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 ad ad !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 ad ad . are are a )art of $lasa Vol& - *BC/$ *BC/$las lasa a Tota Totall Itra Itra Vas#u Vas#ular lar Volu Volue e 123& 123& - ' i#r i#rease ease i "CF "CF osola osolarit rity y is ses sesed ed (y osor osore#e) e#e)tor tors s i hy)othalaus& - 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 )erea )erea(ili (ility ty of of late late se#tio se#tios s of the e)hro - The resu resulti ltig g fall i i e#r e#reti etio o of wate waterr hel)s hel)s rest restor ore e "CF osolarity& $lasa Volue Volue ")asio 10 iutes after !20l IV ifusio3:
Fluid
Plasm a Vol.
ISF Vol
ICF Vol
2%
7l
80l
6!l
*9+
20l
!00l
0l
Colloids
!20l
0l
0l
'l(ui !2%
000l
--820l
0l
8&2% +alie
820l
--200l
--000l
8&2% +alie 1at e;ui3
!20l
000l
--000l
Fluid losses o##ur as: -
5aeorrhage <IT osses .rd s)a#e losses Burs $ul ul oary osses Itr Itra ao)er o)erat ati= i=e e os osse ses s $olyuria 5eat "haustio
For#es For#es #otrollig Fluid o=eet i i #a)illaries
Starling’s Law of Capillary Capill ary Filtration: The role of hydrostati# ad o#oti# for#es 1starlig>s for#es3 i the o=eet of ?uids a#ross the #a)illary e(rae& Q Q
=
k A [ (Pc—Pif ) + (!if " " ! p ) #
= Fluid Fil!aion
" = Capillary Filtration Co$%ci$nt A = Ar$a of Capillary &$'ran$ Pc = Capillary Capillary Pr$ssr$ Pr$ssr$ (*yrostatic pr$ssr$) Pif = ,nt$rstitial ,nt$rstitial Fli Pr$ssr$ (*yrostatic Pr$ssr$) = R#$#%ion Co#%i#n o' Al(umin !if = = In#!siial Fluid Colloid Osmoi% P!#ssu!# ! p = Plasma Colloid Osmoi% P!#ssu!# '))li#atio of +tarlig>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 - Iterstitial ede edea *e-etry of ?uids i to #a)illary s)a#e - Coll Colloid oids s tted ed to retai etai #a)ill #a)illar ary y? ?uid uid aitea#e of )lasa =olue - 5y)o-) )o-)rroteie eia I+F draws ?uid fro )lasa edea
's a ife lie *e)la#eet *e)la#ee t of Water loss $art of $osto)erati=e $osto)erati=e Fluid Thera)y I <I Ifusio Thera)y 's a ediu to deli=er rugs e&g& o)aie, eri)hylli, Isuli Contra-indications:
5ead IDuries ia(eti# Coa
5y)oatreia95y)o@aleia
'asar#a $uloary Oedea *eal Failure ail ure
FEI
<
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:
*iger la#tate: Idi#atios: -
5eo eorrhagi# +ho +ho# #@ 5y)o 5y)o=o =ole lei ia a due due to <IT <IT osse osses s 5y)otesio Burs $osto osto)e )era rati ti=e =e Flu Fluid id The Thera ra)y )y 's a $reloa eloadi dig g Flu luid id 's a 5eodil 5eodiluet uet i '#ut '#ute e or oro=o o=ole lei# i# 5aeo 5aeodilu dilutio tio
5y)ertesio $atiets with u@ow Blood <) Bleedig iathesis
5ydroy 5ydroy "thyl +tar#hes: o
o
o
o
'other for of hy)ertoi# sytheti# #olloids used for =olue e)asio Cotai sodiu ad #hloride ad used for heodyai# =olue re)la#eet followig aDor surgery ad to treat aDor (urs ess e)esi=e tha al(ui ad their eHe#ts #a last !4 to .6 hours ess I#ide#es of iue rea#tios #o)ared to 5ea##el&
'd=atages of Colloids: -
+al +alle lerr Ifu Ifuse sed d Volu olues es $rolo ologe ged d I# I#rrease ease i $V $V ii iial al Oede Oedea a 1$er 1$eri)h i)her eral al9C 9Cer ere(r e(ral al33 5ighe 5igherr O! O! 1+yst 1+yste ei# i# Oy Oyge ge eli= eli=er ery3 y3 Eseful Eseful i $reloa $reloadig dig (efor (efore e +u( +u( 'ra# 'ra#hoi hoid d Blo#@ Blo#@
'iety, 'gi 'gittatio Cool Cool $ale ale +@i +@i,, Cof Cofus usio io e#r e#rea ease sed d or or o o uri urie e Out) Out)ut ut *a)id (r (reathig iso isori riet eted ed,, os oss s Of Of Co Cos#i s#iou ous sess ess ow B$ B$,, Cold Cold "tr "tre eit 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% so%"* *a)id ifusio of -! of isotoi# salie 10&% +3 as ra)idly as )ossi(le to restore tissue )erfusio
43 5ild o mod#!a# )/o0ol#mia* Choose a rate that is 20-009h greater tha estiated ?uid losses& #al#ulatig ?uid loss as follows:
Erie out)ut
Isesi(le losses .0l9h
20l9h
'dditioal loss su#h as Voitig or iarrhoea or high fe=er 1additioal 00- 20 l9day for ea#h degree of te) .8 C3
+igs ad sy)tos of Fluid o=erload: They are ot always ty)i#al (ut ost #ooly are: - "dea 1swellig3 - )arti#ularly feet, ad a@les !- iM#ulty (reathig while lyig dow .- Cra#@les o aus#ultatio 4- 5igh (lood )ressure 2- Irritated #ough 6- Lugular =ei distesio 8- +hortess of (reath 1dys)ea3 7- +trog, ra)id )ulse
aageet: -
$re=e e=eti tio o is the the (es (estt way way +odi diu u restri#tio io Fluid rest strri#ti #tio iureti#s ialysis
5ow to Cal#ulate IV Flow *ate:
What is a dro) fa#torK ro) fa#tor is the u(er of dro)s i oe illiliter used i IV ?uid adiistratio 1also #alled dri) fa#tor3& ' u(er of diHeret dro) fa#tors are a=aila(le (ut the Cooest are: - 0 dro)s9l 1(lood set3 !- 2 dro)s 9 l 1regular set3 .- 60 dro)s 9 l 1i#rodro), (urette3
0olum# 6ml7 8 d!o/ 'a%o! 6d!o/s 9 ml3
= d!o/s 9 min 6$o- !a#7
--------------------------------------------im# 6min7 *e#et ad=a#eets: - Iter Iteross osseous eous *out *oute e N ti(ia, ti(ia, feur, feur, +u)er +u)erior ior ilia# ilia# #rest #rest,, head of the huerus - 'u 'uto to-t -tra ras sfus fusio io Te#hi e#hi;ue ;ues s - 'rtiJ#i 'rtiJ#ial al 5ae 5aeoglo oglo(is (is N $er? $er?uor uoro o Car(o Car(o (ased (ased ad ad 5aeoglo(i (ased - 5y)er )ertoi# +ali ie es - +altlt-fre free 'l 'l(ui uis - Tetra etrast star ar#h #hes es 1V 1Volu olu=e =e3 3