Fluid And Electrolytes Imbalance Flashcards
Factors requiring fluid therapy
Disease preventing oral intake - peritonitis, surgery
Intestinal resection
Surgical and medical conditions - intestinal obstruction, diarrhea, vomiting
Percentage of total body water of adult male from weight
60%
Percentage of total body water of adult female from weight
50%
Determinants of total body water
Age
Sex
Degree of obesity
2 compartments of water distribution
Intracellular - 40% or 2/3 of TBW (28L)
Extracellular - 20% or 1/3 of TBW ( 14L)
Extracellular division in TBW
Intravascular
Extravascular
Amount of potassium in the cells
140 mmol per liter
Amount of sodium in extracellular
135-145 mmol/l
Most important cations and onions in the intracellular compartment
Potassium 140
Magnesium 15
phosphate 26
proteins 9
Most important onions and cations in the extracellular compartment
Sodium 135-145
chloride 95-105
bicarbonate24-29
Water gained and lost every day in tropical and temperate regions
3400 mL
2700ml
Amounts of water necessary in fluid therapy in the tropic and temperate regions in surgical patients who is expected not to pass stool
Reduced to 3L in tropics
2300ml in temperate
How do we compensate in flu therapy for high temperature Leading to more sweating
12% of the daily requirement in fluid added added for every 1°C rise
Sodium lost in the tropics and temperate regions
Tropics - 130-140mmol
Temperate - 90-120mmol
Potassium lost in the tropics and temperate regions
Tropics - 60mmol
Temperate - 70mmol
Sodium replacement therapy in tropics and temperate regions
Tropical - 130
Temp.- 80-110
Potassium replacement therapy in tropics and temperate regions
Tropical - 50
Temp.- 60
Amount of glucose given daily to surgical patients to reduce gluconeogenesis and minimize acidosis
2 L of 5% glucose daily
Type of sugar given because it can be infused in concentration of up to 30% peripherally and provide more energy
Sorbitol
Amount of glucose given exogenously if IV therapy is prolonged
5 g/ kilogram / day
Amount of vitamin C required daily for supplementation
100 to 200 mg
Summarized daily requirement in the tropic of surgical patient
3 L of water
130 mmol of sodium
50 mmol potassium
100 g of carbohydrates
Which IV solution can provide the daily requirement in the tropical surgical patient
1 L of ringers lactate
2 L of 5% dextrose
50mmol of potassium chloride
Or
3L badoes maintenance solution
which patients are not eligible for badoes maintenance solution
Patient with liver disease or acidosis
neonate
How to calculate water infusion rates
4 mL/kg/hr for first 10 kg + 2 mL/kg/hr for the next 10 kg + 1 mL/kg/hr for remaining body weight
Sodium infusion / day calculation
1 or 2 mmol /kg/day
Daily requirements in surgical patient in temperate regions
2.5 L of water
80-100mmol of sodium
60 mmol of potassium
100 g of carbohydrates
Solution given for fluid replacements in surgical patient of temperate region
Half liter of NS
2 L of 5% dextrose
3 g of potassium chloride
vitamin B and C
DISEASE with rapid dehydration
Acute intestinal obstruction
peritonitis
diarrhea
Dx with slow dehydration
Gastric outlet Obstruction
Causes of dehydration
Vomiting or nasal gastric aspiration
diarrhea
internal fluid shift as in burns , peritonitis , , paralytic ileus, mechanical intestinal obstruction , pancreatitis
Enterocutaneous fistula
excessive sweating
polyuria
Main clinical features of dehydration
Dry inelastic skin ,loss of turgor
dry mouth
Sunken eyes
collapsed veins
tachycardia
scanty highly concentrated urine
Metabolic alkalosis (gastric juice loss) or acidosis ( diarrhea )
shock with hypotension and sweating
Bio chemistry of dehydration
High hematocrit ,hemoglobin ,blood urea
reduced sodium,potassium and chloride levels in serum
concentrated urine , high osmolality
Low or absent sodium
normal or elevated potassium
Goal of urine output in treatment of dehydration
30-50 mL per hour
Amount of fluid needed in shock
3.5 L
Clinical features of water overload
Added breath sounds
central venous pressure higher
increased intracranial pressure symptoms like headache, nausea ,vomiting ,weakness ,lethargy, confusion ,drowsiness ,convulsions
symptoms of cardiac failure like tachypnea, tachycardia, hypoxia, pulmonary and peripheral edema ,distended jugular vein
pulmonary congestion on cxr
Treatment of water of overload
Diuretics - furosemide , ethacrynic acid
Mannitol
