IV Fluids and electrolytes in surgical patients

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IV FLUIDS & ELECTROL ELECTR OLYTES YTES in i n SURGICAL SURGI CAL PATIENTS PATIENTS IV Fluids: - 60% 60% of Total otal Bod Body y weig weight ht is is Wat Water er - Out Out of of ttha hatt 60% 60%,, 40% 40% is is ICF ICF ad ad !0% !0% is " "CF CF - ICF is is ri#h ri#h i $ota $otassiu ssiu& & '(ou '(outt !l of of ICF Fluid Fluid is a )art )art of *BCs - "CF is ri#h ri#h i i +odiu +odiu&&   are are a )art )art of of I+F I+F ad ad . are are a )art of $lasa Vol& - *BC/$ *BC/$las lasa a  Tota Totall Itra Itra Vas#u Vas#ular lar Volu Volue e 123& 123& - ' i#r i#rease ease i "CF "CF osola osolarit rity y is ses sesed ed (y osor osore#e) e#e)tor tors s i hy)othalaus& - This This i#rease i#reases s '5 relea release se (y the the )osteri )osterior or )ituit )ituitary ary&& - '5 i#re i#reases ases the wate waterr )erea )erea(ili (ility ty of of late late se#tio se#tios s of the e)hro - The resu resulti ltig g fall i i e#r e#reti etio o of wate waterr hel)s hel)s rest restor ore e "CF osolarity& $lasa Volue Volue ")asio 10 iutes after !20l IV ifusio3:

Fluid

Plasm a Vol.

ISF Vol

ICF Vol

2%

7l

80l

6!l

*9+

20l

!00l

0l

Colloids

!20l

0l

0l

'l(ui !2%

000l

--820l

0l

8&2% +alie

820l

--200l

--000l

8&2% +alie 1at e;ui3

!20l

000l

--000l

Fluid losses o##ur as: -

5aeorrhage <IT osses .rd s)a#e losses Burs $ul ul oary osses Itr Itra ao)er o)erat ati= i=e e os osse ses s $olyuria 5eat "haustio

For#es For#es #otrollig Fluid o=eet i i  #a)illaries

 Starling’s Law of Capillary Capill ary Filtration:  The role of hydrostati# ad o#oti# for#es 1starlig>s for#es3 i the o=eet of ?uids a#ross the #a)illary e(rae& Q Q

=

k A [ (Pc—Pif   ) + (!if  "  " ! p ) #

= Fluid Fil!aion

" = Capillary Filtration Co$%ci$nt   A = Ar$a of Capillary &$'ran$ Pc = Capillary Capillary Pr$ssr$ Pr$ssr$ (*yrostatic pr$ssr$) Pif  = ,nt$rstitial ,nt$rstitial Fli Pr$ssr$ (*yrostatic Pr$ssr$)  = R#$#%ion Co#%i#n o' Al(umin !if  =  = In#!siial Fluid Colloid Osmoi% P!#ssu!# ! p = Plasma Colloid Osmoi% P!#ssu!# '))li#atio of +tarlig>s ";uatio to ?uids: - Crysta Crystalloi lloids ds i#rease i#rease #a)illa #a)illary ry )ress )ressur ure e  ore lea@age i to I+F - Iterstitial ede edea  *e-etry of ?uids i to #a)illary s)a#e - Coll Colloid oids s tted ed to retai etai #a)ill #a)illar ary y? ?uid uid  aitea#e of )lasa =olue - 5y)o-) )o-)rroteie eia  I+F draws ?uid fro )lasa  edea 









C*A+T'OI+:

C!)sallos * Clear I#e Eidos

* '))eara#e

Commonl) Us#d* 2% etrose, *iger>s a#tate, oral +alie, etrose oral +alie In'!#+u#nl) Us#d* 0% etrose, arrow>s +olutio 1la#tated )ot& +alie3, 5y)ertoi# +alie 2% etrose: Indications:

's a ife lie *e)la#eet *e)la#ee t of Water loss $art of $osto)erati=e $osto)erati=e Fluid Thera)y I <I Ifusio Thera)y 's a ediu to deli=er rugs e&g& o)aie, eri)hylli, Isuli Contra-indications:

5ead IDuries ia(eti# Coa  

5y)oatreia95y)o@aleia

 

'asar#a $uloary Oedea *eal Failure ail ure

FEI

<

a /

  /

Ca/ /

C l-

5CO.-

Os

Cal

)5

2%e

2<

--

*

--

.

