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Fluid Therapy.pptx

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Dr.Amjed Alnatsheh

This document discusses fluid imbalance and its management. It notes that fluid input and output should be equal and that imbalances can result from gastrointestinal, renal, skin or third-space losses. Clinical manifestations of fluid loss include symptoms related to dehydration and electrolyte disturbances. The document then outlines guidelines for maintenance fluid therapy to replace ongoing losses and replacement fluid therapy to correct existing deficits, noting appropriate fluid types and administration rates depending on the situation.

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Fluid Therapy.pptx
obligatory water intake or generation obligatory water output Fluid input and output should be equal.
Volume depletion result from : Gastrointestinal losses, including vomiting, diarrhea, bleeding, and external drainage Renal losses, including the effects of diuretics, osmotic diuresis, salt-wasting nephropathies, and hypoaldosteronism Skin losses, including sweat, burns, and other dermatological conditions Third-space sequestration, including intestinal obstruction, crush injury, fracture, and acute pancreatitis.
Clinical manifestation of fluid loss Symptoms related to fluid and symptoms related to electrolytes disturbances. Symptoms related to fluid : Easy fatigability, Thirst , Muscle Cramps and Postural Dizziness. More severe fluid loss can lead to abdominal pain, chest pain, or lethargy and confusion
Symptoms related to electrolyte Muscle weakness due to hypokalemia or hyperkalemia Polyuria and polydipsia due to severe hypokalemia Tachypnea due to acidosis Neuromuscular irritability and confusion due to metabolic alkalosis Lethargy, confusion, seizures, and coma due to hyponatremia or hypernatremia
Fluid imbalance
1. Maintenance replaces the ongoing losses of water and electrolytes urine, sweat, respiration, and stool 2. Replacement corrects any existing water and electrolyte deficits Gastrointestinal, Urinary, or Skin losses, Bleeding, and Third-space sequestration
1.Maintenance Fluid Therapy (Water + Electrolytes) In the presence of normal or near-normal kidney function, maintenance fluid therapy is usually undertaken when the patient is not expected to be able to eat or drink normally for a prolonged period of time (eg, perioperatively or on a ventilator). Goal one to two weeks
best estimate of water balance does not provide any information on volume status Weighing the patient daily best means for estimating net gain or loss of fluid clinical signs edema reduced skin turgor, fall in blood pressure 1.Maintenance Fluid Therapy (Water + Electrolytes)
less than one liter of electrolyte (sodium and potassium)-free water as maintenance fluid 1. Increased water intake fever, sweating, burns, tachypnea, surgical drains, polyuria, or ongoing significant gastrointestinal losses. 1. Decreased water intake oliguric renal failure, the use of humidified air, edematous states, and hypothyroidism. 1.Maintenance Fluid Therapy (Water + Electrolytes)
1.Maintenance Fluid Therapy (Water + Electrolytes)
2 liters per day of one-half isotonic saline in 5 % dextrose to which 20 mEq of Potassium Chloride is added per liter. 400 kilocalories 1.Maintenance Fluid Therapy (Water + Electrolytes)
Electrolytes The original solution can be continued unless one of the following occurs: If the serum Na starts to fall, a more concentrated solution should be given (eg, isotonic saline in 5 % dextrose) If the serum Na starts to rise due, for example, to increased insensible losses from high fever, a more dilute solution should be given (eg, one-quarter isotonic saline in 5 % dextrose) If the serum K starts to fall, more K should be added and, should it rise above normal, K should be eliminated. In patients with normal or near-normal renal function, hyperkalemia is a rare problem. 1.Maintenance Fluid Therapy (Water + Electrolytes)
2.Replacement Fluid Therapy (Water Deficit)
blood pressure jugular venous pressure urine Na concentration urine output the hematocrit below 15 mEq/L 2.Replacement Fluid Therapy (Water Deficit)
at least 1 to 2 liters of isotonic fluids eg, low blood pressure, low urine output, and/or impaired mental status 2.Replacement Fluid Therapy (Rate of Replacement)
must be greater than the rate of continued fluid losses equal to the urine output plus estimated insensible losses (usually 30 to 50 mL/hour) plus any other fluid losses 50 to 100 mL/hour greater than estimated fluid losses 2.Replacement Fluid Therapy (Rate of Replacement)
isotonic or one-half isotonic saline Hypotonic solutions Isotonic or hypertonic saline Isotonic saline and/or blood Potassium or bicarbonate 2.Replacement Fluid Therapy (Choice of replacement fluid)
Fluid Therapy.pptx

