Aspect to Consider in Fluid Therapy

7/25/2019 Aspect to Consider in Fluid Therapy

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Aspect to Consider in Fluid Therapy


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Fluid Therapy

Resuscitation

Maintenance fluid therapy

Nutrition


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Resuscitation

In Shockevery stage of shock

Dehydration

leeding urn

!eakage syndro"ehypovole"ia


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Class I Class II Class III Class I#

lood loss $p to %&' %&'()&'' )&''(*''' +*'''

lood loss

, -.#/

$p to )&- )&(0'- 0'(1'- +1'-

2ulse rate 3)'' +)'' +)*' +)1'

loodpressure

Nor"al Nor"al Decrease Decrease

2ulse pressure Nor"al ordecrease

Decrease Decrease Decrease

Respiratoryrate

)1(*' *'(0' 0'(0& +0&

$rine output +0' *'(0' &()& No $4

CNS5 "entalstatus

Slightlyan6ious

Mildly an6ious An6ious andconfused

Confused andlethargic

Fluidreplace"ent

crystalloid crystalloid Crystalloid5colloid

Crystallloid5colloid


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.sti"ated lood #olu"e

Age lood #olu"e

Neonate

2re"ature 7&(8'5kg9Full(ter" 7& "l5:g9

Infant 7' "l5:g9

AdultMale %& "l5:g9

Fe"ale ;& "l5:g9


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D4* < Cardiac Output6 Ca4* , arterial 4* content /

,=> 6Sp4* 6)?01 /@ , '?''0 6 2a4*/

Stroke #ol 6 =R

#olu"e 6 contractility


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Duration of fluid intravascular

Type of fluid Duration in intravascular

Al>u"in &- *(0 hour

HES ( Hydroxy Ethyl Starch) 4-5 hour

elatin , hae"acel? gelofusin/ )B& * hour

De6tran )B& * hour

Crystalloid )& *' "inute


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Colloids are superior to cristalloids at

attaining resuscitation he"odyna"ic

endpoint?


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9hat are the stakes

Risks of inadeEuate resuscitation

!ife(threatening

Nonfatal

Risks of e6cessive resuscitation

!ife(threatening

Nonfatal


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!ife(Threatening ConseEuences of

InadeEuate Resuscitation

!actic acidosis Acute renal failure

Multisyste" organ failure


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Maintenance Fluid Support

(2atient fasting ith nor"al >ody fluid

co"position

( Critically ill patients ith altered >odyfluid co"position

( 2erioperative losses , 2reoperative?

during the operation? postoperatively/


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asic 2rinciples of Fluid Maintenance

Therapy

Replace

Maintenance

Repair

A>nor"al lossG IT? 0rdspace?

4ngoing loss? septic and

=ypovole"ic shock

I9! @ urine

Acid >ase? electrolyte i">alances


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Nor"al Adult 9ater and .lectrolyte

ReEuire"ent,electrolyte "eE5kg95day and ater cc5"*/

150080!ater

'?% ( 0?;'?0Cl

'?0 ( '?%'?* ( '?1Mg

'?1 ( )?)'?*Ca

'?% ( *?)'?0 ( '?&:

'?%(0?;'?0Na

$sual needsMini"al needsCo"ponent


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0 G ) ( ) H )lukosa G le"ak

): "eE5kg5hari

) (*Na "eE5kg5hari

) )?&AsBA"ino5prot

r5kg5hari

*& 0' ,kritis/

0' &'

.nergi :cal5kg5hari

*& 0' ,kritis/

0' &'

Air cc5kg5hari

u"lahSu>strat nutrisi

Maintenance

fluid5electrolytereEuire"ents


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Co"position of Maintenance Fluid

Type fluid Na Cl : Ca Mg lactate Sugar Tutofusin 42S )'' 8' )7 1 ; 075acetate &'5sor>itol

:a.n Mg0 &' &' *' ( ( *' )''

:a.n 0 &' &' *' ( ( *' *%

:a.n 0A ;' &' )' ( ( *' *%

R! )0) ))* 1 1B& ( *7 (

:a.n ) 07B& 07B& ( ( ( ( 0%B&


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.lectro(neutrality

In aEueous solutionthe su" of all negatively charge

ion "ust eEual the su" of all positively charged ion

In pure aterG the concentration of =

@

< =C40(

In plas"aG other charged ion present also have an

effect on the relative proportion of =@and =C40(

These other charged "olecule , hich affect the

dissociation of ater to give =@/independentvaria>le ,SID? AT4T? 2aC4*/


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" #aria$le

%la&'a pH or H*

+ndependent

#aria$le

Steart 2AB Can 2hysiol

2har"acol ;)G)111()1;)?

)870B

,ependent

#aria$leJ

pCO" S+, - ./O/ pH CO- H- OH- .- .H HCO-

H"0 CO" H"CO H HCO-

./O/ .

-

.H(2a3Ca) ( Cl- lactate )


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a">legra"

2a

140

KK++ 44

CaCa++++

MgMg++++

Cl-

102

HCO-

"4

3./+O2 .2+O2

S+,

S/RO2 +O2 ,+ERE2CE

A- 42A- 42


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NaNa NaNa NaNa

K K KHCO3

ClCl ClCl ClCl

HCO3HCO3SID

Normal Acidosis Alkalosis

!ea6 acid i'$alance

( al$u'in or pho&phate )

AlbAlbAlbAlbAlbAlb

SID

SID

AlkalosisAlkalosis

hypoalbumin/hypoalbumin/

phosphatphosphat

A!i"osis --#A!i"osis --#

Hyp$p$otin /Hyp$p$otin /

hyp$albuminhyp$albumin

o$ phosphato$ phosphat


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Rule& o7 i&olated a$nor'alitie& in &tron ion

di77erence (S+,) and total concentration o7 !ea6

.cid

S+,9./O/ +&olateda$nor'alitie&

Re&ult

SID Increase Meta>olic alkalosis

SID Decrease Meta>olic acidosis

AT4T Increase Meta>olic acidosis

AT4T Decrease Meta>olic alkalosis


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2a: 140 'E;9 8S+, > 8 = : al6alo&i&= : al6alo&i&

Contracted alkalosisContracted alkalosis

2las"a 2las"a


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Na@ < )1' ".E5!

Cl( < )'* ".E5!

SID < 07 ".E5!

)1'5* < %' ".E5!

)'*5* < &) ".E5!

SID < )8 ".E5!

) liter * liter

!./ER E?CESS

1


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Na@< )1' ".E5!

Cl(< )'* ".E5!

SID < 07 ".E5!

Na@< )&1 ".E5!

Cl(< )&1 ".E5!

SID < ' ".E5!) liter ) liter

2!ASMA @ NaCl 'B8-

SID G 07

2las"a NaCl 'B8-


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* liter

=yperchlore"ic acidosis after NaCl 'B8-

infusion

:

SID G )8 acidosis

2a: (140154)9" 'E;9


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2a: 140 'E;9ase >alance

Type of fluidFor volu"e effect

Maintenance All ill influence acid >ase and electrolyte

>alance


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Aspect to Consider in Fluid Therapy