+

+

 - --

24

2<

24

--

02 ---

-0! ---

--

 24 24

--

!87

!0

!

!84

--

6&.

--

.07

--

08

272

!0

08

--

$ro)erties of Crystalloids:

*iger la#tate: Idi#atios: -

5eo eorrhagi# +ho +ho# #@ 5y)o 5y)o=o =ole lei ia a due due to <IT <IT osse osses s 5y)otesio Burs $osto osto)e )era rati ti=e =e Flu Fluid id The Thera ra)y )y 's a $reloa eloadi dig g Flu luid id 's a 5eodil 5eodiluet uet i '#ut '#ute e or oro=o o=ole lei# i# 5aeo 5aeodilu dilutio tio 

Cotra-idi#atios: -

5e)a e)ati# Failur ilure e eta eta(oli (oli# # '# '#id ido osis 5y)ertesio 5y)er@aleia 5ead IDuries

oral +alie: Idi#atios: <IT osses 5ead IDuries $ost o)erati=e ?uid Thera)y

08

aitea#e Fluid i I   5y)oatreia Water Itoi#atio Itoi#ati o <astri#9$eritoeal a=age Cotra-idi#atios: 5y)eratreia, 5y)eratreia, 5y)ertesio *eal failure, 'asar#a 'd=atages of Crystalloids: -

ess " " )esi=e "asy '= '=aila ila(ilit ility y <rea <reatter Eria riarry Flow low *e)la e)la#e #e +e;u +e;ues estr trat ated ed Flui Fluids ds ow ow I#i I#ide de#e #e of of 'lle 'llerg rgi# i# *ea#t ea#tio ios s Ca Be Be <i <i=e *a *a)id idly ly o Iterf Iterfer ere#e e#e with with <rou) <rou)ig ig G Cross Cross at#hi at#hig g o Coagulo)athy

isad=atages of Crystalloids: -

Fluid *e *ea#tios Water ater It Itoi#a i#attio io ysel sele#tr #troly lytteia $ul ul oary Oede dea *e-etry fro .rd +)a#e I#r I#rea ease sed d Car Cardi dia# a# Wor Wor@l @loa oad d ilut ilutio ioal al ' 'ae aei ia a Coag Coagulo ulo)a )ath thy y

Colloids: olia : <lue "idos: '))eara#e Cooly Esed Colloids: 5ea##el, 5es- steril .%,6%,0%, Blood, aitol Ifre;uetly Esed Colloids: Colloids: $lasa, 'l(ui 2%,!2%, ")a, oode 40,60 5aea##el: Idi#atios:

5eorrhagi# 5eorrhagi# +ho#@ $ost-s)ial 5y)otesio 'a)hyla#ti# +ho#@ 5eodiluet i '5 +urgi#al $atiets with +9'+ Cotra-idi#atios: $atiets with 'to)y Bro#hial 'stha +e)ti#eia $uloary oedea9'*+  

5y)ertesio $atiets with u@ow Blood <) Bleedig iathesis

5ydroy 5ydroy "thyl +tar#hes: o

o

o

o

 'other for of hy)ertoi# sytheti# #olloids used for =olue e)asio Cotai sodiu ad #hloride ad used for heodyai# =olue re)la#eet followig aDor surgery ad to treat aDor (urs  ess e)esi=e tha al(ui ad their eHe#ts #a last !4 to .6 hours ess I#ide#es of iue rea#tios #o)ared to 5ea##el&

'd=atages of Colloids: -

+al +alle lerr Ifu Ifuse sed d Volu olues es $rolo ologe ged d I# I#rrease ease i $V $V ii iial al Oede Oedea a 1$er 1$eri)h i)her eral al9C 9Cer ere(r e(ral al33 5ighe 5igherr O! O! 1+yst 1+yste ei# i# Oy Oyge ge  eli= eli=er ery3 y3 Eseful Eseful i $reloa $reloadig dig (efor (efore e +u( +u( 'ra# 'ra#hoi hoid d Blo#@ Blo#@

