1. BY DR M AL-AMOODI

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

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

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

5. FLUID TUNROVER G.I 6000-9000 cc/day 200-400cc/day RENAL 1000-1500cc/day INSENSIBLE LOSSES 400cc/m/day or 600- 800cc/day(60% as water vapor from lungs;40% as perspiration and water vapor from skin.

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

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

8. Assessment History Physical exam Laboratory Urine output should be 0.5-1.0 cc/kg/hr

9. 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

10. 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)=

11. 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

12. 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

13. ACID-BASE METABOLIC ACIDOSIS METABOLIC ALKALOSIS RESPIRATORY ACIDOSIS RESPIRATORY ALKALOSIS