1. Fluid Replacement Therapy
Group B

2. A 54-year old man is undergoing a laparotomy and colon resection for Carcinoma. The anesthesiologist is attempting to calculate the fluid Replacement.

3. loss 500 ml and urine output is 400 ml
What are the compartment that must be considered when calculating ?
The patient body weight is 80 kg, 8 hours fasting with bowel preparation blood
loss 500 ml and urine output is 400 ml

4. The patient body weight is 80 kg
Total body water= 48 L
(60% of body weight in male)
Intracellular water= 32 L
(40% of total body weight)
Extracellular water= 16 L
(20% of total body weight)
Interstitial (extravascular)= 12 L (3/4 the extracellular water)
Intravascular= 12 L
(3/4 the
extracellular water)
Rich in potassium
and fixed anions (protein, phosphate and sulphate)
Rich in sodium and chloride and low in potassium

5. Discuss the volume of fluid that should be replaced?

6. Perioperative fluid application basically must replace two kinds of losses:
losses occurring all the time (mainly urine production and insensible perspiration), possibly to another extent than under “normal” conditions.
losses occurring exclusively during trauma and surgery (mainly blood losses).
1- replacement of fluid losses from the body via  insensible perspiration and urinary output Maintenance therapy
2-replacement of plasma losses from the circulation due to fluid shifting or acute bleeding. Replacement therapy
The first kind of loss affects the entire extracellular space, i.e.  , the intravascular plus the interstitial space, and normally does not lead to a loss of colloid osmotic force from the intravascular space.
The second loss induces a primarily isolated intravascular deficit, including losses of all blood components. In practice, we only have access to the vascular space, even when treatment of the entire extracellular compartment is intended

7. The following factors must be taken into account:
1- Maintenance fluid requirements
2- NPO and other deficits: NG suction, bowel prep
3- Third space losses
4- Replacement of blood loss
5- Special additional losses: diarrhea

8. What are the signs of preoperative hypovolemia ?
Supine Hypotension
Tachycardia
Cold dry skin
Low JVP
Pale
Oliguria
Positive tilt test
Positive tilt test (Increase in heart rate of at least 20 beats/minute and a decrease in systolic blood pressure of at least 20 mmHg or more when the patient assumes the upright position)

9. How to calculate the fluid replacement in the intraoperative period all of which take into consideration the preoperative fluid deficits?

10. loss 500 ml and urine output is 400 ml
The patient body weight is 80 kg, 8 hours fasting with bowel preparation blood
loss 500 ml and urine output is 400 ml
120 x 8hrs = 960 ml
Maintenance:
Number of hours NPO x maintenance fluid requirement. 8 x 120 = 960 and ml 1000 ml for bowel prep = 1960 ml
Each 1cc of blood loss is replaced by 3 cc of crystalloid solution
Fluid deficit (NPO):
500 ml x 3 = 1500 ml
Blood Loss:

11. Greatest third space losses: *open laparotomies
400 ml of crystalloid
Urine output:
(4-6 ml/kg/hr possibly), 4 x 80 x 8 = 2560
Third Space Losses:
= 5880 ml
Total:
Some believe that the third spacing concept is overrated and has given anesthesiologists an
excuse for overloading patients with fluids
Recent studies suggests that conservative fluid management improves outcomes with colon
and pulmonary resections
Greatest third space losses: *open laparotomies

12. What is your choice of fluid for replacement Crystalloid vs Colloids?

13. Thank You