- Esefu sefull i i 5e 5eod odil ilut utio io  - Fewer ewer yse ysele le#t #trrolyt olyte eia ias s isad=atages of Colloids: -

<reater " ")ese Coag Coagul ulo) o)at athy hy 1e 1et tra ra 5" 5"+3 +3 Ite Iterf rfer eres es i i <rou) <rou)i ig g G Cros Cross s at# at#hi hig g $ulo uloar ary y Oede Oedea a 1+e)t 1+e)ti#e i#ei ia a G '*+ '*+33 e#reased <F* Osoti Osoti# # iure iuresis, sis, 5y)o#a 5y)o#al#e l#eia ia 1wit 1with h 'l( 'l(ui ui3 3

Body Fluid *e;uireets at *est: & easura(le easura(le osses1* osses1*eal eal / <IT / rais3 / OOl OOl !& !0 to to 40 l9@ l9@g9da g9day y .& 000 000 l to20 to200 0 l9 l9 !9ay 4& 0 to 0@g BW04 BW04 l9@g9hr l9@g9hr /0 to !0@g BW0! l9@g9hr / For reg BW0 l9@g9hr l9@g9h r Fluid *esus#itatio: - Corre Corre#ti #tio o of eist eistig ig a(or a(oral alitie ities s i =olu =olue e status status or or seru ele#trolytes 1asi hy)o=olei# sho#@3 - $araeters $araeters used to assess =olue deJ#itK & Blood )ressure !& Erie out)ut .& Lugular =eous ) )ressure ressure 4& Erie sodiu #o#etratio

,o- o "no- a # /ai#n as ,)/o0ol#mi% So%"1 -

'iety, 'gi 'gittatio Cool Cool $ale ale +@i +@i,, Cof Cofus usio io  e#r e#rea ease sed d or or o o uri urie e Out) Out)ut ut *a)id (r (reathig iso isori riet eted ed,, os oss s Of Of Co Cos#i s#iou ous sess ess ow B$ B$,, Cold Cold "tr "tre eit itie ies s *a)id a)id,, Threa hready dy $ul ulse se

*ate of ?uid re)letio:

23 S#0#!# 0olum# d#/l#ion o! )/o0ol#mi% so%"*  *a)id ifusio of -! of isotoi# salie 10&% +3 as ra)idly as )ossi(le to restore tissue )erfusio

43 5ild o mod#!a# )/o0ol#mia* Choose a rate that is 20-009h greater tha estiated ?uid losses& #al#ulatig ?uid loss as follows: 

Erie out)ut



Isesi(le losses  .0l9h



20l9h

'dditioal loss su#h as Voitig or iarrhoea or high fe=er 1additioal 00- 20 l9day for ea#h degree of te) .8 C3

+igs ad sy)tos of Fluid o=erload:  They are ot always ty)i#al (ut ost #ooly are: - "dea 1swellig3 - )arti#ularly feet, ad a@les !- iM#ulty (reathig while lyig dow .- Cra#@les o aus#ultatio 4- 5igh (lood )ressure 2- Irritated #ough 6- Lugular =ei distesio 8- +hortess of (reath 1dys)ea3 7- +trog, ra)id )ulse

aageet: -

$re=e e=eti tio o is the the (es (estt way way +odi diu u restri#tio io Fluid rest strri#ti #tio iureti#s ialysis

5ow to Cal#ulate IV Flow *ate:

What is a dro) fa#torK ro) fa#tor is the u(er of dro)s i oe illiliter used i IV ?uid adiistratio 1also #alled dri) fa#tor3& ' u(er of diHeret dro) fa#tors are a=aila(le (ut the Cooest are: - 0 dro)s9l 1(lood set3 !- 2 dro)s 9 l 1regular set3 .- 60 dro)s 9 l 1i#rodro), (urette3

