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FLUIDS AND ELECTROLYTES

FLUIDS AND ELECTROLYTES. D E L P R A D O M. D. FLUID COMPOSITION. Total Body Water: 60% Body Weight Intracellular 40% Body Weight Extracellular 20% Body Weight Interstitial: 15% Body Weight Intravascular: 5 % Body Weight. INTRACELLULAR AND EXTRACELLULAR FLUID COMPOSITION.

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FLUIDS AND ELECTROLYTES

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  1. FLUIDS AND ELECTROLYTES D E L P R A D O M. D.

  2. FLUID COMPOSITION • Total Body Water: • 60% Body Weight • Intracellular • 40% Body Weight • Extracellular • 20% Body Weight • Interstitial: 15% Body Weight • Intravascular: 5 % Body Weight

  3. INTRACELLULAR AND EXTRACELLULAR FLUID COMPOSITION

  4. Maintenance Requirements • Holiday-Segar Method • Estimates caloric expenditure in fixed weight categories; it assumes that for each 100 calories metabolized, 100ml of water will be required.

  5. HOLIDAY-SEGAR METHOD

  6. BODY SURFACE AREA METHOD Mosteller’s Formula • Surface area (m2): • Square root (Height (cm) x Weight (kg)/ 3600)

  7. STANDARD VALUES FOR USE IN BODY SURFACE AREA METHOD

  8. BSA • TFR: Insensible water loss + urine output • IWL: 400-600 ml/m2/day x BSA • Urine: 600-1000 ml/m2/day x BSA

  9. Fever: 12% for each C >37.5 C or 7ml/kg for each 0.5C > 37.5C Room temp: >31 C 30% per degree rise Hypermetabolism Major surgery Burns 20-30% 20% increase per 1% area burn CONDITIONS THAT ALTER MAINTENANCE FLUID

  10. Less required Hypothermia High Humidity Oliguria/Edema Sedated/Paralyzed 12% for each C <37.5 30% Case to case/ 30% 40% CONDITIONS THAT ALTER MAINTENANCE FLUID

  11. DEFICIT THERAPY • Fluid Deficit (L) • pre-illness weight (kg) - illness weight (kg) • % Dehydration • (pre-illness weight - illness weight)/pre-illness weight x 100%

  12. PERCENTAGE OF DEFICIT FROM EXTRACELLULAR AND INTRACELLULAR COMPARTMENTS

  13. CLINICAL OBSERVATION IN DEHYRATION

  14. CLINICAL OBSERVATION IN DEHYDRATION

  15. LUDANS METHOD

  16. COMPOSITION OF FREQUENTLY USED PARENTERAL FLUIDS

  17. ELECTROLYTE COMPOSITION OF VARIOUS BODY FLUIDS

  18. ANION GAP (Na + K) - (Cl + HCO3) N.V. : 8-16 mg/dL

  19. SODIUM DEFICIT • mEq Na deficit : • (desired - actual) x TBW • TBW = 0.6 x BW (kg) • Initial goal : 120 mEq/L subsequent 130mEq/L in 24 hrs • Correct up to 12 mEq/L/day

  20. HYPERNATREMIA (Plasma Na - 140) / 140 x TBW Correct up to 10-15 mmol/L/day

  21. HYPOKALEMIA • mmol K deficit : • (desired-actual) x 0.3 x wt.kg. • Deficit : Wt. (kg) x 50 x Estimated % deficit

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