1 / 15

Fluids and Electrolytes

Fluids and Electrolytes. Lori F Gentile UF Surgery. Fluid Compartments. Total body water(TBW)= ICF + ECF = 50-60% weight ICF = 2/3 TBW ECF = 1/3 TBW Interstitial fluid = 2/3 ECF Intravascular fluid(blood volume) = 1/3 ECF. Composition of Fluid Compartments.

sylvie
Download Presentation

Fluids and Electrolytes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Fluids and Electrolytes Lori F Gentile UF Surgery

  2. Fluid Compartments • Total body water(TBW)= ICF + ECF = 50-60% weight ICF = 2/3 TBW ECF = 1/3 TBW • Interstitial fluid = 2/3 ECF • Intravascular fluid(blood volume) = 1/3 ECF

  3. Composition of Fluid Compartments ICF = K, Mg, Phos, proteins Na determines intracellular/extracellular osmotic pressure ECF = plasma & interstitial fluid very similar. Plasma has a higher protein concentration. Na is confined to the ECF(1/3 plasma, 2/3 interstitial space) - IVF w/Na expands the interstitial space more than it does the intravascular space.

  4. Maintenance Fluid: Composition What is D5 NS + 20KCl? D5 = 5% glucose = 5g dextrose/100mL of solution or 50g/L (prevents mobilization of protein as fuel source) 1L NS = 154mEq Na, 154mEq Cl 20KCl = 20mEq KCl per L What is LR? 1L LR = Na 130 mEq, K 4 mEq, Ca 3 mEq, Cl 109 mEq and lactate 28 mEq. The electrolyte content is isotonic (273 mOsmol/L) in relation to the ECF (approx. 280 mOsmol/L). The pH of the solution is 6.6.

  5. Maintenance IVF: Adults MIVF rate calculation: 4 / 2 / 1 rule (per hour) For the first 10kg → 4mL/kg/hr For the next 10-20kg → 2mL/kg/hr For each kg after 20kg → 1mL/kg/hr Typical MIVF: D5 1/2NS +20KCl Electrolyte requirements: Sodium = 2-3 mEq/kg/day Potassium = 0.5-1 mEq/kg/day

  6. IVFs After Surgery Fluid Loss during surgery- 0.5-1L/hour, + blood loss Calculate initial MIVF rate with 4-2-1 rule, then adjust for blood loss Use LR/NS for first 24 hours, then switch to D5 2 NS +20KCl Daily BMPs while NPO to manage electrolytes

  7. Resuscitation Remember your ABC’s C = includes IV access Important: what is adequate IV access? Evaluate hemodynamic status: look at BP, HR, skin perfusion, temperature, mental status Start with isotonic crystalloid fluids Initial bolus: 20mL/kg in children, 2L in adults Assess response to bolus: If responsive, continue evaluation If unresponsive, THERE IS A PROBLEM THAT YOU NEED TO IDENTIFY NOW: bleeding, cardiac tamponade, spinal cord injury, tension PTX, MI, myocardial contusion, air embolism

  8. Assessment of Volume Status Daily weights Swelling/edema Edema pattern on CXR UOP UOP > 0.5mL/kg/h adults UOP for children > 1mL/kg/h

  9. Case #1: Presentation H&P: 6wk-old, first-born M p/w 5d h/o projectile nonbilious, postprandial emesis - otherwise, pt w/good appetite PE: firm, mobile “olive” in epigastrum, and visible gastric peristaltic waves U/S: pyloric muscle elongated & thickened (4mm thick) Questions: What is the diagnosis? What is the associated metabolic/electrolyte abnormality? What is the management?

  10. Electrolyte Abnormalities • GI (vomiting/diarrhea) – K and Cl • Stomach – H and Cl • Bile/Pancreas – bicarb • Hypochloremic, hypokalemic metabolic alkalosis

  11. Hyperkalemia • Renal failure (missed dialysis), hemolysis • Peaked T waves on EKG • Management – confirm lab value (r/o lab hemolysis) • Calcium gluconate for heart (stabilizes membranes) • NaBicarb, 10U insulin, 1 amp dextrose • Kayexalate / Dialysis Hyokalemia can cause an ileus

  12. Hyponatremia • SIADH, Rule out hyperglycemia (pseudohyponatremia) • Water restriction, diuresis, replacment • Slow Na correction (1mEq/hr) • Avoid central pontinemyelinosis Hypernatremia – tx with free water

  13. Hypercalcemia • Seen in hyperthyroidism, parathyroid tumors, bone metastates, renal failure • Bones, stones, moans, psychiatric overtones • Tx: NS + lasix • Avoid LR (has Ca) • Avoid thiazide diuretics (retains Ca) • Calcitonin, dialysis

  14. Case #1: Resolution Dx: Hypertrophic pyloric stenosis (HPS) Metabolic abnormality: hypochloremic, hypokalemic metabolic alkalosis with paradoxical aciduria Loss of H+ and Cl- with vomiting Initial excretion of Na-bicarbonate in response to Cl loss Aldosterone acts to promote K excretion for Na retention Finally, H exchanged for Na, resulting in paradoxic aciduria Treatment: +/- NS bolus, when UOP is demonstrated, K is added to IVF D5 ½ NS + 20K @ 1.5-2x maintenance Must resolve electrolyte abnormalities prior to surgery Pyloromyotomy: laparoscopic vs. open Advance PO intake as tolerated

  15. Take Home Points 4-2-1 rule for calculation of MIVF rate ABC(DE) is important in many situations Bolus IVF are not the same as MIVF Action is required if a patient is unresponsive to initial resuscitation

More Related