0olum# 6ml7 8 d!o/ 'a%o! 6d!o/s 9 ml3

= d!o/s 9 min 6$o- !a#7

--------------------------------------------im# 6min7 *e#et ad=a#eets: - Iter Iteross osseous eous *out *oute e N ti(ia, ti(ia, feur, feur, +u)er +u)erior ior ilia# ilia# #rest #rest,, head of the huerus - 'u 'uto to-t -tra ras sfus fusio io Te#hi e#hi;ue ;ues s - 'rtiJ#i 'rtiJ#ial al 5ae 5aeoglo oglo(is (is N $er? $er?uor uoro o Car(o Car(o  (ased (ased ad ad 5aeoglo(i (ased - 5y)er )ertoi# +ali ie es - +altlt-fre free 'l 'l(ui uis - Tetra etrast star ar#h #hes es 1V 1Volu olu=e =e3 3

"le#trolytes: 5y)oatraeia: - ef : .2 ";9 - Causes: - $s $seud eudoh ohy) y)o oat atrreia eia 1high 1high li)i li)id d le=el le=els3 s3 - 5y)o=olei# - "u=olei#

- 5y)er=olei# - Cli Clii# i#al al Feat eatures ures:: - aDo aDori rity ty:: 's 'sy y)t )to oat ati# i# - <IT 1!0 1!0 ";93 ";93:: ausea ausea,, Voitig oitig,, 'ore 'oreia ia - C+ C+ 1!0 1!0 "; ";9 93: 3: Cof Cofusi usio o,, Coa, Coa, +eiP +eiPur ures es  Treatet:  Treatet: - aageet: - 5y)er 5y)erto toi# i# sali salie e wit with h Fru Fruse seide ide - aageet of of IC IC$ - Water ater *est estri#t ri#tio io  - Corr Corre# e#ti tio o of of $r $re#i)it e#i)itat atig ig fa#t fa#tor or - ee#lo ee#lo#y# #y#lie lie 1redu 1redu#es #es res)o res)osi si=e =eess ess of of CT to '53 '53 - Oral Oral +alt +alt +u)) +u))le lee et tat atio io  - 5ourly 5ourly a/ oito oitori rig g 1till 1till seru seru a/ .0" .0";9 ;933 Co)li#atios: - Cet Cetra rall $o $oti tie e yel yeli ios osis is - Iatr Iatrog oge ei# i# 5y)e 5y)erratr atre eia ia

5y)eratraeia: ef:

42 ";9

Causes: - Iatrogei# - Iad Iade; e;ua uate te Water ater Ita Ita@ @e - Water ater os oss: s: <IT <IT,, *e *eal, al, 5eat 5eat +tr +tro@ o@e e - Ise Ises si( i(le le oss, oss, Burs urs

- ear ear row rowi ig g i +ea +ea Wat Water er - alf alfu u#t #tio ioi ig g 5eo 5eodi dial alys ysis is Clii#al Features: - <IT: 'ore 'oreia ia ,ausea ,ausea ,V ,Voi oitig tig ,Thirs ,Thirstt - C+: C+: ethar ethargy gy ,Irrit ,Irrita(il a(ility ity ,rows ,rowsie iess ss - *eal: eal: Olig Oligur uria ia,, $re-r $re-re eal al Fai Failur lure e - Other: Other: $yr $yre eia, ia, 5y)e 5y)erto rtoia, ia, $ostura osturall 5y)ot 5y)otesi esio o aageet: - Cor Corre#ti e#tio o of 5y)o 5y)ote tes sio io  - Oral Water - IV isti istill lled ed Water ater --Q --Q - 0& 0&42 42% % +al +ali ie e / 2% et etrrose ose - ' 'V$ 1es 1eso)r o)ress essi i a#etat a#etate e N 0&-0 0&-0&7 &7g g N di=ided di=ided dose doses s 1B3 3 - *ate ate of of *edu *edu#t #tio io: : 0! ";9 ";9 ) )er er 5r 5y)o@aleia: ef: .&2 ";9 Causes: -

Iad ade;ua ;uate It Ita@e <IT osse osses: s: iar iarrh rhoea oea,, Voi Voiti tig, g, asog asogast astri# ri# +u#tio +u#tio  *eal osses iur iuret eti# i#s: s: ost ost Co Co o Co) o)artet +hi +hifft

