BY DR M AL-AMOODI

BODY FLUID COMPT INTRACELLULAR FLUID(60% BODY WEIGHT) EXTRACELLULAR FLUID (40% BODY WEIGHT) 50-70% TOTAL BODY WEIGHT IS WATER

EXTRACELLULAR FLUID INTERSTITIAL FLUID INTRAVASCULAR FLUID(PLASMA PART OF BLOOD)

FLUID/ELECT REQ/DAY 35 cc/kg/day or 1500cc/m/day Na 100 mmol K 70 MMOL

FLUID TUNROVER G.I cc/day cc/day RENAL cc/day INSENSIBLE LOSSES 400cc/m/day or cc/day(60% as water vapor from lungs;40% as perspiration and water vapor from skin.

FLUID BALANCE REQUIRES 1.NORMAL DAILY REQ 2.REPLACEMENT OF ONGOING LOSSES 3.CORRECTION OF ABNORMALITIES

Increased requirements in patients with abnormal losses e.g fever 15% increase in insensible losses for each 1c above 37

Assessment History Physical exam Laboratory Urine output should be cc/kg/hr

VOLUME DISORDERS HYPOVOLAEMIA shock-8% TBW loss,>40% blood volume Signs and symptoms mental status changes-sleepiness cardiac-tachycardia,decreased cvp,ect Also oligouria,weakness

TYPES OF FLUIDS NON –BLOOD 0.9% SALINE/ 1:150MMOL Na –ISOTONIC 5% DEXTROSE/ 1:278MMOL GLUCOSE- ISOTONIC DS /1:30MMOL Na ;4% GLU(222mmol)=

Crystalloids :saline,dextrose,hartmann’s(ringer’s lactate),ringer’s solution Ringer’s(Na 147,Cl 156, k 4, Ca 2.2 Hart (Na 131, Cl 111, k 5, Ca 2,Hco3 29mmol as lactate) Colloids : Dextran,gelatin,starch

CLINICAL FEATURES LOW Na : CELLULAR OVERHYDRATION: CONFUSION, FITS WATER EXCESS: HYPERTENSION,CARDIAC FAILURE,OEDEMA,ANOREXIA,NAUSEA, MUSCLE WEAKNESS HIGH Na : THIRST,,CONFUSION,COMA LOW K :MUSCLE WEAKNESS, FATIGUE,DECREASED DEEP TENDON REFLEXES,PARALYTIC ILEUS

ACID-BASE METABOLIC ACIDOSIS METABOLIC ALKALOSIS RESPIRATORY ACIDOSIS RESPIRATORY ALKALOSIS