FLUID THERAPYDr Indragiri SpAn

To Begin with:Body Fluid ,the balanceFluid disarrangementArtificial FluidTherapy and PracticesIon derangementIon and Acid base balance

Body Fluid - The BalanceJUST SAY 60% AverageHuman body largely composed of fluids

Total body fluid ranges from 46 80%Decreased in the elderly

Fluid depositionIntracellularExtra cellularIntravascular

Composition Osmolarity = solute/(solute+solvent) Osmolality = solute/solvent (290~310mOsm/L) Tonicity = effective osmolality Plasma osmolility = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma tonicity = 2 x (Na) + (Glucose/18)BALANCEION

Composition

Fluid disordersNormalIntravascular lossTotal body water deficitHipervolemia

Electrolytes disorderNaKCa, mgBody Water

Regulation

Regulation

Artificial body fluidTo have normal characteristic to natural body fluid.Normal measurement of - electrolyte - osmotic, oncotic pressure - pHNO SUCH A THING!!!!

We Do Have..CRISTALOID, Saline, ringers, so onKOLOID, Gelatin, Starch, DextranPLASMA/ Albumin.

Crystalloids

Fluids in general

SolutionsVolumesNa+K+Ca2+Mg2+Cl-HCO3-DextrosemOsm/LECF1424510327280-310Lactated Ringers13043109282730.9% NaCl1541543080.45% NaCl7777154D5WD5/0.45% NaCl7777504063% NaCl51351310266% Hetastarch5001541543105% Albumin250,500130-160

Parenteral FluidFluid therapy

1. Replacement fluids2. Maintenance of fluids3. Correction of electrolytes

Fluid Management Goal: - to maintain urine output of 0.5~1.0mg/kg/h Rule: 4 2 -1 Electrolytes require: - Na+: 1-2mmol/kg/day - K+: 0.5~1.0mmol/kg/day Avoid fluid overload, especially in malnutrition, heart failure and renal insufficiency patient

RESUCITATION For acute intravascular volume loss - Large borne IV line - Begin with 2-3L isotonic crystalloid to restore blood pressure and peripheral perfusion - Early use of colloid - Crystalloid + 5% albumin in a ratio of 4:1 - Blood transfusion

DehydrationLoss of Total Body Water

Replace water deficit in 8 24 hours.Use resuscitation fluid.Normal Saline give you acidosis.Treat shock aggressively.

While doing resuscitation also give maintenance

The DifferenceAcute Intra Vascular Volume loss

Heart rate, BP change first followed decrease interstitial volumeChronic volume Loss

Total body water deficit develop followed by HR, BP change

Fluid Shifting in ResuscitationIntra vascularInterstitialIntra CellularMonitored in Vital SignMonitored in Metabolic values

Fluid In Resuscitation1000cc500cc500cc500cc2006001000Lactated Ringers5% Albumin6% HetastarchWhole bloodBlood volumeInfusion volume

Crystalloids Isotonic crystalloids - Lactated Ringers, 0.9% NaCl - only 25% remain intravascularly Hypertonic saline solutions - 3% NaCl Hypotonic solutions - D5W, 0.45% NaCl - less than 10% remain intra- vascularly, inadequate for fluid resuscitation

Colloid Contain high molecular weight substancesdo not readily migrate across capillary walls Preparations - Albumin: 5%, 25% - Dextran - Gelifundol - Haes-steril 10%

The Choice Crystalloids ColloidsIVVP Poor GoodHemod Stability Transient ProlongInfusate volume Large ModeratePlasma COP Reduced MaintainTissue edema Obvious InsignificAnaphylaxis Non-exist low-modCost Inexpensive Expensive

The QuestionTwo Patients came with the same vital Sign, Lethargic, somnolence, BP 90/50, HR 160 bpm, RR 40. Body weight about 60 kg.Ones have traumatic amputation of right arm 2 hour ago, others had diarrhea for three days.How to manage this patients?

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