Clii#al Features: -

Wea@ ea@es ess s - Ruad Ruadri ri)l )leg egia ia 5y)o 5y)oto toi# i#it ity y - $os $ostu tura rall 5y)ot 5y)ote esio sio  'dya dyai i# # Ileu Ileus s - Voit oiti igs gs 5y)o=e 5y)o=eti tilat latio io - *es)irat es)iratory ory Failure ailure 'trial 't rial 9 Vet Vetri#u ri#ular lar Ta#h Ta#hy#a y#ard rdia ia - 'rre 'rrest st *ha( *ha(do doy yol olys ysis is i i Chr Chroi# oi# Cas Cases es

"C< Chages:

-

$rolo ologe ged d $* $* It Iter er=a =all e)r e)res essi sio o of +T +eg +ege ett T Wa= Wa=e e Flat Flatte tei ig g - - I=e I=ers rsio io  $roi oiet et E Wa=es '))ar ') )are ett $r $rolog ologat atio io  Of RT RT Ite Iter= r=al al 5y)o@ 5y)o@ale aleia ia $otetia otetiates tes igital igitalis is '# '#tio tio 

 Treatet:  Treatet: - $otas otassi siu u +u)) +u))le lee et tat atio io  - Oral: Oral: Food, ood, $ot#hlor ot#hlor,, elaye elayed d *elea *elease se For Forulat ulatio ios s - IV: IV: C, '# '#eta etate, te, Citrat Citrate, e, <lu#oa <lu#oate, te, Bi#ar( Bi#ar(oa oate, te, $hos)hate - *ate *ate Of Of Corr Corre# e#tio tio  ot ot  0 0 ";9 ";9  )er )er 5r 5r - "su "surre *e *eal al Fu#t u#tio io  - "C< "C< o oit itor orig ig N Bolu Bolus s" "He He#t #t o 5ear 5eartt - +to +to) o oo) iu iurreti#s i#s - Ese Ese $ot $otass assiu iu +)ar +)ari ig g iur iuret eti#s i#s 5y)er@aleia: ef:  2&0 ";9 Causes: - $seud seudoh ohy) y)er er@ @ale aleia ia - "#e "#essi ssi=e =e Ita@ Ita@e e 1"og 1"ogeo eous3 us3:: - Oral Oral,, IV, IV, Bl Blood ood Tras rasfus fusio io,, - <I Bl Blee eedi dig g,, T$ T$,,  $e $ei# i#il illi li  - "#e "#essi ssi=e =e *eleas elease e 1"d 1"dog ogeo eous3 us3:: - Tissue issue aag aage, e, Tuour uour ysis ysis,, Bu Burs rs,, *ha(doyolysis, 5aeolysis, +e)ti#eia - e#r e#rea eased sed *e *eal al "#r "#ret etio io:: rugs rugs,, *F - Co) Co)ar art tet et shif shift: t: '#id '#idos osis, is, Isu Isuli li eJ eJ,, - igo igoi i  O=er O=er os osage age,, +#oli +#olie e,, B Blo#@ Blo#@er ers s aageet: - Treat eat if if   6&2 6&2 ";9 ";9 - e(r e(ra ae e +ta( +ta(il iliP iPat atiio: o:

-  or ! a) a) of of CaCl! CaCl! IV +tat +tat 1oset 1oset i se#, se#, last lasts s .0 is3 is3 - +hif +hiftt Of Of $ot $otas assi siu u i ito to Cell Cells: s: - IV Isu Isuli li / <lu#ose <lu#ose 1os 1oset et ! or . is, is, last lasts s few few 5rs3 5rs3 - 's 'stthali hali  e( e(ul uliP iPat atio io  - IV +od +odiu iu  Bi# Bi#ar ar(o (oa ate te ! a) a) +ta +tatt - *eo= eo=al al of $otas otassi siu u:: - oo) iureti#s - <I $ota $otassiu ssiu  Bidig Bidig *esi *esi: : Sa Saye yeala alate te .0g .0gs$O s$O or or 20gs $* - '#ute #ute 5eod eodia ialy lysi sis: s: - I ife ife Thr Threa eate tei ig g 5y)e 5y)er@ r@al ale eia ia 5y)o#al#aeia:

D#'* S#!um Ca:: ; < m> Caus#s*- <IT: <IT: Fistulae - *eal eal::

