit:
 (Replace1/2 first hr, 1/4 2nd hr, 1/4 3rd hour)
 Maintenance: 1.5 ml/kg/hr x 3hrs = 360mls
 Third Space Losses: 6 ml/kg/hr x 3 hrs =1440 mls
 Blood Loss: 500ml x 3 = 1500ml
 Total = 2200+360+1440+1500=5500mls
THANKS