Fluid Therapy

Dr.Praful Chhasatia

Basic Physiology• BODY WATER • Distribution• Normal value• ELECTROLYTES• Distribution• Normal value• UNITS OF MEASUREMENT• Moles and millimoles• Equivalent and milli equivalent• Osmotic pressure• Osmolality and osmolarity

Total body water

• Total body water content is about 60% of body weight in an young adult male and about 50% in young adult fema

Distribution of body fiuid

• Out of total body water two third (40% of body weight) is intracellular fiuid (ICF) and one third (20% of body weight) is extracellular fluid (ECF) ECF is divided into interstitial fluid (3/4 of ECF or 15% of total body weight) and plasma or intravascular volume (1/4 of ECF, 1/12 total body water or 5% of total body weight)

Distribution of fluid volumeFluidmType Total ICF ECF Interstitial Plasma

% of Body weight 60% 40% 20% 15% 5%

Volume for 70kg weight

42.0L 28.0L 14.0L 10.5L 3.5L

Normal Water balance

• Oral (or I.V.) fluid intake and urine output are important measurable parameters of body fluid balance .to determine daily fluid requirement of body we need to fluid input and loss as summarized below

Normal Water balance

• Insensible fliud input = 300water due to oxidation.

• Insensible fluid loss = 500ml through skin• =400ml through lung• =100ml through stool• Fluid loss- Fluid input = 1000-300ml =700ml.

Normal Water balance

• NORMAL DAILY INSENSIBLE FLUID LOSS = 700ML.

• Fluid loss =500ml.through moderate sweating

• (Abnormal) =1.0-5 liter through severe sweating/high fever

• = 0.5-3.3 liter through exposed wound surface (burns) and body cavity (laparatomy)

Normal Water balance

• High water loss during:exercise,abnormal perspiration,pyrexia,surgery.

• This information is required to know for IV fluid calculation

• In normal person daily fiuid requirement is sum of urine output and insenble losses. In normal person daily insensible loss is 700ml. So daily fluid requirement = urine output +700ml.

Distribution of Electrolytes

• Major cation is sodium in ECF and potassium and magnesiumin ICF, while major anion is chloride in ECF and phosphate, sulphate and proteins in ICF.

Distribution of ElectrolytesElectrolytes (meq/L) ICF ECF

Sodium

Potassium

Chloride

HCO3

Calcium

Magnesium

Phosphate and sulphate

10.00

150..00

2.00

6.00

0.01

40.00

150.00

142.00

4.30

104.00

24.00

5.00

3.00

8.00

Major Cation Major Anion

Potassium and Magnesium

Sodium PhosphateSulphate and protein

Chloride and Bicarbonate

BASIC PRINCIPLES OF FLUD THERAPY

• INTRODUCTION• BASIC PRINCIPLES OF• FLUID THERAPY• COMPOSITION OF I. V. FLUIDS• BIRD VIEW ON• CHARACTERISTICS• CLASSIFICATION OF I.V.• FLUIDS• PHARMACOLOGY & CLINICAL• BASIS OF I.V FLUIDS• 5% dextrose• Inverted sugar solution• Isotonic saline (0.9%NaCl)• 5%dextrose,0.45% NaCl• Dextrose saline• Ringer’s lactate• Lsolyte-G• Lsolyte-M• Lsolyte-P• Lsolyte-E

• SPECIAL FLUIDS• Sodium bicarbonate• Potassium chloride• 25% dextrose• COLLOID SOLUTIONS• Albumin• Dextran• Gelatine polymers• Hetastrch• Pentastarch• GUIDELINES FOR FLUID• THERAPY• Fluid therapy in hypovolemia• Monitoring fluid therapy• CVP monitoring• Pulmonary artery wedge• Pressure measurement• Methods to calculate rate of• Fluid infusion

Proper fluid therapy

• Etiology of fluid deficit and type of electro lyte imbalance present.• Associated illness (i.e.DM, HT,IHD, renal or hepatic disorders etc.)• Clinical staus (hydration,vital data,urin output etc)• For rational and adequate fluid therapy it is necessary to answer following

questions;• When to give l.V.fluid and when to avoid?• Which fluid to give and why?• How much fluid to give and how to calculate it ?• At which rate l,V. fluid to be infused ? • How to calculate the drop rate ?• 5 What are the contraindications of different types of l.V. fluids and why ?• 6 How to correct electrolyte problems ? • After such detailed evaluation necessary f

BASIC PRINCIPLES OF FLUID THERAPY

• As a principle, oral route is aiways preferred over l.V.route. But l.V.fluid therapy has great importance in various clinical problems.

• Basic principles ofl l.V. fluid therapy are summarized. • Advantage– Accurate, controlled and predictable way of

administration.– Immediate response due to direct infusion in intravascular

compartment.– Prompt correction of serious fluid and electrolyte

disturbance•

• Indications:• Fluid therapy is widely used for restoration of fluids and electrolytes, as a

drug carrier and for nutrition. Most common and important indications are as mentioned below.

• Patients where oral intake not possible, surgery (intra operative and post operative), severe vomiting and diarrhoea, un-cooperative and unconscious patients.

• Severe dehydration and shok, where urgent and fast fluid replacement is needed.

• S[pecial condition like hypoglycemia, where 25% dextrose is life saving.• As a vehicle for various l.V.medication (i.e.antibiotics, chemotherapeutic

agents, insulin, vasopressor agents etc.)• Total parenteral nutrition.• Treatment of critical problems: Shock,cardiac arrest, anaphylaxis, severe

asthma etc. •