'#ute $a#reatitis, $a#reati# 9 "teri# "teri # '#ute #ute 9 Chr Chroi# oi# *F

- "do#r "do#rial ial:5y :5y)o )o $T5, $T5, "#isi "#isio o of of $T5, $T5, 5y)ot 5y)othyr hyroidi oidis s - e#r e#rot otiP iPi ig g Fas#i as#iit itis is - +e=e +e=erre 'l@ 'l@alosi alosis, s, 5y) 5y)o o ag ages ese ee eia ia - *a)id a)id Bl Bloo ood d Tra Tras sfu fusi sio o +y)tos: -

$ete# ete#hi hiae ae,, $aras arasth thes esia ias s 5y)er 5y)erre re?e ?eia ia,, Car) Car)o)ed o)edal al +)as +)as,, Ch=o Ch=oste ste@>s @>s +ig us# us#le le 9 '( '(do do i ial al Cra Cra )s "C<: "C<: $rol $rolog ogat atio io  of of RT RT It Iter er=a =all ife thr threat eatei eig: g: ary arygos) gos)as as,, #ardia# #ardia# arr arrhyt hythi hias as

aageet: - Cor Corre#ti e#tio o of of Ede Ederl rlyi yig g Cau Cause se - Cor Corre#ti e#tio o of eJ# eJ#it it::

- '#ute #ute:: ID ID CaCl CaCl! ! 9 Ca Ca <lu <lu#o #oa ate te IV - Chr Chroi#: oi#: Cal# Cal#iu iu  a#t a#tat ate, e, il@ il@ Ora Orally lly - urig urig assi assi=e =e Blood Blood Tra Trasfu sfusio sio: : 0! l l of 0% 0% CaCl! CaCl! IV )er "=ery 200 l of (lood Through a +e)arate ie - oito oitorr +eru +eru Ca// Ca// e=e e=els: ls: Wat# Wat#h h for 5y)o#al 5y)o#al#e #eia ia ad ad e)hrolithiasis after log ter #al#iu thera)y& thera)y& - oit oitor or RT It Iter=a er=als ls 5y)er#al#aeia: -

ef ef: +eru +eru  Ca// Ca//   g % Causes: $seud seudo ohy)e hy)err#al# #al#e eia ia $T5 edia ediated ted:: 5y)er) 5y)er)ara arathy thyro roidi idis, s, Ca Ca $ara $arathy thyro roid id <lad - 42%

PT, Nonm#dia#d* -

Other Other alig aliga a#ie #ies, s, " " Ty)e y)e I G II II Vita itai i ' G  It Ito oi#a i#ati tio o,, il@ il@--'l 'l@ @ali ali +yd +ydrroe, oe, Ortho: Ortho: $aget>s aget>s iseas isease, e, *heua *heuatoi toid d 'rth 'rthrit ritis is *eal: eal: *ea *eall Tra Tras)la s)lat, t, iur iureti eti# # )hase )hase of *F *F <ra <raulo uloa ato tous us isea isease ses: s: TB, TB, +ar#o +ar#oido idosi sis s

Clii#al Features: - 'sy)toati# - <IT: <IT: 'or 'oreia eia,, ausea ausea,, Cost Costi)a i)ati tio o - C+: C+: Irrita Irrita(ili (ility, ty, Wea@ Wea@ess ess,, Fati Fatigue, gue, $hot $hoto)h o)ho(i o(ia, a, +tu)or, Coa - *eal: eal: e)hr e)hro#a o#al#i l#iosi osis, s, e)hr e)hrolit olithias hiasis is - "C<: "C<: $r $rolog ologed ed $* It Iter er=a =al, l, +hor +horte tee ed d RT aageet: -

Cal#i Cal#iur uret eti# i# iur iures esis is - - +ali +alie e / asi asi  ID Cal#i Cal#ito toi i 4 to 7 IE IE 9 g g s# s# ; 66-! ! 5rs 5rs i)ho i)hos) s)ho hoat ates es:: idr idro oel el 8&2 8&2 g 9 g g ! <all <alliu iu  it itra rate te 0 00N 0N!0 !00 0 g9 g9  B+'9!4 5rs IV $hos)hate, IV "T', "T', 5aeodialysis

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