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  • Fluids Electrolytes

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    Yuet Chin Low
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    01. Fluids electrolytes

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    7 views2 pages

    Fluids Electrolytes

    Uploaded by

    Yuet Chin Low

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Body Fluid Crystalloid (prefer) - small → goes into cell

    • Male (60%) > female (50%) Colloid (↑ Cl → SE: acidosis) - max 1 - 1.5 L can be given, then crystalloid
    • Most concentrated in skeletal muscle Colloid - bigger → stay in circulation; Ex: Dextran, Gelofusine (gelatin based)
    • TBW = 0.6 x BW
    • ICF = 0.4 x BW • Isotonic - NaCl 0.9%, Ringer’s lactate
    • ECF = 0.2 x BW • Hypertonic - NaCl 1.8%, when diuretic → low Na but adequate body vol → so give small
    • 3/4 → Extravascular interstitial fluid vol but high [Na]
    • 1/4 → Intravascular plasma • Hypotonic - NaCl 0.18% or 0.45%, when diuretic → high Na & under vol → so give more
    water than Na
    Fluid regulation
    • Renal sympathetic nerves Surgical pts prone to disruption
    Fluid Requirement : 40ml/kg/DAY
    • Renin-angiotensin-aldosterone system • Nil orally
    Electrolytes require :
    • Renin secreted when • Anaesthesia
    - Na+: 1-2mmol/kg/day
    • ↓ BP • Trauma
    - K+: 0.5~1.0mmol/kg/day
    • ↓ Na delivery to kidney • Sepsis
    • ↑ sympathetic tone
    Avoid fluid overload, esp in malnutrition, heart failure,
    • Ag II → ↑ vascular tone
    renal insufficiency
    • ↑ catecolamine release
    • ↓ renal blood flow
    Normal maintenance requirements
    • ↑ Na reabsorption
    • Use BW formula
    • Stimulate aldosterone release
    On going losses
    • Aldosterone
    • Measure all losses in I/O chart
    • Release stimutlated by
    • Estimate 3rd space losses
    • Angiotensin II
    Deficits
    • ↑K
    • Estimate using vital signs & HCT
    • ACTH
    • Effect - Na and water
    After therapy started observe
    absorption in distal tubular • Vital signs
    segments • Urine output (0.5mls/Kg/hr)
    • Atrial natriuretic peptide (ANP)
    • Central venous pressure

    1
    Crsytalloid
    • Hartmanns, D5%, NS 0.9%, Ringer’s lactate
    • Advantage - cheap, easily available, no allergic rxn, isotonic
    • Disadvantage - diffuse easily into Interstitial space

    Colloid
    • Dextran, gelafundin, starch, albumin
    • Advantage – stays in intravascular space better
    • Disadvantage – expensive, allergic rxn, affects cross-matching

    Blood products
    • Whole blood, packed cells, FFP
    • Advantage – exact blood constituents, O2 carrying capacity 2
    • Disadvantage – transfusion rxn, expensive to produce

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