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Fluid Therapy.pptx

  • 2. obligatory water intake or generation obligatory water output Fluid input and output should be equal.
  • 3. Volume depletion result from : Gastrointestinal losses, including vomiting, diarrhea, bleeding, and external drainage Renal losses, including the effects of diuretics, osmotic diuresis, salt-wasting nephropathies, and hypoaldosteronism Skin losses, including sweat, burns, and other dermatological conditions Third-space sequestration, including intestinal obstruction, crush injury, fracture, and acute pancreatitis.
  • 4. Clinical manifestation of fluid loss Symptoms related to fluid and symptoms related to electrolytes disturbances. Symptoms related to fluid : Easy fatigability, Thirst , Muscle Cramps and Postural Dizziness. More severe fluid loss can lead to abdominal pain, chest pain, or lethargy and confusion
  • 5. Symptoms related to electrolyte Muscle weakness due to hypokalemia or hyperkalemia Polyuria and polydipsia due to severe hypokalemia Tachypnea due to acidosis Neuromuscular irritability and confusion due to metabolic alkalosis Lethargy, confusion, seizures, and coma due to hyponatremia or hypernatremia
  • 7. 1. Maintenance replaces the ongoing losses of water and electrolytes urine, sweat, respiration, and stool 2. Replacement corrects any existing water and electrolyte deficits Gastrointestinal, Urinary, or Skin losses, Bleeding, and Third-space sequestration
  • 8. 1.Maintenance Fluid Therapy (Water + Electrolytes) In the presence of normal or near-normal kidney function, maintenance fluid therapy is usually undertaken when the patient is not expected to be able to eat or drink normally for a prolonged period of time (eg, perioperatively or on a ventilator). Goal one to two weeks
  • 9. best estimate of water balance does not provide any information on volume status Weighing the patient daily best means for estimating net gain or loss of fluid clinical signs edema reduced skin turgor, fall in blood pressure 1.Maintenance Fluid Therapy (Water + Electrolytes)
  • 10. less than one liter of electrolyte (sodium and potassium)-free water as maintenance fluid 1. Increased water intake fever, sweating, burns, tachypnea, surgical drains, polyuria, or ongoing significant gastrointestinal losses. 1. Decreased water intake oliguric renal failure, the use of humidified air, edematous states, and hypothyroidism. 1.Maintenance Fluid Therapy (Water + Electrolytes)
  • 12. 2 liters per day of one-half isotonic saline in 5 % dextrose to which 20 mEq of Potassium Chloride is added per liter. 400 kilocalories 1.Maintenance Fluid Therapy (Water + Electrolytes)
  • 13. Electrolytes The original solution can be continued unless one of the following occurs: If the serum Na starts to fall, a more concentrated solution should be given (eg, isotonic saline in 5 % dextrose) If the serum Na starts to rise due, for example, to increased insensible losses from high fever, a more dilute solution should be given (eg, one-quarter isotonic saline in 5 % dextrose) If the serum K starts to fall, more K should be added and, should it rise above normal, K should be eliminated. In patients with normal or near-normal renal function, hyperkalemia is a rare problem. 1.Maintenance Fluid Therapy (Water + Electrolytes)
  • 15. blood pressure jugular venous pressure urine Na concentration urine output the hematocrit below 15 mEq/L 2.Replacement Fluid Therapy (Water Deficit)
  • 16. at least 1 to 2 liters of isotonic fluids eg, low blood pressure, low urine output, and/or impaired mental status 2.Replacement Fluid Therapy (Rate of Replacement)
  • 17. must be greater than the rate of continued fluid losses equal to the urine output plus estimated insensible losses (usually 30 to 50 mL/hour) plus any other fluid losses 50 to 100 mL/hour greater than estimated fluid losses 2.Replacement Fluid Therapy (Rate of Replacement)
  • 18. isotonic or one-half isotonic saline Hypotonic solutions Isotonic or hypertonic saline Isotonic saline and/or blood Potassium or bicarbonate 2.Replacement Fluid Therapy (Choice of replacement fluid)