Fluid maintenance 27/3/2019 Ammar Hiasat.

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Presentation transcript:

Fluid maintenance 27/3/2019 Ammar Hiasat

In surgery the patient must be NPO, there for fluid maintenance very important. When patient in fating status there is no input , but we have output (urination , gi secretions , respiration …ect ))) If we don’t maintain sufficient amount of fluid the patient at risk of complications …

ROLE OF 4-2-1

4-2-1 rule depends on (weight) 5 kg …..5*4=20ml/hour 15kg….40+(2*5)=50ml/hour 75kg…..60+(55*1)=110ml/hour

Maintenance of electrolytes Normal k level (3.5-5.3) Meq/L Normal sodium level (135-148)Meq/l Daily requirements of : Na :2-3meq/kg /day K:1-2meq/kg/day

The most common maintenance fluid is D 5 ½ NS with 20 or 40 mEq KCL (because as we said normal saline doesn’t have potassium) But usually its 20 mEq because with 40 you have higher risks on the cardiac conducting system 20 mEq of potassium = 1500 mg (daily requirement 3.5-4.6 g) 5 mEq of sodium = 100 mg (daily requirement of < 2g) So if we have an adult male patients that weighs 70kg, what is the maintenance therapy plan for him? You tell me…  = 10x4 + 10x2 + 50x1 = 110 ml/hour x 24 hours = 2640 so roughly 2.5 liters Na = 1.5 mEq x 70 = 105 mEq/day K= 1 x 70 = 70 mEq/day 

Our choice D5 1/2NS with kcl

1. as a result of a period of fasting ( NPO deficit ) : In the absence of oral intake ; fluid and electrolyte deficits can rapidly develop as a result of continued urine formation, gastrointestinal secretions , and insensible losses ( from the skin and lungs ) .. can be calculated by multiplying the patient's hourly maintenance requirements by the number of hours fasted ---> Maintenance requirements / hour x number of hours fasted $ 75 kg 115 ml/hr $ = 115 × 8 = 920 ml ** in surgery that takes 4 hrs for ex. we give half deficit in 1st hour ( 920/2 = 460) & other half divided by 3hrs ( 460/3 ) per hr ** 2. preoperative losses from the gastrointestinal tract ( eg. vomitting or diarrhea ) ,,

IF the hours of fasting unknown or the patient has abnormal fluid loss….(Diarrhoea ,vomiting,…ect) Give fluid and check the vital signs Check the urine output

Replacing in :: Third space :depends on the cause Blood loss