aspect to consider in fluid therapy
TRANSCRIPT
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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/ .
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.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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