fluid & electrolytes management

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Fluid & Electrolytes Management

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By: rahelkassabayou (38 month(s) ago)

managment has always been my problem concerning flud and electrolyte. Nice presentation. Can i download?

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Fluid & Electrolytes Management: Part I : 

Fluid & Electrolytes Management: Part I Component & composition of body fluid Mechanisms of fluid homeostasis Parenteral fluid therapy

Body Fluid Compartments: : 

Body Fluid Compartments: ICF: 55%~75% Intravascular plasma X 50~70% lean body weight Extravascular Interstitial fluid TBW ECF 3/4 1/4 Male (60%) > female (50%) Most concentrated in skeletal muscle TBW=0.6xBW ICF=0.4xBW ECF=0.2xBW 2/3 1/3

Composition of Body Fluids: : 

Composition of Body Fluids: 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)

Regulation of Fluids: : 

Regulation of Fluids: Hydrostatic pressure v.s. Oncotic pressure  Albumin is the major determining oncotic pressure

Regulation of Fluids: : 

Regulation of Fluids: Renal sympathetic nerves Renin-angiotensin- aldosterone system Atrial natriuretic peptide (ANP)

Composition of GI Secretions: : 

Composition of GI Secretions: * Average concentration: mmol/L

Signs of Hypovolemia: : 

Signs of Hypovolemia: Diminished skin turgor Dry oral mucus membrane Oliguria - <500ml/day - normal: 0.5~1ml/kg/h Tachycardia Hypotension Hypoperfusioncyanosis Altered mental status

Clinical Diagnosis of Hypovolemia: : 

Clinical Diagnosis of Hypovolemia: Thorough history taking: poor intake, GI bleeding…etc BUN : Creatinine > 20 : 1 - BUN↑: hyperalimentation, glucocorticoid therapy, UGI bleeding Increased specific gravity Increased hematocrit Electrolytes imbalance Acid-base disorder

Parenteral Fluid Therapy: : 

Parenteral Fluid Therapy: Crystalloids: - contain Na as the main osmotically active particle - useful for volume expansion (mainly interstitial space) - for maintenance infusion - correction of electrolyte abnormality

Crystalloids: : 

Crystalloids: Isotonic crystalloids - Lactated Ringer’s, 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 Solutions: : 

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

Slide 12: 

Common parenteral fluid therapy

The Influence of Colloid & Crystalloid on Blood Volume: : 

The Influence of Colloid & Crystalloid on Blood Volume: 1000cc 500cc 500cc 500cc 200 600 1000 Lactated Ringers 5% Albumin 6% Hetastarch Whole blood Blood volume Infusion volume

Signs of Hypervolemia: : 

Signs of Hypervolemia: Hypertension Polyuria Peripheral edema Wet lung Jugular vein engorgement Especially when hypo-albuminemia

Management of Hypervolemia: : 

Management of Hypervolemia: Prevention is the best way Guide fluid therapy with CVP level or pulmonary wedge pressure Diuretics Increase oncotic pressure: FFP or albumin infusion (may followed by diuretics) Dialysis

Fluid Management: : 

Fluid Management: Goal: - to maintain urine output of 0.5~1.0mg/kg/h Rule: 100*10 + 50*10 +〔 (x-20)/10 〕*20 = 1460 + 2x 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

Fluid Management: : 

Fluid Management: For acute blood loss - 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 - Large borne IV line

To be Continued !!! : 

To be Continued !!!